Need help with delegation question

truern · Mar 5, 2005

2005 Lippincott Williams & Wilkins, Inc. Volume 35(2) February 2005 p 14 Who's in charge here? [ADVICE, P.R.N.: LPN SUPERVISING RN]

At some nursing homes, including the one where I work, the trend is to put an LPN in charge as facility supervisor, even when RNs are on duty. I'm wondering what would happen if the LPN supervisor responded to an emergency herself, rather than directing an RN on duty to take over--even though the RN might be better qualified to intervene. What does your legal consultant say? --S.P., N.C.

She says the situation you describe is both poor practice and at odds with the law. Most nurse practice acts specify that RNs supervise LPNs, not vice versa. Employers can't disregard the law to suit their convenience or their budget. If a patient were harmed in the circumstances you describe, the patient or his family could sue the LPN ...

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I'm not sure this addresses the question, but it was somewhat in the ballpark

hcmanp, NP · Mar 5, 2005

2005 Lippincott Williams & Wilkins, Inc. Volume 35(2) February 2005 p 14 Who's in charge here? [ADVICE, P.R.N.: LPN SUPERVISING RN]
At some nursing homes, including the one where I work, the trend is to put an LPN in charge as facility supervisor, even when RNs are on duty. I'm wondering what would happen if the LPN supervisor responded to an emergency herself, rather than directing an RN on duty to take over--even though the RN might be better qualified to intervene. What does your legal consultant say? --S.P., N.C.
She says the situation you describe is both poor practice and at odds with the law. Most nurse practice acts specify that RNs supervise LPNs, not vice versa. Employers can't disregard the law to suit their convenience or their budget. If a patient were harmed in the circumstances you describe, the patient or his family could sue the LPN ...
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I'm not sure this addresses the question, but it was somewhat in the ballpark

that sums it up nicely! Thank you truesn :Melody:

germain · Mar 5, 2005

WHere I am the NA can call housecleaning or clean tehmselves, an overflowing toilet is maybe more important than the breakfast trays?

dbsn00 · Mar 6, 2005

WHere I am the NA can call housecleaning or clean tehmselves, an overflowing toilet is maybe more important than the breakfast trays?

Because the unit secretary can make this call to maintenance &/or housekeeping & the NA can assist the nurses by passing out trays to people who may need to eat on time due to medications, diabetes, etc., and check the call bells while passing trays.

Where I work the housekeeping staff is responsible for a clean up such as an overflowing toilet (I wouldn't even want to be around if someone suggested that a CNA do this at my job!!) and the CNA's clean the residents.

dbsn00 · Mar 6, 2005

This RN must disagree. The LPN can provide plenty of assistance and orientation to a new grad....if the new grad is willing to learn.
I learned some of my best tricks of the trade from LPNs.
And if the facility is worried about legalistic definitions of supervision and orientation, they should have provided an RN to do so.

Thank you caroladybelle on behalf of all the LPN's who daily train/orientate the new grad RN's...it's nice to know our experience does count for something!!

snowfreeze, BSN, RN · Mar 6, 2005

Well this might seem kinda realistic but here goes. You freak out and page the nursing supervisor (who is me). I ask for a quick description of what the heck is going on.

tell the LPN to give the insulins, give the RN the task of checking on the wife giving pressure... he is not gonna die if she is that adept to hold pressure and call for help. She needs reassurance not an army.

LPN, 3 insulins..8 mins tops, then go help with trays.

secretary calls maintenace about the toilet and the nursing supervisor to find help passing trays.

Check on Ms Johnson for true comotose state then call family.

Now the Medical director is called. She isn't gonna die nor is her patient in the next 15 mins. and this a probably a pharmacy issue more than a nursing issue anyhow. 3 days and no chemo drugs isn't a nursing thing its more a supplier thing usually. Toss that over to the medical director to chat with pharmacy.

leslie :-D · Mar 6, 2005

there isn't any reason in the world why the lpn w/10 yrs experience cannot precept the new rn.

snowfreeze, BSN, RN · Mar 6, 2005

why does the lpn have to precept the rn, let the rn take care of what she/he can and the lpn do what the lpn can do which is most everything in my opinion in this situation. New RN will not know how to manage a lot of stuff yet. the secretary already called about the toilet I am sure...they have a knack for getting stuff done.

caroladybelle, BSN, RN · Mar 6, 2005

That is a good question. The scenerio does not say one way or another. Since it says that this was not unexpected, I assume she is a no code.

