Responsibilities of RN in nursing home in NJ

[Revolutionaryroad]

Hello, I am a new grad (less than one year of experience) that is currently working in a nursing home in NJ. I am an RN,  but I did not sign up to be an RN supervisor; I simply signed on to be a cart nurse. With that said I have varying concerns such as my roles and responsibilities as an RN. I am one of the few RNs in the building, with most of it staffed by LPNs, including the unit manager positions. However, a lot of the LPNs have this attitude that if anything happens in the building with the RN supervisor not present it automatically becomes my problem. Also, receptionists will call me when there's no supervisor and ask me questions about the building which I obviously don't know the answer to. In my conversations with the RN supervisor at the nurse's station she also has this attitude that I should be prepared if she is not around. I did not sign up to be the RN supervisor if the building does not have one. So I am asking, legally, what am I responsible for if there is no other RN in the building, and it's just me. What I am expected to do or be responsible for?

[hppygr8ful, ASN, RN, EMT-I]

You would have to check the laws in your state as well as the policy and procedure manual in your facility. 

In most nursing homes a LVN acts as Charge nurse and the RN does Intake assessments, Manages IV meds and yes they do act as an ad hoc trouble shooter. The laws in almost all states say that certain things have to handled by the highest license in the building.  If and when the SHTF you will be held to the full responsibility of your license irregardless of the P&P in your facility.

As a young nurse it's good to stretch your muscles and improve your skill set.  Because you may not want to spend your career in the SNF (But no shame if you do).

Hppy

[FolksBtrippin, BSN, RN]

If you're the only RN in the building, then yes, you are in charge. It's not the worst thing in the world, but it sounds like you aren't confident about it and need some guidance and training. If I were you, I would ask for a day to shadow the don, or whomever so that you can understand some of the administrator responsibilities you may have to handle if and when you are the only RN in the building. Also, there should be someone you can call (like the don) in case you are stuck on an issue you don't know how to handle.  But if you really never, ever want to do it then get a new job. There are lots of other opportunities in NJ. 

[Revolutionaryroad]

Wow that sucks...I really just want to be a cart nurse; I really don't want to be the de facto leader if anything goes on, especially since I have the least experience in the building. It's crazy to me how LPNs can be unit managers and be my direct boss yet when crap hits the fan, I'm supposed to take charge.  It feels as though my education is being used as a weapon against me. I really want a career in the nursing home doing exactly what I'm doing now, but what you're saying makes that unlikely. It seems almost absurd that a fresh grad RN has more responsibility and liability than seasoned LPNs in positions of authority.

[vampiregirl, BSN, RN]

I was in a similar situation years ago as a new grad RN in a nursing home! This was during a time when nobody wanted to hire new grads though so I was kind of "stuck". 

I quickly figured out which LPN's had clinical skills that I trusted as well as the ones who knew facility policies/ procedures and where to look things up. I am a nerd so I love learning. If I heard of something I was unfamiliar with, I made it a point to look things up so I could become more familiar. I remember that I figured out how to change an ostomy bag from watching a YouTube video in the med room - I wasn't familiar with the products in the treatment order and the patient was non-verbal!

Where I'm going with this is that this experience in the nursing home actually did a great job exposing me to a variety of things to increase my skill set over time. Gradually I became more competent and confident. Looking back, I'm able to see that this job gave me a strong foundation as hospice RN (which I love!). Also, I was recruited into my first hospice nursing job by a hospice nurse who saw patients at the facility I was working at!

 

[Lynker, LPN]

This is what happened to me overnights, except I'm an LPN. I used it as a buff for my resume, which helped me get a nursing supervisor job at another facility. 

It can definitely be hard, but maybe you can use it to your advantage. I also think if they want you in this position, you should ask for more money!

[ComeTogether, LPN]

double check with your board of nursing and the facility policy/procedure however, my understanding is unless you accepted is supervisory position , there should be no difference. 

You are responsible for the patients that you have accepted, no more no less.

[kbrn2002, ADN, RN]

ComeTogether said:

double check with your board of nursing and the facility policy/procedure however, my understanding is unless you accepted is supervisory position , there should be no difference.   

You are responsible for the patients that you have accepted, no more no less.  

Not necessarily as states can and do vary wildly in scope of practice for LPN's. It's quite possible when OP is the only RN in the building that makes her the one in charge even if she doesn't want to be. 

WI even has language in the nurse practice act specific to LPN's in a nursing home setting. LPN's can act as administrative supervisors but can't act as a clinical supervisor over RN's. Weird one to navigate there so the SNF I worked for just didn't hire any LPN supervisors, too much drama from the RN's the one time they tried. LPN's also can't do any assessments so if there was a situation like a fall on a wing where an LPN was working an RN had to leave their unit and go there to assess the resident. 

[nightwingcreations, CNA, LPN]

You will definitely need to check in new jersey laws on that because every state is different. Lpns do assessments and admissions in my facility. And have been nursing supervisors for each wing. Our ADON is an Lpn. This is in Kansas.

[Lynker, LPN]

nightwingcreations said:

You will definitely need to check in new jersey laws on that because every state is different. Lpns do assessments and admissions in my facility. And have been nursing supervisors for each wing. Our ADON is an Lpn. This is in Kansas.

Same here in MA, I am a supervisor, and both LPNs and RNs do assessments and admissions. I am an LPN as well.

All of our unit managers are all LPNs aside from one RN.

[ComeTogether, LPN]

kbrn2002 said:

Not necessarily as states can and do vary wildly in scope of practice for LPN's. It's quite possible when OP is the only RN in the building that makes her the one in charge even if she doesn't want to be. 

WI even has language in the nurse practice act specific to LPN's in a nursing home setting. LPN's can act as administrative supervisors but can't act as a clinical supervisor over RN's. Weird one to navigate there so the SNF I worked for just didn't hire any LPN supervisors, too much drama from the RN's the one time they tried. LPN's also can't do any assessments so if there was a situation like a fall on a wing where an LPN was working an RN had to leave their unit and go there to assess the resident. 

It's going to be up to the nurse practice act for their state, seems to vary widely. 

 In my state nurses can't delegate to other nurses, no matter the license.  LPNs can do assessments as well, but it seems my state is one of the most liberal in terms of the scope. 

To my knowledge the only things LPNs can't do (in my state) is pronounce, IV push and administer blood and place/remove central lines.