The Staff RN’s Role in Nursing Homes

[Queen Tiye, RN]

Hello,

I am a new RN working in a nursing home as a charge nurse along with an LVN charge nurse; we split the hall. I feel so disempowered by my ADON who happens to be an LVN. Can you please tell me what you expect from your staff RNs/ RN charge nurse. This question is for RNs, considering that I’ve met so many LVNs who resent RNs.

[Daisy4RN]

The answers depends on your actual role and job description. If you are a staff RN only (as opposed to RN supervisor) then you should be doing what the LVN does with maybe a few more responsibilities that the LVN cannot do, for instance hang IV Antibiotics. If you are the RN supervisor (usually no pt list) than you will have supervisory/person in charge responsibilities, for instance making schedules, making sure LVNs and CNAs are doing what is needed, basically overseeing day-to-day operations etc. It really can vary from facility to facility so it just depends what your job description states.

[Queen Tiye, RN]

I split the hall with an LVN charge nurse and I thought I was responsible for over-seeing her work — which I do not feel is realistic since I’m am a new nurse still learning to manage my own patient load. Anyway, the TX BON says that LVNs require direction from a RN, NP, PA, physician, or dentist. So I’ve been stressing thinking that I’d be responsible for her failing to initiate interventions.

[Enarra, BSN, RN]

Just FYI a LVN cannot be in charge of RN it’s not experience but state board rules RNs delegate down. I’d watch for new opportunistic ASAP. I don’t know if you’d be responsible for her areas call your state BON and ask but either way not a good situ to be In. Best of luck

[TheDudeWithTheBigDog, ADN, RN]

On 5/30/2020 at 8:59 AM, Enarra said:

Just FYI a LVN cannot be in charge of RN it’s not experience but state board rules RNs delegate down. I’d watch for new opportunistic ASAP. I don’t know if you’d be responsible for her areas call your state BON and ask but either way not a good situ to be In. Best of luck

Usually not, because in most cases where LPNs are allowed to be in supervisor roles, they're still working under the supervision of a manager / director either in the building or on-call who is an RN.  Because of that, in a lot, probably most states, an LPN can be in charge of an RN.  Where the delegation issue is going to come up is when you're working with an LPN on your assignment.  If you have one hall and the LPN has a different hall, the expectation is typically only what's realistically reasonable.  You're not in charge of that shift, so you have no reason to be looking through patients on the other assignment to see who has an IV, but if you know from the night before that a patient has an IV, you should be volunteering to hang the IV or just take the patient.

[Glycerine82, LPN]

The gods honest truth is absolutely nothing different is expected; all staff nurses at my workplace have the same job description as do the charge nurses. 
It isn’t until you get to the level of ADON/DON that there’s a difference in scope.