RN supervising LPN's

[swtonursing]

I currently been a RN for 8 months and started a part time job at a home health agency to supplement my main job. The problem is that the agency is using LPN's to do nursing assessments and they want me to "co-sign," them. In other words the LPN puts the signature on an assessment form and I put my signature underneath theirs. I believe that this is illegal but want to make sure. My supervisor (who is not a nurse) states that it is legal for me to do this.

[Angeljho, MSN, NP]

I've never worked home health, but why would that be illegal? RNs supervise LPNs. Are you saying you don't feel comfortable signing off because you haven't done the assessment yourself?

It would only be illegal if you changed anything that the LPN documented and then put your signature on it.

[calivianya, BSN, RN]

I would check to see what your level of responsibility is for those assessments before you start cosigning them. Are you signing them to say that you agree with them, or just to say that the assessment has been done? If your job is requiring you to say that you agree with the LPN's assessment, and you do not assess the patient yourself, that sounds a little tricky if something goes wrong with the patient.

[TheCommuter, BSN, RN]

the LPN puts the signature on an assessment form and I put my signature underneath theirs. I believe that this is illegal but want to make sure.

Cosigning is legal. it is also a routinized practice in healthcare settings that employ a high ratio of LPNs such as home health, LTC/SNF, private duty, clinics, etc.

As someone who was an LPN for several years before obtaining my RN license, I have absolutely no reservations about cosigning for LPNs. If the practice of cosigning disturbs you, perhaps it might be an optimal idea to find a different second job.

[HouTx, BSN, MSN, EdD]

Check your state Nurse Practice Act. Co-signing as you describe it is illegal in my state - only allowable for pre-licensure students & their clinical instructor. Your non-clinician boss does have a license at stake, but you do. In addition to the possibility of getting cross-ways with your state BON, if you're co-signing to provide CMS 'coverage' for either an RN-only intervention or services that were not actually provided, you could end up being charged with (Federal) fraud. In this case, "my boss told me to sign" is not a defensible position.