LPN goin beyond scope of practice

[SweetheartRN]

LPN was doing assessments and discharges on patients. This is beyond her scope of practice but no patients have been harmed as a result of this so if reported the BON will most likely just "tap her on the hand" right? Nursing Staff development came and told her to stop doing it and she has stopped. I figure as long as she nows realizes she shouldn't be doing it, no harm no foul correct?

My only issue is that our Nurse Manager knew she would be doing these things and still hired her in the department and knowingly allowed her to do these tasks??? Its like she didn't care that this could potentially get this nurse and herself in trouble? Or maybe she feels like its not that big a deal and no serious actions would ever be taken if it were ever to be reported?

Should I bother or not?

[nursel56]

. . .Nursel56--I already know the scope of practice which is why I stated in my first post, "This is beyond her scope of practice." I am an RN so no I do not want her job. :)

Oh-- I'm sorry, I thought you were talking about the LPN who was hired for that outpatient peds clinic job that you wanted. Sorry for jumping to conclusions. Who does skilled nursing care in homes in your state? Are RNs in all charge positions in the LTCs in your state?

[classicdame, MSN, EdD]

In my state only RN's may assess and co-signing is not allowed since the RN was not present to confirm the findings from the assessment. At this point I would leave it alone. You are right that the manager should have known better, but as long as they have d/c the practice there is nothing to report without causing a big stink.

[SweetheartRN]

I could easily spend all day, everyday looking for someone not following the rules and would surely find many many examples of problems. I have learned to pick my battles wisely and mind my own business 99% of the time. I would drive myself (and everyone around me) nuts otherwise.

I agree with you, it's wrong if it is not allowed within your states scope of practice. Someone has corrected the problem. What would be your motive for notifying the BOM now? It sounds as if you are the playing the part of nurse police..a job you will be very busy with. I can't help but ask...do you have a personal grudge against the nurse or manager?

Hi Nascar nurse,

You are right in the fact that I'm sure if I look around me I could find more problems, but not really because we are a small acute care facility apart of a major hospital system and she is the first and only LPN to be hired in this setting since our existence but she isn't able to do alot of the kind of work we do there--assess, discharge, get meds out of the accudose etc.... without an RN going in behind her....now that is. It is outpatient and fast turn over but because of these things it slows the process down and i frankly don't understand why she was hired. Why would a manager hire someone that is not legally able to do alot of things that the job requires on their own....and knowingly let them do those things? To be honest I feel that the nurse manager is showing favoritism to this nurse because she is friends with the nurses father. I do feel that the manager needs to be investigated for her hiring practices mainly. It makes more work for the RN's. But there again, like another poster said I may just be out of my "scope of business." Which I'm sure I will be told again......

[mehitabela]

When an LPN admits and assesses a new patient at my work, they chart on it. I have to cosign in the chart but they do everything else. They also make their own care plans and consult with physicians if need be. There is always an RN on shift and we hang meds, push IVs for them. Our LPNs are awesome! They know as much and in some cases more than we do...depending on how long they have been nurses. I have never yet had to over rule a coworker on a call they have made. Aside from the scope of practice question. I think there has to be give and take and a lot more communication where the OP works. Why would anyone turn a coworker in for anything like this? As RNs we are supposed to be checking on patients an LPN has anyway. If one of my LPN coworkers assessed something and charted it, I would know when I reviewed the chart so anything off base would be apparent pretty quickly. It's great to work with people who take their job seriously but there is a fine line between healthy concern and vindictive whistle blowing. Also we have an LPN in school for her BSN and she's a respiratory therapist so she can do a lot more than the average LPN. Perhaps this is the case?

[SweetheartRN]

Oh-- I'm sorry, I thought you were talking about the LPN who was hired for that outpatient peds clinic job that you wanted. Sorry for jumping to conclusions. Who does skilled nursing care in homes in your state? Are RNs in all charge positions in the LTCs in your state?

Hi Nursel56,

No problem, its only natural. I think I stated in the posts concerning that topic that I attained my RN but I don't remember. I may look back :)

Mainly LPN's I assume. But the RN's are "technically" supposed to do admissions. The LTC facility I worked at did only have RN's doing admissions. There were more RNs working there than I ever would have guessed.

[ObtundedRN, BSN, RN]

Considering management has addressed the situation, I would leave it at that. If it was to continue and management didnt' adress it, then it would be time to go to the board. Also, it is just as much the charge nurse's fault. They delegated the tasks to the LPN and didn't maintain adequate supervision by having an RN sign off on these things.

[mehitabela]

What state is this? Our LPNs have access to the accudose as well. I hadn't realized things were so extremely varied from state to state! This makes me want to look up what precisely is the scope of practice for my state.

[*Posh*]

To answer your original question, if it were me I would think long and hard before reporting something like this to the board.

I don't know how much experience you have, but it sounds like you have a lot to learn about politics in the medical field - especially when it comes to management. If you're really concerned about it, schedule a meeting with your superiors to address those concerns... but look for another job first because you're probably going to need it. When managers are presented with issues like this one, the first person they scrutinize will be you. No matter how hard we work, no matter the lengths we go to to make sure everything we do is "right" they can and will find something that you're doing "wrong". Otherwise, like it was stated previously and it's worth saying again, it's absolutely none of your business.

You will learn, hopefully not the hard way, to come to work, be an advocate for your patients and go home. Obviously, common sense dictates that you will speak up if you see the need... but like I said - common sense.

[*Posh*]

What state is this? Our LPNs have access to the accudose as well. I hadn't realized things were so extremely varied from state to state! This makes me want to look up what precisely is the scope of practice for my state.

We do, too. We initiate iv's, push meds... the only thing we don't push are cardiac drugs. I've worked with a few RN's that I've prayed for my pt's safety when they were pushing those meds, but that's another story . I'm training on vents now and cross-training on the transplant floor. Thank god I live here...

[mehitabela]

We do, too. We initiate iv's, push meds... the only thing we don't push are cardiac drugs. I've worked with a few RN's that I've prayed for my pt's safety when they were pushing those meds, but that's another story . I'm training on vents now and cross-training on the transplant floor. Thank god I live here...

I know exactly what you mean!

[SweetheartRN]

Is reporting to bon not anonymous? Lpns are not resticted that much in the amount of hands on skills they can perform I've read here that it is mainly things that involve the nursing process that they are not allowed to deal with much.

[mehitabela]

Is reporting to bon not anonymous? Lpns are not resticted that much in the amount of hands on skills they can perform I've read here that it is mainly things that involve the nursing process that they are not allowed to deal with much.

Anonymous doesn't make it right.