To what degree is the RN responsible for LPN errors

[downsouthlaff, LPN]

I've been an LPN at the same long term care facility since graduating nursing school in 2014. The facility recently hired a new grad RN to supervise and do wound care on weekends. As a new grad RN she always seemed very intrigued that LPNs have so much autonomy in long term care, and that there are so few RNs on staff. Well on her previous weekend shift one of the charge nurses (LPN) who is also fairly new as a nurse, made a medication error and gave a resident in A bed the meds for B bed. She self reported and the situation was handled accordingly. In our monthly staff nurse meeting this RN went on and on about how she's afraid of losing her license over this and that working with so few RNs on staff she didn't feel safe being responsible for so many CNAs and LPNs. I then spoke up on the issue and voiced my opinion on the matter, that I didn't think that she could be held responsible, and that it was my understating that the LPN is licensed and expected to be competent in (p.o.) med administration and will be held accountable for his or her actions, as long as she (the RN) who is responsible for the entity of the nursing process takes the proper action after the med error is made. She then took a tone like she was very offended. My question is, can the RN be held accountable for things that LPNs have been uniformly deemed competent to perform by licensure ?  My understanding has been that LPNs accountable for there own actions and wrong doing within their scope, but RNs maintain responsibility for the care plans and the nursing process but not individual actions of the Licensed Practical Nurse as long as it's something within the LPN's scope. Just curious. Thanks for the input 

[Golden_RN, MSN]

I agree with you that LVN/LPN are licensed and responsible for their own actions/errors.  However, because legally "assessments" fall under the scope of the RN, and she is charge nurse, I'd say she has some responsibility for the assessment of the resident after the med errors.  If there was an adverse effect as a result of the med error, and the charge RN didn't recognize it, or didn't act appropriately based on the post-med error assessment, then she could be involved.

As charge nurse, she also has responsibility in making sure that all incident reports, necessary paperwork and notifications have been made according to facility policy/regulations, so the error also affects her that way.

I'll also add that many, many RNs go all the way through school with no exposure to LTC, so I see how she might be surprised at how much LPNs are used in LTC and the amount of autonomy and even leadership positions they have.  It is very overwhelming for a new grad to be in a charge position or the only RN in the facility at a given time.

Like you said, the LVN's competency is verified by her license and hopefully your SNF's nurse educator does some med pass competencies as well.

[blue0714, LVN, RN]

I suggest going to the nurses bible; " BON Position's Statement" under "Synopsis of Differences in Scope of Practice for Licensed Vocational, Associate, Diploma and Baccalaureate Degree Nurses"  for this question and any question about differences of scope of practice