RNnLTC

Let me add..I am not saying ALL LPN's are like this one,but it does give a bad rep.

In regards to the replies here (and thank you all for expressing your opinions), I want to clarify that my post is not egotistical. "Do you feel that patient safety is being threatened by having a LPN in charge?" When said nurse is interfering with interventions, the education of families/caregivers or requiring that she have a "say-so" in the way treatment, care planning, and interventions are being carried out, it eventually compromises patient safety and quality of care. This would be the concern regardless of title. However, this happens to be a nurse that did not receive the in-depth training that an RN has, and thus should not be 1) going out of her scope of practice, obviously, by attempting to clinically supervise 2) Addressing herself as charge nurse to families, when she clearly cannot override the clinical decisions made by RN's. (2 nurses, x 3 shifts on this unit, 4 are RN's) I assure you it is not a matter of ego on my part. It is a matter of doing what is best for the patient and families. It appears she is letting her position get to her head and losing sight of her focus...administrative duties. Here is just an example of "her". INR comes back at 2.6. Patient's coumadin was increased from 2.5 mg to 3mg one week ago, because the INR was at 1.8 foreverrrrr. I don't feel I need to call the doctor. I can put it on his board for when he does rounds. She thinks the doctor needs to be called. ? Patient has a hx of Colon CA and esophageal stricture. No recent hx of abx use, no hx of C-Diff, no recent close contact with the patient in the facility that was suspected of having active C.Diff (C&S was pending). Patient get's put on contact isolation--per unit manager--because pt had one episode of large loose stool that smelled bad...please note loose stool, not watery stool. Me: we should monitor for loose stool for 24 hrs before initiating contact isolation. The pt is asymptomatic. Her: No, I want her on contact isolation and you need to call the doctor. Summary: The pt was placed on contact isolation x3 days, in which she didn't tolerate too well with her dementia. The patient was chemically sedated on a couple occasions in order to maintain contact isolation. This issue was being brought to the attention of the physician and thus contact isolation was D/C; pt was no longer having loose stool. Stool samples were completed x3 over a 2 week period, because the pt only had 2 episodes of diarrhea in 2 weeks. The pt would have been started on Flagyl, unnecessarily, if I didn't plea to the doctor to let us at least get one positive stool sample before starting Flagyl. These are true scenarios. Pt. with hx of stroke, anxiety, dementia, attention seeking behaviors, and subdural hematoma roams the unit in W/C . Pt decides to get close to the nurses station and sit. Pt. starts behaviors (asking for help, seeking attention, not causing harm, not getting aggressive or combative). Unit manager: "Will you please give her something! I am tired of hearing it!" Should I sedate pt's at her will? Another pt whom makes repetitive statements, with long hx of psychiatric drug use, is sitting in the W/C in the hallway for a change. Pt always seems to be in room (hmmm). Pt asks for something to drink. I bring pt close to me and administer thickened liquids, as are ordered. Unit Manager: "Why is she out here? She get's obnoxious when she is out here." Unit manager then pushes the pt. into room. Any GOOD-PRUDENT nurse, wouldn't want to tolerate the behavior of this unit manager!

That's different than questioning your nursing judgement and interventions. This nurse tries to "lead" the floor in a clinical sense and most of the time doesn't even understand what's going on. A family member will come to the nurses station and ask to speak to the nurse of their family member and she will say, "I'm the charge nurse. You can talk to me." Really? In order to be charge nurse you have to make clinical decisions and If I'm working with the patient all the time, then the information they seek will better come from me unless I am super busy and she is doing me a favor...which is never the case.

lol that explains why I accuse my poor patients of having bad veins when I have no choice but to draw from their hand lol. Thanks for that advice!

I wouldn't be mad. I mean, a phlebotomist specializes in drawing blood, I don't, I just have to because I get an order for a stat lab. That's not something they teach in nursing school, it's another skill you acquire on the job. I'm always open to listening and learning. I've also learned that I hate using butterfly needles and when I first began drawing blood I loved them...it was because I was blood draw retarded lol.

That really sucks! I can only imagine how you feel as often times in the heat of mental burnout I reflect on how truly grateful I am to be in a position to get mentally burntout! Have you ever considered getting your MSN and teaching theory?

