Unsafe, possibly illegal situation at my workplace

TheCommuter, BSN, RN · Mar 16, 2014

Based on what you have written, I see nothing illegal.

Many assisted living facilities utilize LPNs as directors of wellness, resident care managers and unit managers. At many smaller ALFs, the RN spends virtually no time in the building and can be reached remotely (via phone) if his/her services are needed.

mhy12784 · Mar 16, 2014

Just because this is the second thread on this ive seen, im starting to think that people dont know what the word delegate means.

The CEO of my hospital isnt a RN, that doesnt mean that im being delegated to by a non nurse.

Asystole RN · Mar 16, 2014

Assisted living is not the same thing as a SNF or rehab facility.

The care provided is generally not considered medical or nursing in general (although some things may be provided). Assisted living facilities generally are not required to hire nursing staff, unlike a SNF or rehab facility.

You would have to refer to your state agency that handlers assisted living licensing for the actual rules.

In that assisted living facility you probably are not actually working in the capacity of a LPN but rather a caregiver.

Asystole RN · Mar 16, 2014

Just because this is the second thread on this ive seen, im starting to think that people dont know what the word delegate means.
The CEO of my hospital isnt a RN, that doesnt mean that im being delegated to by a non nurse.

In her state she must work under the license of a RN or LIP if she is working in the capacity of a LPN.

Many RNs can in in fact work independently of anyone else in the capacity of a RN. There are some clinics that are entirely staffed by RNs for example. One of my jobs I work as an independent contractor under my own license, independent of any other licensure or supervision. An LPN, in her state, cannot work independently and must be supervised by someone with a higher licensure.

BrandonLPN, LPN · Mar 16, 2014

In her state she must work under the license of a RN or LIP if she is working in the capacity of a LPN.
Many RNs can in in fact work independently of anyone else in the capacity of a RN. There are some clinics that are entirely staffed by RNs for example. One of my jobs I work as an independent contractor under my own license, independent of any other licensure or supervision. An LPN, in her state, cannot work independently and must be supervised by someone with a higher licensure.

Of course, that supervision does not need to be direct.

Even in SNFs, it is routine to have only LPNs physically present. The LPN's ability to telephone an on-call physician is considered working under supervision.

Asystole RN · Mar 16, 2014

Of course, that supervision does not need to be direct.
Even in SNFs, it is routine to have only LPNs physically present. The LPN's ability to telephone an on-call physician is considered working under supervision.

Oh absolutely, but none-the-less you cannot work independently under your current licensure as a registered nurse can.

Rivalicious · Mar 16, 2014

Assisted living is not the same thing as a SNF or rehab facility.
The care provided is generally not considered medical or nursing in general (although some things may be provided). Assisted living facilities generally are not required to hire nursing staff, unlike a SNF or rehab facility.
You would have to refer to your state agency that handlers assisted living licensing for the actual rules.
In that assisted living facility you probably are not actually working in the capacity of a LPN but rather a caregiver.

I'm actually surprised by the amount of nursing care I do at this facility. I have interviewed/shadowed at another AL facilities and there was really no nursing care given-just handing out pills to a few patients and pre-filling their insulin, but if they couldn't self-administer, they couldn't be there. At this facility I do med pass for about 20 patients-including IM and sub q injections, blood sugars, and wound care. The med pass is honestly no different than the med pass I did in clinicals at a SNF. We have a lot of pretty sick patients there, I'm frankly surprised that many of them are still in AL at all. It's not anything close to a SNF, but I am definitely doing nursing care and that is why I'm concerned with the lack of supervision. Again, under the scope of practice in my state I am only supposed to give nursing care under the supervision of a RN or MD. I realize now that not having someone on-site isn't as unusual as I thought it was, but the lack of official supervision still concerns me as it seems to be a violation of the nurse practice act and could get me in trouble.

I should add, this facility has gotten in hot water with JHACO in the past, and our care manager is brand new herself, which is part of why I'm concerned.

TheCommuter, BSN, RN · Mar 16, 2014

Again, under the scope of practice in my state I am only supposed to give nursing care under the supervision of a RN or MD.

As a previous respondent mentioned, the supervision of the RN or MD can be remote and indirect. If an RN or MD are a quick phone call away, you are still providing nursing care under someone's supervision.

I realize now that not having someone on-site isn't as unusual as I thought it was, but the lack of official supervision still concerns me as it seems to be a violation of the nurse practice act and could get me in trouble.

I see no violations of any state's nurse practice act. You are being 'officially' supervised, and therefore, will not get into trouble. Remember that this supervision can be remote. Good luck to you!

Asystole RN · Mar 16, 2014

I'm actually surprised by the amount of nursing care I do at this facility. I have interviewed/shadowed at another AL facilities and there was really no nursing care given-just handing out pills to a few patients and pre-filling their insulin, but if they couldn't self-administer, they couldn't be there. At this facility I do med pass for about 20 patients-including IM and sub q injections, blood sugars, and wound care. The med pass is honestly no different than the med pass I did in clinicals at a SNF. We have a lot of pretty sick patients there, I'm frankly surprised that many of them are still in AL at all. It's not anything close to a SNF, but I am definitely doing nursing care and that is why I'm concerned with the lack of supervision. Again, under the scope of practice in my state I am only supposed to give nursing care under the supervision of a RN or MD. I realize now that not having someone on-site isn't as unusual as I thought it was, but the lack of official supervision still concerns me as it seems to be a violation of the nurse practice act and could get me in trouble.
I should add, this facility has gotten in hot water with JHACO in the past, and our care manager is brand new herself, which is part of why I'm concerned.

The work you might be doing is similar but the location makes all the difference.

Lay persons provide "nursing care" all the time, every time a mother administers Tylenol to her child, a father provides wound care for his son, or an elderly woman administering insulin to her husband.

The facility could get into trouble for providing too acute of care but in reality that trouble comes in the form of not being reimbursed.

Working in an AL you are fine.

Are you going to tell your kid that you cannot give them Tylenol for their fever because you are practicing out of scope, that you need to call your great aunt Suzy who is a RN to supervise you?

If you are that concerned then contact your BON and/or the Department of Health and ask them.

TheGooch · Mar 16, 2014

Why not contact the state and ask them instead of asking here.

Mn nurse 22 · Mar 16, 2014

Is there an RN in charge anywhere? Even the Corporate office? In my state an assisted living facility had to have an RN as part of the team. They don't have to be in the building all the time but has to be on call 24/7. There can be an LPN on call but she had to have an RN to call if things fall out of her scope.