when to report/notified....

What is your facility's policy? Follow that because it is different everywhere.

I'd continue to report, it DOES protect you. If the nurse is upset about it- I'd be concerned. If you are truly notifying the RN's, then sign that. I'd be worried about a doctor that told me to quit charting that I notified him of change.

"when do i required to report or notied the RN(supervisor) everytime i need to document when pt. have changes of condition i always document rn notified "

When you document 'rn notified' then I think you need to notify the RN. If changes in condition caused you to document that, then it is necessary to bring in other personnel to assess the situation.

If you are receiving your own patient assignment, I don't see why everything has to be reported to an RN, unless that is your facility's policy, like someone else said. Check your state's LPN scope of practice. In my state, it goes something like, the LPN works under the direction of a, ...physician, dentist.. etc. or registered nurse. In most of my positions, I was the one taking report and responsibility for my patients. I notified the MD as needed and documented accordingly, but the only time my RN sup. was involved is if I needed advice or to transfer a pt. off the floor.

You are a nurse and work under your own license.

But take my comments with a grain of salt. I've always tended to lean maybe too much towards autonomy as an LPN which may mean it is a very good thing I'm going to RN school.

when there is changes of condition of the pt. i do notified the rn since shes the supervisor. ei: when pt bs or bp is high. but sometimes rn r too busy to do anythign about it because sometimes pt have ongoing elevated bp or bs. but i do document that i notified the RN. when pt have changes of condition.

well i work under the supervision of an RN.

well i work under the supervision of an rn.

yes continue to chart the way you do. we are supposed to work under the supervision/direction of the rn supervisor so of course i chart "supervisor joe, rn" made aware after the fact i informed them. i chart everything, specific time, how many times i called the md, how many times i called my supervisor. i always chart defensively because i want to make sure my behind is covered at all times. but that is just my style.

angel

when there is changes of condition of the pt. i do notified the rn since shes the supervisor. ei: when pt bs or bp is high. but sometimes rn r too busy to do anythign about it because sometimes pt have ongoing elevated bp or bs. but i do document that i notified the rn. when pt have changes of condition.

yes i do the same thing when there is a change in patient's condition. i inform rn supervisor that i will be calling the on call doctor and carry over the md orders, do all the interventions, and if i have to send my patient to the emergency room. my supervisor does not have to do anything but i inform her because she is my supervisor and i am supposed to update her on things. she can choose to come up and assess the patient or trust me to call md and carry what ever orders i get. it is usually the latter, but i always still chart supervisor rn made aware of the situation.

sample of my charting:

8pm fsbs 495. no s/s of hyperglycemia noted. supervisor jane, rn made aware. placed call to answering service for on call md. awaiting call back.

8:30pm dr. john doe returned call and informed him of fsbs 495 at 8pm. received telephone order to give extra 10 units of regular insulin sub-q x 1 dose now. order noted. supervisor jane, rn made aware.

There's two views on this one. I worked with a guy that was an LPN. He would alert us properly and put that in his charting, which is totally fine.... HOWEVER this does *not* mean you can wipe your hands clean of this patient while the RN "fixes" them... We may intervene with a med, but you're still primary on that patient.

I know the LPN was just kidding when he would tell us, and he would sometimes jokingly say, "Yeah ... Well ... RN NOTIFIED!" He totally DID notify us, but saying that was kind of like *jab jab jab* Maybe they think you're not trying to trouble shoot / intervention with the patient enough?

In the end, you are CYA (covering your a**). I wouldn't let them get you down. When they call a doc and say, "This person's glc is 50 an asymptomatic" ... If the doc didn't give any verbal orders, I'm SURE they would right, "Physician notified, no new orders received" ... It's the same deal. You're following the chain of things, and if they don't want to do anything, great. If they do, great. Either way you're doing your job, and you're charting what you did and who you notified.

yes i do the same thing when there is a change in patient's condition. i inform rn supervisor that i will be calling the on call doctor and carry over the md orders, do all the interventions, and if i have to send my patient to the emergency room. my supervisor does not have to do anything but i inform her because she is my supervisor and i am supposed to update her on things. she can choose to come up and assess the patient or trust me to call md and carry what ever orders i get. it is usually the latter, but i always still chart supervisor rn made aware of the situation.

sample of my charting:

8pm fsbs 495. no s/s of hyperglycemia noted. supervisor jane, rn made aware. placed call to answering service for on call md. awaiting call back.

8:30pm dr. john doe returned call and informed him of fsbs 495 at 8pm. received telephone order to give extra 10 units of regular insulin sub-q x 1 dose now. order noted. supervisor jane, rn made aware.

hi. thanks for the info. im just wondering what intervention did you do everytime your pt have elevated fsbs? esp. ongoing high glucose? do u just call the md? i usually chart my intervention and just notified rn. and did not called the md.

Are you expecting the RN to call the doctor or otherwise fix the problem? I suppose it depends on what kind of a facility you work for, and it definitely depends on what your facility's protocol is. I think you should get this clarified.

In my experience, LPNs call the doctor and fix the problem. Working under someone else's supervision does not mean you drop it in the RN's lap and walk away. But again, check your policy. Ask your manager.

A blood glucose of over 400 or one that isn't responding to treatment justifies a call to the doctor.

FWIW in our facility the RN is the only one that is able to call a physician. I do not know if this is a "State Law" issue, or just hospital wide. I would assume that it'd be the latter b/c aids, even if trained properly are NOT allowed (even though state says they *are*) to place foleys. I have no problem with either. I'm sure there was an issue earlier on in the company history that made this issue a necessity.

I'm in Ohio if you were wondering.