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downsouthlaff

downsouthlaff LPN

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downsouthlaff has 9 years experience as a LPN and specializes in Nursing Home.

Licensed Practical Nurse. Male Nurse. Currently work in the Nursing Home/Long Term care enviroment as a day shift charge nurse

downsouthlaff's Latest Activity

  1. downsouthlaff

    Active RN license working as an LPN

    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.
  2. downsouthlaff

    Do Dept head meetings violate patient privacy ?

    Sounds great in theory. In my brief stent as MDS coordinator we also had a nursing staff meeting after the initial dept head meeting but somehow, they still brought up clinical information.
  3. downsouthlaff

    Active RN license working as an LPN

    In this case and scenario then your argument makes perfect sense. It’s not clear whether the RN/OP holds both licenses. And I wanna reitierate that I am in no delusion that RN and LPN scope is the same or interchangeable, the only point that I was trying to make was many LTCs however will use them interchangeably and the DON will assume responsibility for the practice of the LPN even though they will be entirely hands off, and in reality the LPN will be making most of the assessments, decisions etc. But in the OPs case, I get where your coming from if he/she only has an RN license it needs to be clear that she will be allowed to work under the title and scope of RN. I really don’t see why the wouldn’t other than getting away with paying a Lower wage. But even at my facility our RN staff nurses may make significant less than they do in acute care but they are still employed and called RNs.
  4. downsouthlaff

    Active RN license working as an LPN

    I think we are just misunderstanding each other here because I hear what you are saying, but I don’t know if the OP is maybe confused thinking that her or she is working as an LPN, but an LPN just like an RN is a nurse your either or the other based on your license. But I don’t think it’s possible that an RN could work as an LPN per say. Especially without even having an LPN license. That’s where the confusion comes in. I am not 100 percent certain and I don’t mean to judge the OP, but my suspicion is that the OP may believe she’s working as an LPN because maybe at her facility being a floor nurse is predominantly an LPN job for cost saving measures or for whatever other reason, but the reality is that RNs who work the floor in LTC are not RNs working as LPNs , they are simply working as LTC floor nurses who are RNs.
  5. downsouthlaff

    Active RN license working as an LPN

    Dear OP, I wanna give you the least confusing and best advice possible to find out this answer for sure chat with your DON or ADON, and check to make sure there are no by default rules specific to your state. I can speak from years of experience in this environment that typically the answer is no. As I said I have worked along side RNs that have worked as floor nurses just as I have. They weren’t in a supervisory capacity, only a nurse for their own assignment and responsible for their residents and CNAs. The CMS requirement for all federal nursing homes is that an RN must be present for 8hrs a day. After that time the LPNs May work without an RN present as long as their is an RN (ADON, DON, RN supervisor) available to the LPN by phone. LTC DONs know going in that they will have to be very trusting of LPNs capabilities and of course if they take the position they have no issue with this. So it’s more than likely understood that your DON is filling the legal technicality to complete the practice requirements of the LPNs at your facility. That’s how it typically operates. But just chat with your DON to find out. Best wishes and best of luck in long term care.
  6. downsouthlaff

    Active RN license working as an LPN

    Actually the RSD/MDS Nurse is an LPN. But the DON takes responsibility. I’m not arguing the point that your making. I’m simply saying that If another RN, who is the DON has set forth the care plan, after completing the initial assessment and performing nursing dx, and the staff nurses are implementing the care plan whether it be RN or LPN then they will be doing the same job. I just like a registered nurse who is doing my job can perform ongoing assessments and notify the MD directly of a change in condition. So yes my RN counter parts who can practice the nursing process independently, and perform more tasks that I can do can do things that I cannot. But when we are working as staff nurses we are both implementing the nursing process and conducting on doing assessments so therefore we are doing the same job at that time. But as an RN in LTC just like in the hospital the OP will charge over CNAs and over a unit of patients. She will be the primary nurse for these patients. She will pass the meds, do routine Medicare assessments and report to the DON and the MD. Similar to an acute care RN reporting to the charge RN. It’s no different. As long as she practices these duties as a prudent registered nurse she can’t be held liable for any wrong doing. RN staff nurses in LTC are not a new concept.
  7. downsouthlaff

