question for big al

[merilynRN]

A nurse hired at camp this summer is an LPN. Does she require daily RN supervisory visits under PA law? We have done them based on the ACA requirement that an RN needs to be onsite daily, so I've been alternating daily visits with another RN during sessions the LPN is there. She is also new to camp nursing, having primarily worked in geriatrics, so I thought she might welcome an experienced camp nurse checking in with her to discuss situations.

One year another nurse and I had done shifts rather than whole weeks, and we enjoyed discussing situations and issues together at turnover, pooling our combined knowledge and experience.

I've noticed, however, this particular nurse does not like it when I show up even briefly (I do not take over) and becomes even more furious when the director has called me in for a second opinion on a situation. I actually dread going on these visits as she will not discuss issues with me so I can not get a good idea of what is going on, and find out about things through others later on. She also has what I call 'staff groupies' around her in the health center a good deal of the time.

I know you are pretty familiar with nursing practice law regarding camp nursing and wonder if the daily visits truly are a requirement as I have thought.

Thank you

[Alex Egan, LPN, EMT-B]

Well from a legal standpoint in PA.

(1) An LPN shall communicate with a licensed professional nurse and the patient's health care team members to seek guidance when:

(i) The patient's care needs exceed the licensed practical nursing scope of practice.

(ii) The patient's care needs surpass the LPN's knowledge, skill or ability.

(iii) The patient's condition deteriorates or there is a significant change in condition, the patient is not responding to therapy, the patient becomes unstable or the patient needs immediate assistance.

So pa doesn't mandate direct supervision or really weigh on on how it should be provided. This is different for GPN and GN where the physical presence of the RN is required on the unit where care is provided.

The ACA however does mandate under HW.1 that a resident camp must have a physician or RN on site daily. A day camp may have pre arranged phone access.

The ACA does not seem to recognize LPNs as professional health care providers, and in order to be in compliance you would have to be on site daily

I won't try to delve into the mind of your LPN. It would seem that the relationship is sour, and as long as your camp director is aware and unable or unwilling to intervene you would seem to be stuck with it.

Feel free to pm me if you want to discuss your situation more privately.

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings

[merilynRN]

Thanks so much big al ... this would confirm the need to do the daily's, as I have thought. I did attempt to PM you first, but it seems a poster needs to have a minimum of 15 posts before they can PM anyone. It would be helpful though, if possible. Thank you.

[Alex Egan, LPN, EMT-B]

You can email me. [email protected].

I use my phone, to type, I work at night, and I'm a bad speller. Pick any reason you want for my misspellings