RN Oversight of LVN care

[theantichick]

Ok, my facility has started having RN's sign off at the end of the shift that they provided oversight for the LVN's care for the patient. It's done as a free-form text input field and since I work ICU I've never had to do it. Tonight they're having me do it for LVN's out on the med-surg floor. I have been told different things by different people about what exactly I'm signing off on. Some say it's the total care, some say it's only the "observations" the LVN makes because they're not legally able to do "assessments".

Anyone else worked with this, what am I actually attesting to, and what kind of wording works?

[theantichick]

I should add I've already pulled down a copy of the nurse practice act from my BON and it doesn't address this that I can find.

[amoLucia]

I don't know that I'd be comfortable with that.

I'm sure all LPN/LVN Nurse Practice Acts have some kind of similar clause that states "under the direction and / or supervision of an RN or MD".

If I'm NOT there, can't do it. Get the supervisor to sign it.

[HouTx, BSN, MSN, EdD]

YIKES!! I don't blame you for being very reluctant to put your signature on this.

If you have not been involved in the care of a patient, how the heck can you assume post-hoc accountability for everything that was done during that shift. IMO, if the organization wants to put this in place, they should have a staffing model that supports it - such as an RN/LVN dyad that cares for a group of patients. LVNs (TX) scope is limited to practice under the 'supervision' of an RN or MD, but that doesn't mean that they can't function on their own until they run into something that is beyond their scope of practice & need to notify you - so it's demeaning to them also. I'll bet that this 'change' was triggered by a clinical error & somebody in Risk Management or Quality decided that this was the way to fix it. Numbskulls.

[applewhitern, BSN, RN]

I once worked on a telemetry unit that required the RN to write a quick note on each LPN's chart, but I was there and saw the patients myself, too. I would not sign anything that I did not witness. The LPN's in my state cannot do assessments, care plans, or skin assessments, so we do these things for them. (The RN's actually DO it, not just sign that we provided oversight.) If you are in the ICU, how are you supposed to provide oversight for the LPN's on the med-surg floor? Oh, I need to clarify that the LPN's cannot do INITIAL assessments; they can do them after an RN has done the initial one, but not care plans or skin sheets.

[vintage_RN, BSN, RN]

Yikes. I'm so glad that I am accountable for my own practice as an RPN in Canada.

[Alex Egan, LPN, EMT-B]

I would chart something to this effect. "Charting reviewed by this RN who was available for consultation and collaboration for the duration of the shift. All documentation demonstrates care carried out appropriately per plan of care and nurse practice act, and I have no knowledge of the contrary at this time"

[theantichick]

I ended up assessing each patient and reviewing the LVN's observation and documenting that I agreed with her observation. Come to find out the shift supervisors mis-construed the instructions from our CNO and overloaded us contrary to her instructions and she was not happy. She's not going to let the supervisors put it on the ICU nurses again. I still disagree with it, period, but would have had a lot less issue if I at least worked the same unit.

I did find an unofficial advisement from our BON cautioning against this practice and forwarded a copy to my nurse manager. We'll see what happens.

Thanks to everyone for the feedback.