The patient to CNA ratio in the hospital can be more than slightly unfair. I worked on a cardiac step-down unit and our rooms were constantly full. We would have 2 CNA's for 40 patients. Needless to say, we nurses were always working short and had to take on more patients and half of the patients being total care patients! That meant we had to pass bed pans, change briefs, answer call lights, pass meds, hang IV's, complete assessments with vitals every four hours, print and read tele strips every four hours, perform EKG's and blood draws, weigh patients, chart, call doctors, complete admission paperwork and assessments, talk to family members, draw blood again, participate in codes while a drug seeking patient in the next room over watches the clock for the minute of IV push Morphine and threatens to pull out their PICC line if you don't ignore the critical patient and push that medicine in that line in less than five minutes! They do it and come bleeding down the hall zombie style! Even then I didn't act out rudely to any of my CNA's. So, there's no excuse for that nurse's behavior! However, the point is the patients are "our" patients and it is all of "Our" jobs to answer call lights and do what is needed to provide care for the patient. That nurse sounds like an A_h*le. I see a lot more of those types working in Long-term care. We have almost just enough CNA's to attend to the basic needs of the patients on our unit, but many times the needs exceed the hands! When that happens, I see lots of nurses that refuse to put a patient on a bed pan, change a brief, change clothes or even transfer a patient from bed to wheel chair to prevent them from injuring themselves! They run down the halls looking for a CNA! I'm thinking to myself...really? The time it took you to find a CNA, you could have already completed the task! Perhaps I think like that because I was a CNA for 11 years prior to becoming an RN... Part of being a nurse includes butt wiping, passing bed pans, dressing, bathing etc. What the heck did they think Florence Nightingale did? Lol.

According to Michigan, the LPN is required to practice under an RN, Physician or Dentist, and cannot clinically supervise an RN or ancillary personnel for that matter. They are allowed to administratively supervise, which entails staffing and paperwork. An RN is required to practice under a physician or dentist and can supervise LPN's and ancillary personnel. With that being said, I am still confused as to why my facility does not comply with that.

I don't deny that there are some very good LPN's. My best friend happens to be an LPN and if she were unit manager I wouldn't complain because she knows a lot and she has people and communication skills...that makes all the difference in the world when someone is in a supervisor position. However, education and scope of practice does matter. If it didn't matter, all nursing programs would be a year in length at full time. Me personally--with only an ADN RN--I had to take 2 years of prerequisite work and 2 years of nursing classes, which accompanied co-requisite classes. So, there is a difference...and no disrespect, but less educated individuals shouldn't be put in supervisory positions, when they are not qualified to supervise skills which exceed their scope of practice.

What I don't understand is why are LPN's allowed to supervise RN's in Long-term care? Due to the education of an RN vs an LPN, this has caused problems! I'm an RN and have been working in Long-term care for the past year. The unit manager on my unit is an LPN and is always trying to delegate things to me, question me as to why I do certain things, why I take some things serious and not other's...and she doesn't approach it in a way as if she was trying to learn, she attacks it. As an RN I was taught the disease process, what to watch for and what to expect! I was also taught to educate families regarding the disease process and be able to explain to them what is happening when their loved one is experiencing a decline. In doing-so, I was recently scolded by my unit manager in her saying "you're practicing outside of your scope of practice!" Really? The DON didn't think so...It just annoys me that the Scope of Practice for RN and LPN in Michigan clearly states that an LPN cannot clinically supervise an RN, yet this is actually happening at my facility! What can I do about this?

I'm a RN and I work in Long term care at the moment. I'm a humble nurse, but I also am a confident nurse. I handle problems when they arise, regardless of the age of my patients; patients have the same rights regardless of their age! Communication with families is a big part of my position and I strive to make them feel comfortable in entrusting their loved one(s) into our care. I've been experiencing a problem with the unit manager since I began my position at this facility one-year ago. It seems the unit manager is always trying to "check" me about what I discuss with families, why I use certain interventions with my patients, and why I go "above and beyond"! She recently accused me of practicing outside of my scope of practice, when I sat down with a family and explained signs and symptoms of a diagnosis that was given to the patient. I suppose I would feel differently about her being my unit manager if she were more polite and more educated. Education has a lot to do with clinical supervision. Since when did educating a family and knowing the disease process become practicing outside the scope of practice for an RN?