LVN to "fill in" for ADON while she is away

[csuchon]

The ADON at our hospice agency has had to take a leave while her daughter is sick, and may not be back at all. In the meantime an LVN will be filling in for her - and while she will not have the ADON title, she will be doing everything the ADON did - including CQI ing the charts and having her office. This is of concern to the RN's in the field, as an LVN will be monitoring our charting, productivity, etc. it is upsetting that an RN was not offered the position and we know this is because the company doesn't want to pay what they would for an RN to fill the position. Are we right to be upset? It seems to go against all I learned in nursing - RN's supervise LVN's, not the other way around. Any feedback is appreciated - are we wrong to feel this way and is this a legitimate concern?

[Medic09, BSN, RN, EMT-P]

Let's put aside legalities and protocols for the moment. Focus on the individual. Is s/he really experienced and capable? Honestly, there are some LPNs in our ER whose charts I have to sign as an RN, when they are better nurses than I. More experience, practical wisdom, common sense. More time on the job.

So, are you all being snobs or is this nurse really unsuited for the task?

[csuchon]

She is perfectly suited for the task, smart, has been at our Hospice for a very long time and I think she will be great. I think it just hurt my feelings really, and I am getting adjusted to the idea. Just didn't know if this is something that is done. And thank you for the reply, I appreciate it.

[TheCommuter, BSN, RN]

I live in Texas. While I don't work in hospice, I do know that all of the nursing homes in my area utilize LVNs as ADONs. These LVN/ADONs are often in charge of RNs who work the floor.

An LVN can supervise an RN administratively, but not clinically.

[jsmithlvn]

The Texas Nurse Practice Act in the Scope of Practice of the Vocational Nurse states "It is beyond the scope of practice for a LVN to supervise the nursing practice of a RN.

[toomuchbaloney]

The Texas Nurse Practice Act in the Scope of Practice of the Vocational Nurse states "It is beyond the scope of practice for a LVN to supervise the nursing practice of a RN.

So is the DON an RN who will then be supervising the practice of the RNs?

[TheCommuter, BSN, RN]

The Texas Nurse Practice Act in the Scope of Practice of the Vocational Nurse states "It is beyond the scope of practice for a LVN to supervise the nursing practice of a RN.

Exactly. The LVN cannot supervise the RN clinically. Only RNs can oversee another RN's nursing practice clinically.

But the LVN, and any unlicensed person, can supervise an RN administratively. Most administrators of hospitals, nursing homes, hospices, ALFs, and home health companies are non-nursing people, yet they can supervise RNs in an administrative capacity.

[areensee]

No this is not appropriate. It has nothing to do with the person, just the title. Law requires an RN to supervise and this is very clear. While the LVN could take on some of the responsibilities that don't involve supervision or clinical decision making, the LVN can not supervise other nurses and can not make the clinical decisions that a ADON or PCM must make. Pretty sure this is violation of your state's nurse practice act, unless they are very clear about the acceptable duties and have someone else pick up the clinical duties.

[caliotter3]

Lots of offices use LVN/LPNs in roles that an RN could/should fill. They like to save money. I'll bet if an RN volunteered to do the job at LVN pay, they might take her up on her/his offer.

[IrishErin]

I have, as an RPN, filled in for the ADOC when they were on vacation at the retirement home that I used to work at. I was offered that because my skills and experience at that job surpassed the new grad full time RN at the time.

The DOC was also in the building so I was never officially "supervising" the RN, even when she came to me with questions that I could answer for her. If the nurse is competent I don't see an issue if they aren't supervising anyone's practice that they aren't legally able to.