Actually, LPN's can NEVER delegate to RN's. It may seem that one when the LPN is charge nurse (or in many places they can be supervisors) but legally an RN is always responsible for her own practice. The "delegating" in LTC is by the DON who has set the policies and assignments for what nurses will do in each assignment. Each nurse then is responsible for his/her own work. In places (like where I currently live, CT) where an RN must be present to supervise the LPN, the shift supervisor is the RN responsible for supervisionm even if there is an RN working the unit with an LPN. On any given day the LPN may be charge and the RN, med or treatment nurse. Since there is lttle to no difference, depending upon locale, in the duties of a staff nurse in LTC, you may be oriented by an LPN or, especially while you are new, work with one in charge.
The presence of both an RN and an LPN in any given place, does not automatically make that RN supervisor of that LPN. Of course, any good nurse looks to his/her colleagues for support. The experienced LPN may still be lacking some of the knowledge that a brand new RN has and vice versa. Remember, I am talking ONLY about LTC.
I think this advisory ruling by the MA Board of Nursing is a good summation:
Licensed Practical Nurse Charge Nurses/Nurse Supervisors
The Massachusetts Board of Registration in Nursing issues this Advisory Ruling on Nursing practice pursuant to Massachusetts General Laws, chapter 30A, section 8 and chapter 112, section 80B. Date Issued: November 12, 1997
Date Revised: July 10, 2002
Scope of Practice:
Licensed Practical Nurse
To guide the practice of the Licensed Practical Nurse (LPN) who is employed and/or assigned to the functions of charge-nurse or supervisor and the Registered Nurse (RN) who is assigned to and/or employed as a staff nurse in the same facility.
This is an administrative function only.
Pursuant to the Board's regulations at 244 Code of Massachusetts Regulations (CMR) 3.04: Responsibility and Functions-Practical Nurse, it states "making appropriate assignments, teaching, directing and supervising unlicensed personnel, delegating activities to unlicensed personnel, participating in collaborative planning, and making informed judgements as to the specific elements of nursing care mandated by a particular situation.
The Registered Nurse (RN) who is employed or assigned to a staff position when the LPN is charge nurse or supervisor remains and retains full responsibility and accountability for the clinical course of the patients under his/her care.
The LPN charge nurse/supervisor does not mean clinical decision-making authority regarding the patients that are assigned to the RN.
This information is provided by the Division of Health Professions Licensure within the Department of Public Health.