Honest question - NOT trying to start a war!

  1. I have heard, many times over, about how an LPN "works under" an RN's license, and many RN's don't like that. LPN's have their own licenses, and are supervised by an MD or RN, so how does that work when the MD or RN aren't even there? More to the point, I'm curious if anyone has had experience getting in trouble or losing their license solely because the LPN did something wrong. If so, what happened???
    Please, please, please. I don't want to start a war!!. I'm honestly curious to hear what the situations were that may have caused the RN to lose his/her license along with the LPN. I wouldn't want anyone to lose their license, because of me.
    Thank you for your polite replies!!!
  2. Visit mc3 profile page

    About mc3, LPN

    Joined: Jun '05; Posts: 1,028; Likes: 1,757
    from US
    Specialty: 12 year(s) of experience


  3. by   proud nurse
    When I was an LPN, my DON at the nursing home always said that we worked under her license.

    That's all I know...
  4. by   AgentBeast
    No one works on or under someone elses license.
  5. by   MrsMig
    No, this is a misconception. You have your own license. Your license would only be in jeopardy if you didn't prevent a situation of abuse, harm or illegal activity of another nurse...
  6. by   rncat2000
    I have not heard about any instances about a RN losing their license due to a LPN. I do work with LPNs at a peds hospital and here it means that a RN is responsible for the things a LPN can't due like care plans, and iv pushes. So they under the RN license in that respect. The LPNs that I work with are excellent and are a great team players. I know on nights I would not make it many times without them.
  7. by   nursel56
    I've never heard that an LPN works under an RN's license. Never heard of an RN losing their license over something an LPN did. If you familiarize yourself with both scopes of practice in your state and stick to that you should be fine.

    Sometimes facilities have policies that restrict what an LPN can do, but you won't lose your license if it is something within the respective scopes of practice. You could lose your job, though (for not adhering to your employer's policy).
  8. by   JBMmom
    Licenses apply only to the person named on the license, no one ever works under another person's license. However, the responsibilities of one person may involve directing the activities of those around them. In nursing school we never worked "under" our instructor's license, however, if we were to make a medication error while in clinicals, it would impact the instructor because part of their responsibility was to ensure that appropriate medications were administered by students. Similarly, LPNs in some facilities are able to carry out certain tasks only under the supervision of the RN, who is ultimately responsibility for ensuring that certain aspects of care are administered correctly.
  9. by   DavidKarl
    I know of one RN (she was nursing director at a Phoenix nursing home), who lost her nursing license, based on the actions of LPNs and OTHER RNs in the nursing home that allowed patients to be abused. It began with a complaint, which led to a survey, which led to citations, which led to a complaint against her license by the survey team, which led to her license being revoked by the BON, for failure to be informed of what was happening in the place- in effect, for lack of supervision of the nursing staff. Some of the staff nurses were also disciplined. Accountability for supervising other staff will equal or lesser degrees of their own responsibility can be a tricky issue.
  10. by   Seas
    Everybody works under their own license. It is an individual license and titles don't have anything to do with it. However, LPN's work under direct supervision of RN and/or MD. Are you getting these two mixep up maybe?

    And no, I haven't heard of any RN losing their license because of LPN actions. However, RN should cover LPN's duties and things that only RN can do. So if you don't do your part, you may get in trouble.
  11. by   TheCommuter
    I know a DON at a nursing home who had her license number referred to the state's BON due to an ongoing Coumadin med error made by an evening shift medication aide that resulted in the patient's death. The DON's license was referred because she had no plan of care in place for Coumadin monitoring or an anticoagulation protocol in a facility where at least 20 percent of patients take this drug.

    The PT/INR had not been checked in over 6 weeks and the patient had been receiving too high a dose of Coumadin. At the time of death, the patient's INR was almost 20 and she was bleeding out of every orifice. The evening shift LVN had his license number referred too, because although he was not physically passing the med to the patient, he was expected to monitor for side effects while the DON was not in the building.

    I know another DON whose license number was referred by a surgeon because he was furious that her mostly-LVN nursing staff could not properly care for one of his postsurgical patients who ended up in the nursing home she ran. To be fair, this patient was a totally inappropriate admission that the DON fought to prevent from getting admitted into the nursing home, but the admissions coordinator circumvented her efforts and got the patient admitted anyway.

    I know another DON who lost her license after a particularly horrible state survey where the nursing home received 47 deficiency tags, 8 of which were IJ (immediate jeopardy) citations. Her nursing staff consisted mostly of LVNs. She was caught lying to federal surveyors during the survey, had her license number referred, and eventually lost her license due to failing to show up at the BON hearing where her fate would be determined.
  12. by   mc3
    Thanks, everyone. You confirmed what I'd always understood, but then looking at some AN postings, the question of "working" under an RN license seems to appear alot. Maybe it was just another subtle RN vs. LPN thing, or just misinformation, because I myself have been told that by a few RN's......I am now duly educated! Thank you all!
  13. by   jadelpn
    In my state, an LPN works under their own license. If they are delegated by an RN to do something that is not within their scope, and the LPN complies, then in fact the LPN would stand to lose their license. What can be stickier, however, is if an RN OR an LPN delegate to a UAP something they should not be doing, or do incorrectly and causes patient harm, THEN the "working under one's license" could come into play. It is not literally "working under license" as it is being delegated by a licensed person who should know better.
    I too have had RN's (and interestingly, most former LPN's) INSISTENT that LPN's "work under my license and I could be implicated...." YA, not so much....
  14. by   uthscsa2011
    What we were taught in school is that the LPN, LNV, CNA, work "under" the RN, DON, MD because they are delegated to by these higher authorities. For example, if an RN gives an assignment or task to an LVN and the LVN does something wrong, not only do they get in trouble but the RN will be questioned as well (was their delegation clear? thorough? correct? did they provide adequate teaching to the LVN before delegating the task?) That is what they mean by the LVN works under the RN, they work under the RN's supervision.