downsouthlaff

Interesting question. The answer is yes and no. Say for instance at an LTC facility. A nursing facility administrator would count as being a unlicensed person in the world of nursing practice. But in the administrative chain of command he/she would be the highest ranking official. Can he/she evaluate your work performance? Absolutely. Are you getting all assigned duties done, are you wearing the proper uniform, are you on time, do you work well with others. An LPN who is ADON could also supervise an RN in that capacity. But when it comes to the practice of nursing. No. An LPN cannot evaluate an RNs clinical decision making . Neither can a Nursing Home Administrator. But in my opinion experience where LPNs are unit managers, or ADONs the issue rarely comes up. Most of the issues are administrative.

Im sure by now most nurses in LTC have heard the new CMS mandates set forth by the biden administration. Setting forth new minimal federal staffing requirements for all nursing homes. These proposed mandates wipe LPN/LVNs from providing meaningful cost effective nursing services to LTC/SNFs by not including them in mandated staffing hours. New requirements set forth would require every US skilled nursing facility to provide 0.55 RN hours per day, 2.45 CNA hours per resident per day, and facilities would decide whether to utlize LPN/LVNs are not. Im sure that some facilities in northern states would be fine, but what will happen in the southern states with such a nursing shortage? LPNs in the south keep nursing homes open. Employers in more desirable areas of nursing to work in here are having a hard time finding RNs, much less trying to recruit them to LTC facilities! I think I would have a better chance of winning the lottery, before my state would be able to replace all of its LTC LPNs with RNs. Sounds like a very big mess, and mission impossible. What's everyone's thoughts on this? Legislators are taking steps to block these mandates

Not a problem at all! You sound like the kind of nurse who would take the input and do well. But yes indeed. LPNs are usually the direct care staff nurses in LTC. Doing the assessments, notifying the physician, charging over the CNAs. Long term care is where you will see LPNs working the most autonomous. Now with that being said it still doesnt change the legality that the RN is some degree responsible for the LPNs practice. But if your willing to trust and learn from the seasoned LPNs youll do just fine!

Experienced LPN here in the LTC realm. Yes this is typically how LTC facilities are staffed. CMS only requires an RN be present eight hours a day seven days a week. A weekend RN supervisor covers this requirement on the weekends. You have one of two choices here, you should either decline the position, or accept the fact that your going to have to take a fair amount of direction and input from the seasoned LPNs. Long Term Care is so much different from acute care, there are rules and regs present that you couldnt even dream up. Working at an acute care facility does not give you the experience needed to call the shots in LTC. Trust this. If you do accept the position, even tho its a part time weekend postion, ask your DON for plenty orientation, and ask your DON who your most seasoned and competent LPNs are, and listen to them. They know the routine to nurse those patients, they know the CNAs, and thet probly already have a great rapport withe the families and physicians to know which shots need to be called. The best RN superiviors I have ever worked with are the ones who know how to respect the facilities routine, and not throw their weight of being an RN around. And also, offer to be of help, when nursing is overwhelmed. This could be a great opportunity for you, or one that could be really negative, depending on how you approach it. LPNs and CNAs have much greater responsibility in LTC facilities than in hospitals. And typically RNs who are anti LPN, generally don't like long term care. Good luck to you ! Hope it goes well.

I am an LTC nurse. I’ve practiced as an LPN in LTC my whole 8 year career as a licensed nurse. I recently started at another facility with young floor nurses, a young ADON, and we share a different opinion on documenting results of labs. Most of the nurses at this facility, receive the lab work, notify the physician, and then proceed to retype the lab results into a nurses note. For ex if the lab result is a CBC or CMP they will type all the details of the report into a note. The WBC lebel, RBC, all the way down the report until the nurses note is basically a copy of the report. I however throughout my whole career have always been taught that interpreting labs is outside of a nurses scope of practice therefore it doesn’t belong in our nursing progress notes. For example, my nurses note would read “Received result of CBC from lab. Notified MD of the result, no new orders given,-J. Smith, LPN” And that would be it I would leave it at that because I was always thought that the nursing responsibility wants receiving lab work is to notify the physician of the results, and saying only what you need to say is better than saying to much. I just wanted to get the opinion of other experienced LTC nurses