    Active RN license working as an LPN

    It sounds to me as if you speak from a place of ignorance Iike you don’t understand the way long term care works at all. First of all, I am not arguing that LPNs and RNs are interchangeable. RNs are responsible for the entirety of the nursing process. I get that. There are thing RNs do that LPNs aren’t allowed to do. But the reason that I think you speak from a place of ignorance is the comment you made earlier about LPNs being on the med cart and just passing meds. LPNs in LTC take an assignment of patients and do more than just pass meds for them. We do Medicare assessments, we determine when to send residents to the ED with the guidance of the MD, we carry out new MD orders, dress wounds, assess for injuries after falls, complete accident report. But again I will tell you that yes to be a staff nurse in LTC an RN and an LPN can be used interchangeably. It may bother you but it’s just a matter of fact. The RN passes meds, competes Medicare charting, provides emergency care and would care as needed, assesses condition. The LPN will do the same job. Because once again they are both implementing the care plan. Just because the RN who is a staff nurse can complete the entire process doesn’t mean that they will be. The OP can not be held responsible for every LPNs action in the building just I can’t be held responsible for every CNAs action in the building by default. Our DON remains accountable 24/7 for supervising nursing practice of all staff nurses if not in person by telephone. Being a staff nurse in a nursing home is perfectly OK for an RN to do. They are more than capable of passing Meds, charting on residents, and by doing so they are not putting there license in danger as they would any other job. Closed Account I think most of us just don’t understand what your arguing ? That by passing meds in a nursing home and performing assessments on residents that RNs are putting there license in jeopardy ? Nearly every acute care registered nurse I know passes meds. So what do you mean ?
  8. downsouthlaff

    Active RN license working as an LPN

    I work as an LPN in an LTC and I’m sorry to inform you that we do use RNs and LPNs interchangeably. We are both considered charge nurses, have our own patients, we both pass meds for our assigned group, both chart, both follow the care plan set forth by the RSD/MDS Nurse, we complete nurses notes, and we both notify DON and Primary MD of abnormal assessment findings. Both RNs and LPNs can work as staff nurses in LTC and they will most likely be doing the exact same job to the T. And the reason for this is because they are both primarily IMPLEMENTING the care plan. And typically the patients only need PO meds and Injections maybe an occasional IV abx and a few PEGs. The OP is not putting her license at risk. She is simply working as an LTC staff nurse. As long as she follows nursing protocols for her assigned patients her license is not at risk.
  9. downsouthlaff

    Active RN license working as an LPN

  10. I’ve been an LPN at the same long term care facility since graduating nursing school in 2014. The facility recently hired a new grad RN to supervise and do wound care on weekends. As a new grad RN she always seemed very intrigued that LPNs have so much autonomy in long term care, and that there are so few RNs on staff. Well on her previous weekend shift one of the charge nurses (LPN) who is also fairly new as a nurse, made a medication error and gave a resident in A bed the meds for B bed. She self reported and the situation was handled accordingly. In our monthly staff nurse meeting this RN went on and on about how she’s afraid of losing her license over this and that working with so few RNs on staff she didn’t feel safe being responsible for so many CNAs and LPNs. I then spoke up on the issue and voiced my opinion on the matter, that I didn’t think that she could be held responsible, and that it was my understating that the LPN is licensed and expected to be competent in (p.o.) med administration and will be held accountable for his or her actions, as long as she (the RN) who is responsible for the entity of the nursing process takes the proper action after the med error is made. She then took a tone like she was very offended. My question is, can the RN be held accountable for things that LPNs have been uniformly deemed competent to perform by licensure ? My understanding has been that LPNs accountable for there own actions and wrong doing within their scope, but RNs maintain responsibility for the care plans and the nursing process but not individual actions of the Licensed Practical Nurse as long as it’s something within the LPN’s scope. Just curious. Thanks for the input
  11. The practice at many nursing homes if not all, involve some type of daily meeting where the Administrator meets in private with department coordinators at the facility, (DON, SSD, Activity Director, Housekeeping Sup.) to have round table discussion about issues at the facility. One contract nurse at my facility recently brought up a good point regarding HIPAA, and that nursing/healthcare issues brought up regarding patient condition in these meetings in front of staff such as the Housekeeping supervisor, Activity Director, maintenance repairman, May actually violate HIPAA and the patients right to privacy of the information is not needed or doesn’t pertain to the particular department. What are your thoughts on this issue ? Seems to me these issues should be kept between DON and nursing staff out of privacy concerns if the issue is not relevant to the other department coordinators job.
  12. I have worked at a handful of nursing facilities who seem to handle dietary waivers differently. Some in which for example if the resident is NPO and on a continuous enteral feeding d/t risk of aspiration, and the patient refuses to follow these orders, and requests regular meals and beverages how is that handled at your facility? Or another example resident is prescribed nectar thick liquids, but signs a refusal, Is it the acceptable for the facility to provide regular liquids, or does the resident and family have to provid it ? Just interested to see how different LTC/SNF facilities handle this
  13. downsouthlaff

