RN assessments in LTC

[whereisrebecca]

Hey Everyone,

I am a new grad who just got hired and I am wonder what the regulations are regarding assessments for an average pt. in LTC. I know some pts. require more attention according to acuity, but for the average pt. are they assessed once/24hrs....twice/24hrs?? How is it split up betweent he 3 shifts? We have LPN's and CNA's and we do not do our own med passes, but there is only one RN/shift which leaves us in charge of alot of Pts!

Of course in my dream world I would be able to assess everyone once a shift, but with the nurse to patient ratio in this facility it is not even mathematically possible. I do not like not being able to assess everyone!

Thanks for any info and advice!

[TheCommuter, BSN, RN]

The state where I live does not require an initial RN assessment upon admission in LTC. This state does not require daily RN assessments, either. The LPN/LVN has a nursing license and is more than capable of collecting data on the residents.

If the resident's payor source is Medicare, an assessment will need to be documented every shift for reimbursement purposes. However, if an LPN/LVN is the resident's primary nurse, (s)he can perform this assessment and document it.

[DixieRedHead, ASN, RN]

In NC, the new admission must have a physical assessment on admission done by an RN, other assessments can be done by any licensed nurse. I do try to assess any acute residents and anyone on the acute board for Medicare. I check the chart to make sure the charting is focused on the reason for admission.

[whereisrebecca]

I should have mentioned I am in California. Anyone know the regulations for California? LPN's are not able to assess here, I thought that was a nationwide thing?

Now I have another question....if LPN's in the previous states mentioned are able to assess, then what is the difference between LPN's and RN's? It seems LPN's do not have the science background for assessing.

[PsychNurseWannaBe, BSN, RN]

I should have mentioned I am in California. Anyone know the regulations for California? LPN's are not able to assess here, I thought that was a nationwide thing?

Now I have another question....if LPN's in the previous states mentioned are able to assess, then what is the difference between LPN's and RN's? It seems LPN's do not have the science background for assessing.

This is why I wish we had one board of nursing or at least the same scopes of practice for each state. But each state has the authority to do what they wish. This leads to a lot of confusion and can get frustrating on this site when people ask scopes of practice questions because they will get so many different replies.

[PsychNurseWannaBe, BSN, RN]

Hey Everyone,

I am a new grad who just got hired and I am wonder what the regulations are regarding assessments for an average pt. in LTC. I know some pts. require more attention according to acuity, but for the average pt. are they assessed once/24hrs....twice/24hrs?? How is it split up betweent he 3 shifts? We have LPN's and CNA's and we do not do our own med passes, but there is only one RN/shift which leaves us in charge of alot of Pts!

Thanks for any info and advice!

You will do different types of assessments. But generally, if a resident is placed on report, then you do a focused assessment. Once the resident returns to baseline, they are generally removed from report and you assess as needed. One of the nice things about doing a med pass is you are interacting with each resident and even in that short of period of giving meds, you are kinda assessing how they are doing. But you won't be doing a med pass.

Upon admission, then you normally do a head to toe assessment. Then there are medicare assessments that have to have an assessment including a set of vitals every 24 hours. That assessment is focused on their primary diagnosis, but will cover multiple areas of systems. My state, states, that a resident must have a full assessment at least monthly. We break this down to weekly assessments. Then for MDS, there are quartely assessments, which is basically a head to toe with a whole bunch of paperwork. Ugh! LOL

It really depends on what your facility states is your responsibility. Make sure to understand what your role is.

[lori.lvn]

LVN's are as different in their 'science' of assessment skills as their conscientious attention to care allows. LVN's cannot be judged as a whole any more than any other specific group of licensed professionals. Expertise, knowledge and application are very individual, personal, attributes. I've worked with RN's whose personal dedication was nowhere near my own and have had pts who've commented that they'd never received a more thorough assessment from even a doctor! It really is an individual issue. Some LVN's simply didn't have the four years necessary to attend school and receive an RN license. Hope this helps.

[whereisrebecca]

You are exactly right Lori, which is why I always encourage LVN's to go for their RN. I tell them, clinically speaking, they are miles ahead of the nursing students w/no LVN background and even the new grad RN with no experience. However, my question is regarding regulations from a legal standpoint not ability or inability and certainly not inferiority or superiority.

[lori.lvn]

Well said and much thanks. Would love to have worked under you.

[jimthorp]

I should have mentioned I am in California. Anyone know the regulations for California? LPN's are not able to assess here, I thought that was a nationwide thing?

Now I have another question....if LPN's in the previous states mentioned are able to assess, then what is the difference between LPN's and RN's? It seems LPN's do not have the science background for assessing.

In PA an LPN can do an initial admission assessment and f/u assessments. You also need to check with your facility policy.

Read your nurse practice act!

[Aem1215]

Actually, in PA an RN must provide assessment, but an LPN may evaluate or observe.