Sorry your going through it. Sad reality is that short staffing in healthcare has caused many employers to trend toward a much more lenient approach. These are not guranteed methods but I’ll give you a few approaches. Be open minded. Be polite to the CNAs even the bad ones. Try to correct and teach in a non condescending way. Pick up a little slack at times to show that you appreciate their efforts. You are the nurse and are responsible for directing assistive personell, but show them that you don’t look down on them and believe they are a valued staff member. Don’t jump to conclusions on what management hasn’t done. Don’t assume because an employee wasn’t terminated because you wrote them up that nothing was done. HR won’t discuss all employee discipline with clinical staff members outside of pertinent administrative staff. The employees that you write up may not receive a raise, may not be kept past the probation period, etc. There may be things occurring that your not seeing, even tho I know the helpless and frustration when it feels like nothing is done. Also, as per CMS regs, non licensed staff, or staff that are not given special permission like med aides to carry out MD orders should not have acesss to med carts or TX carts this is a major no no. Carts must stay Locked. Focus on being a great nurse rather than focusing on the negatives and the drama. LTC nursing is hard, tedious, and very challenging. And lasting as a nurse in these facilities requires a great deal of patience, innovative thinking, and motivation. The energy you bring could inspire others. I know it’s frustrating but chances are you will not fix all the problems of the long term care industry , good luck to you

Do a career search on the internet regarding what a Licensed Practical Nurse does. You’ll find something along the lines of Then on the flip side pull information from any NCLEX RN review material it will say that that the LPN can't teach, assess, or perform any duties regarding IV therapy. The reasoning behind this is that this is general description for the LPN role. But upon looking at a good percentage of Laws regarding practical nursing. Most states, nearly all states, haven’t found one yet that doesn’t allow LPNs to start IVs and hang fluids or administer prescription medication. Also many states address the issue of patient teaching, and assessment, and the BON clearly states that LPNs can assess patients. This is not meant to start a debate of LPN vs RN, nothing of the sort. Just simply raising the question of why the LPN/LVN scope is so watered down to nearly the scope of a nursing assistant. The overwhelming vast majority of states allow LPNs to perform many of these tasks that are listed as prohibited.

You once considered a career a nursing. You browsed the web, looking for different types of nursing education. And then comes the big question, what is the difference between an RN and LPN. On some job information website you Probly come across a job description for an LPN/LVN that more accurately describes what a CNA routinely does. Then you probably talk to friends who are Nurses, LPNs and RNs alike, who will tell you that an LPNs do nearly everything RNs do aside from one or two skills, sound familiar yet ? Now it’s time to get to the real difference between LPNs and RNs. The difference has nothing to do with skill. In some states there is essentially no difference between the physical skill that an LPN and RN perform. Today, In some states LPNs hang blood, push IV meds, manage PICC lines, you name it. The real difference between LPNs and RNs, is the type of nursing being practiced and the approach to nursing. One thing LPNs and RNs have in common? Both have met the states requirement to become what can legally be called a nurse. But what’s different is an RN is a professional nurse who practices professional nursing. An LPN or LVN is a nurse who practices practical nursing. Most states define practical nursing or vocational nursing as any paid nursing services that do not require the skill or practice of a professional nurse. sounds offensive at first but it’s really not. It boils down to professional nursing practice standards and which part of the nursing process has to be done by whom, and it has little to do with skills performed. By default, only professional nurses can assess, diagnose, plan, and evaluate. Practical nursing is all about implementing. Now, with that said, do LPNs assess, of course they do. Assessment simply means to measure the value of something. The nursing profession did not invent the word assess. In every state, LPNs carry the knowledge and training to measure the value of their observations, and determine how to address them. And this is assessing. But LPNs are not allowed to assess within the realm of the nursing process. And this simply means that as LPNs we are not allowed to take our observations to independently formulate a diagnosis and create a care plan. That action would require the scope of a professional nurse. So again, yes LPNs and RNs when it comes to skill typically do the same things. And the truth is in that aspect, you may not notice much of a difference between the two. Again, the difference is that LPNs practice practical nursing which in nearly all 50 states is a seperate practice from that of professional nursing. I hope this sheds some light on the confusion regarding the issue, that I have encountered.