I have plenty of onco patients that we "expect" are going to die soon. The MD is aware, the nurse is aware, the patient is fully aware and has had the realities clearly and repeatedly explained to them. But they have chosen (or their family has chosen for them) a full code status.

Just because you "expect" death doesn't mean they are a no code.

caroladybelle, BSN, RN · Mar 6, 2005

the clue is in the statement, the lpn oversees the rn - legally this is not an option. Yes, the lpn can assist the new rn, yes, the lpn knows WAY more than the new rn (most likely given the experience in this case), but the RN oversees the LPN legally. It was a semantic problem.

Orientation and supervision are not the same things.

When a new president comes into the White House and government, he gets oriented by his chief of staff, and any number of individuals. Yes, he is the POTUS and outranks them, but they still orient him to situations beyond his kin (knowledge).

When new interns fly in into the hospitals every July...nurses frequently orient them to the unit, equipment, use of the computer and what they need to order and how to use things. We are sometimes not allowed to put down NG tubes or push Cardiac drugs in teaching hospitals. Do they know how...frequently no. We teach them the equipment needed and the practical knowledge and metaphorically hold their hands, as they stumble through these procedures for the first few times. Residents ocasionally assist and attending almost never do. We then have to show them how to initial the MAR for the drug that we cannot give in this facility due P&P.

We are orienting them....but in the legal sense, their resident is still "supervising".

A new MD has a newly diagnosed cancer patient that is in intractible pain. When I call him for pain meds, he asks me what the onco MDs usually order in the facility. I tell him the choices that are common in this facility. He chooses his preference and asks me to write a telephone order. I initiate the order and give the med.

I am "orienting" that MD. He is nowhere in the facility to "supervise", yet he is still legally overseeing the care of his patient.

So we m

LPNer · Mar 6, 2005

My leadership and management midterm is take home and the following is the scenerio I was given with which to delegate. I hope you guys can help me with it!!! What would you do if you came in to this besides slit your wrists, which was my initial reaction after I read it!!
You are the charge nurse for the 7a - 7p shift on an oncology unit. Immediately after report (around 7:30 AM), you overwhelmed by the following information:
1. The nursing assistant reports that Ms. Johnson has become comatose. Although this is not unexpected, her famliy members are not present and you know they would liek to be notified immediately.
2. There are 3 patients who need 7:30 sub q insulin injections. One of the patients had a 6 AM blood glucose of 400.
3. Mr. Johnson has pulled out his central line when he was turning in bed. his wife just notifeid the medical receptionist by the call light and states she is appying pressure.
4. The public toilet is overflowing and urine and feces is spilling into the floor
5. Breakfast trays arrived 15 minutes ago and patients are usinf their call lights to ask where there breakfasts are?
6. The medical director of the unit has just discovered that one of her patients has not been strated on the chemo drug she ordered three days ago, and is furious and is demanding to talk to you.
You have the following personnel to delegate to: a medical receptionist, a nurisng assistant, a RN who graduated two montha ago and is still on orientation, a LPN who has worked on the unit for 10 years, and yourself. Decide who should do what and in what priority. justify your answers.
I would greatly appreciate any advice.
Thank you for your replies ahead of time!

After I got done wondering why the 7p - 7a shift didn't take care of the insulin as is routine at all the hospitals around here, I actually gave the scenario some thought.

Don't worry about the trays, the CNA will pass them out. She surely does this every AM.

The receptionist can call maint about the toilet.

Your new RN can attend to the insullin. It's very task oriented and does not require a lot of experience.

Your LPN can take care of the central line. In 10 years on an oncology unit s/he has surely seen it and dealt with it many times over.

You need to address the chemo that has not been started after 3 days, that Doc is going to be in your face until you do.

After the LPN has dressed the central line site and ensured that it is not still oozing, she can call the family about the comatose pt since you will likely still be trying to find a reason for that chemo not getting started (getting it from the pharmacy and getting it started).

LPNer · Mar 6, 2005

oops, misunderstood what was said until I reread it. Think I will take my post away!