    How can LPN/LVNs supervise RNs? WE

    Horseshoe, in my state LPNs can perform focused assessments as well, we can also perform new admission assessment with an RN co-signature. I think the lines are very blurry, I’m which what constitutes admistrative supervision and clinical supervision. I believe that as long as the LPN is supervising that all nurses in the facility or completing all there duties d/t what the facility outlines is required of them, like completing all the charting, clearing mars, transcribing physician orders per facility protocol, making sure they have the right color uniform on, it could be argued that all this still constitutes administrative supervision, in the same capacity that a Nursing Facility Administrator would supervise a Nurse. Now if an LPN were to tell an RN how to assess there resident, or give guidance as to what to do via a residents change in condition, this is violating the practice act. But I also think that it would be perfectly okay for an experienced LPN/LVN to contribute there knowledge to an RN in this given situation, but not supervise which means telling the RN which action to take.
  14. downsouthlaff

    "LPNs are glorified CNAs"

    1. CNAs should be glorified in my opinion for the work they do. 2. No your not a glorified CNA, your a Licensed Nurse. It’s in your title. You are licensed to perform nursing functions that CNAs cannot. I know that the patients really don’t know better, but I also know how this can get under our skin. But you do learn to ignore these things after some time, because at the end of the day, they really don’t matter. Sometimes I’m so busy and tired of telling a dementia patient that I’m your nurse and so and so is your aide, when they refer to these aides as there nurse, I just nod and agree and get back to my ocean of charting to do so I can go home in time lol
  15. downsouthlaff

    How can LPN/LVNs supervise RNs? WE

    This post is to shed light on a frequently confusing topic to many nurses. Let me start out by saying that in no state is it permitted for an LPN to supevise or delegate nursing practice to an RN. Many Registered Nurses’ first reaction (not all) is to take some offense or have concerns about learning that in some nursing specialties LPNs serve as charge nurses, managers, ADONs, etc. In my experience, they often question how can LPN hold such a position when there work must be supervised by RNs or physicians? The role of a bedside nurse in long term care settings often do not require the skills that most BONs restrict LPNs from. For instance, administering medications, documentation, taking verbal orders from APRNs or MDs, wound care, basic first aid. While you will see both RNs and LPNs employed as bedside nurses in these environments, you will often see that in these environments, when this is the case, there will be almost no difference in there job duties or role despite the different letters behind there name. But how do facilities get away with allowing LPNs to work independently with no RN on duty? That’s just it, they don’t. The BON in my state for instance states that an LPN can be in a LTC facility without a supervising RN, as long as there’s an RN available by phone. Many facilities use the services of an on call APRN 24/7 for both RNs and LPNs to contact either by call or text. Therefore the LPN is not truly making independent assessments or decisions, just gathering assessment data and reporting it to the on call RN supervisor or provider by phone. Assessment in my opinion is a fluid term. It’s hard to regulate assessment. For instance some could say that an LPN working independently during the night hours at an LTC facility auscultates lung sounds and notes crackles, and then measures temperature and notes pyrexia then calls the 24 hr APRN service and reports this, and is then given orders to adress this. It could be argued that the LPN performed an assessment and made a decision wich BONs restrict in some states, but it could also be compellingly argued that the LPN gathered data, and reported it to an APRN using methods that are acceptable per BONs in some states. With that being said, this brings me to my next point. How can LPNs be in charge or hold titles like charge nurse or ADON or evaluate the work of RNs? The answer is admistratively. Can a nursing home administrator who has a degree in education or finance perform an evaluation on an RN? The answer is yes. While it is true that an LPN cannot clinically supervise an RN, again the actual role of a bedside nurse in many LTC settings doesn’t change with the nurse being an LPN or RN. There are rarely advanced level skills being used in LTC. There far in many LTCs a beside RNs and LPNs will do the same job. It is very different from acute care. Therefore, an LPN who was experienced bedside nurse in a supervisory role would be a good candidate to supervise the work administratively of less experienced nurses be it LPNs or RNs in these settings. Scenario, “Jane is the LVN/ADON at Green Leaf Retirement Center. Jennifer is a new RN floor nurse at Green leaf. It has been brought to Janes attention that Jennifer has not been completing Medicare nurses notes, or reordering medications per facility policy. Jane being Jennifer’s administrative supervisor serves Jennifer with a verbal warning and written infraction form,” In this scenario, Jane did not delegate to Jennifer or supervise clinical nursing practice or judgement. She simply administratively supervised and evaluated Jennifer based on the policy of the facility. And Administrator who is a not a nurse could have legally taken the same action. So while an LPN can’t clinically supervise an RN, in almost all states anyone who owners of a business such as nursing facilities appoint can supervise anyone administratively no matter what the lettere are behind there name. I hope this thread helps RNs who really haven’t worked in these long term care settings understand why LPNs and LVNs are able to hold these positions.
  16. downsouthlaff

    Tell me why an LVN/LPN is a "real nurse"

    It's not a matter of opinion it's a matter of fact. LPNs are real nurses, because the Boards of Nursing in every state grant them legal authority to practice nursing and call themselves nurses. Anyone who doesn't understand that are can't comprehend that simple fact, is just not a person worth arguing with ! Let it roll !