Hi, let me just start off by saying welcome to LTC. Although I am an LPN and have never been a DON, I have been working in LTC for 11 years. I’ve been an Asst. in the Activity Department, a CNA, then a floor nurse (LPN), an MDS coordinator, and a Assistant Director of Nursing as an LPN. It sounds as if your facility is in dire need of staff and getting rid of them will be more detrimental than beneficial. What I have seen work, instead of cracking the whip, employee rewards. Get your current staff to want to work for you. Show them that you will appreciate the good work they do. Examples, all nurses that complete all routine charting we’ll be placed in a drawing for an extra paid day off, or a 50$ restaurant gift card. For the CNAs maybe a turn reward program. Place a ticket in the resident room that could be daily prize for the CNA 20$ gas card, a free pizza. It will not solve all of your problems but I gurantee employee rewards will increase production. As far as you not having a lot of LTC experience, find your tenured LPN or RN floor nurses that are held in high regard and listen to them. Make them your number 1 advisors. These nurses know the refs and the rules of LTC inside and out, don’t dismiss them because your the RN, LTC is a different animal and no degree or amount of acute care experience will prepare you. Good luck

I’m a Work in an LTC facility and you don’t imagine the drama between staff members even in this kind of setting. People are just so entertained by other people’s lives and nothing is gonna change that. When I was a newbie fresh out of LPN school I trained with another LPN who was held in high regard as the best nurse at the particular LTC facility, she was so commited to her job and residents. She had been employed their for 15 years. I asked her what was the secret to her longevity she said staying out the gossip. For the few days I followed her and trained with her, I noticed her responses to gossip when it was told to her. She would reply in a friendly way with “I’m gonna keep my comments to myself,” or “Some people go through a lot, we should pray for them,”. And the gossip would need their.

OK first breathe ! This is what you need to do and what helped me tremendously as a new nurse in LTC. One, realize that LTC is very hard. Until you have the advantage of knowing the routine to a T. And it’s still challenging. Next make a check list of every task that you’re responsible for (Medicare charting, weekly room charting, ABX progress notes, chart checking, pharmacy reorder, Glucometer control) make copies of this, check them off as you complete them. Also, make a binder of your facilities step by step processes like sending to ER, a new admission, entering new orders and refer to it each time the situation arises. Just remember the basic nursing practice rules when it comes to nurses notes and when to do them. 1. your facility policy for notes (skilled, Part B, weekly, ABX) 2. Anytime a resident leaves and returns 3. Anytime a NP/PA/MD rounds and or gives new orders by telephone or anytime you notify. 4. any change in condition and prudent action you took (PIE) 5. refusals of care best of luck

Congratulations and welcome to nursing. NCLEX PN is a nerve wracking test. It really makes you put your critical thinking cap on. The PVT used to be spot on, now we know it’s lost some credibility

You’ve have my complete aggreance! LPN and RN practice isn’t the same. I agree that we had beat this one to death but I want you to know that completely agree with you on that. Law is law Even if facilities hire them for staff nurse positions interchangeably, and they perform identical tasks.

The best for our facility when we had this problem was 12 hour rotations. It worked well for our nursing home. 6a-6p and 6p-6a nurses rotate between working a M,T,F,S,Sone week and then only working Weds, thurs the next giving them every other Fri sat sun off. It has worked wonders for satisfaction of floor nurses at our facility and requires less staff

I agree entirely. One of my pet peeves as a CNA for a couple years also. We were told that they can only know the type of precautions pertinent to the disease, but not the disease itself. I also think they should have a right to know, especially before an Activity Director or Social Worker would know but hey I just follow the rules