Rehab RN working for a supervisor LPN

[workinmomRN2012, BSN]

I was hired by a LTC/Rehab about 7 months ago and I knew that the supervisor on one of my evenings was an LPN that got her license at the same time as I did. I didn't have a problem with this arrangement since I did my research on allnurses and the consensus was that an LPN only supervises an RN administratively. Well a situation came up the other night where the supervisor wanted me to do a test that I thought was unnecessary, I did not perform it. It was no big deal. I went to my DON and asked for clarification on roles and I told her that I believed that she was only supervising me administratively not clinically, and she said no- she is the supervisor in both ways. Hmmm. By the way, when the supervisor asked me to have this test performed she did not ask for my opinion, and I did not offer mine either- that was my fault. I should have encouraged a conversation about it.

My DON also stated that she did not want to turn this into a ******* contest(I couldn't agree more) and said that "their just letters after the name", and the DON just recently decided to put ONLY the RN's on the rehab side of the facility.

So, with that being said, here's my issue- I really don't want to take direction from someone that has had their license for the same amount of time as me and the fact that she is not an RN. I know that the LPN's out there will be ****** about this statement but I worked damn hard to get my RN, 4 years to get a 2 year degree and I am currently enrolled in a RN to BSN program. I have nothing against LPN's, I just would like it if the one supervising me had more experience (I've seen her in different situations). The letters behind my name mean a lot to me apparently to a lot of the medical community. I have worked with other LPN's, with a lot more experience, where I have asked for their opinion on more that one occasion when I had no clue about what I was doing.

I think what really has gotten me more that a little upset is the fact that my DON said that she can supervise me clinically, administratively is fine. I have been doing research online, and I believe it is actually against law (nurse practice act)? I just can't find a definitive statement about it. Any help or suggestions would be greatly appreciated. I live in Connecticut- if that helps.

[mlbluvr]

It's an age old issue that will never be resolved and will always be brewing. Maybe if 'supervisor' was changed to 'unit manager', or something, that might help- because be definition an LPN works under the supervision of an RN or MD. A curious thing I've seen is that ADNs seem to take more offense at the LPN role, overall, in any capacity, than I have found with BSNs, in my long years. And MSNs seem to have almost no problem with LPNs, at all- almost welcoming them, in fact. Is it because ADNs have more practical clinical hand's on experience? That's my thoughts.

[workinmomRN2012, BSN]

I was just looking at Ct's nurse practice act and it states " the LPN will preform duties under the direction of an RN". Does that mean that she is working under the direction of the DON, even though the DON is not in the building. Or, does that automatically mean under the direction of the RN in the building? Either it's vague or people have found away around the practice acts

[TheCommuter, BSN, RN]

I was just looking at Ct's nurse practice act and it states " the LPN will preform duties under the direction of an RN". Does that mean that she is working under the direction of the DON, even though the DON is not in the building. Or, does that automatically mean under the direction of the RN in the building? Either it's vague or people have found away around the practice acts

Virtually every state in the union has a nurse practice act specifying that LPNs work under the direction of an RN or physician. However, real world nursing practice does not work in that manner, especially in nursing homes.

LPN nurse supervisors, LPN unit managers, and LPN/ADONs all work under the licensure of the DON (who is always an RN). If you do not feel comfortable receiving supervision and directives from an LPN, your best bet is to get into the acute care hospital setting where LPN supervisors are virtually nonexistent.

[fairyluv]

Wow I would have a prob with that also. I'm an LPN and I would feel a little upset if I were being supervised by a CNA. I can understand your frustration. I would call your SBON and ask them for some clarity on that.

[BrandonLPN, LPN]

While it is true that LPNs work under the direction of a RN/MD/DO, it's also true that nursing homes are very creative about getting around that.

As others said, since this LPN is working under the direction of the DON (a RN), anything she tells you to do is actually an order from the DON, viacariously. In other words, this LPN supervisor is the proxy of the DON. I know, it's iffy, but there it is. Would such an argument stand up to scrutiny from the BON? I don't know.... I'm guessing, yes. It's a loophole in the rules.

I think your best bet would have been to ask this LPN why she wanted this test. I bet she thinks it's silly too, but she's just following protocol.

[TheCommuter, BSN, RN]

Wow I would have a prob with that also. I'm an LPN and I would feel a little upset if I were being supervised by a CNA. I can understand your frustration. I would call your SBON and ask them for some clarity on that.

When I was an LPN in the nursing home setting, some of the 'supervisors' were CNAs. The staffing coordinator, central supply manager, director of housekeeping, and activities director were all CNAs.

The staffing coordinator would discipline nurses for administrative issues: absenteeism, tardiness, etc. The written warnings were always co-signed by the DON. Since she also coordinated transportation for residents, she would always tell the nursing staff to make appointments for Mrs. So-and-So.

In other words, CNAs can (and do) supervise LPNs and RNs administratively in some nursing homes due to cost effectiveness. The CNA cannot clinically supervise the nurse, but (s)he can administratively supervise the nurse.

Again, anyone who is uncomfortable with receiving directives and orders from an unlicensed person may wish to seek hospital employment where the likelihood of a CNA assuming a managerial role over licensed nursing staff is nearly nonexistent.

[workinmomRN2012, BSN]

I couldn't agree more that I need to be in a hospital setting but that is not possible right now. You would think that with the influx of RN's to the SNF's/LTC's facilities that would eliminate this issue altogether, right? I guess the bottom line is that if I strongly disagree with her direction I need to tell her to call the DON to back her up and if the DON agrees with her assessment of the situation, then it's ok- I've CMA

[systoly]

my wife was a CNA for a couple of years and she had no problems supervising me

[NurseGuyBri]

I have been an LPN in a "supervising" role on the floor. This is how I handled it then, and it how I handle it now as the DON when our LPN Unit Managers are supervising the floor. When I was an LPN, I *always* made it clear that although I am their facility supervisor, when it comes to a clinical judgment, I will do 2 things: Agree or disagree. If I disagreed with the RN, I would ask them to please explain what their rationale is. If we still disagreed, I asked our ADON (RN) for guidance. I made it CRUCIALLY clear that I understand the division of RN/LPN and respect the work it took to get the RN. I will, as an experienced supervisor, question the motives and rationales if i disagreed with the RN, but in the end, the RN would be responsible if the BON or law got involved. This type of open communication helped me move up the ladder with the respect of the staff.