Just curious. Work as LTC Weekend Supervisor. Have LVN who works the floor, but also takes call for a physician who has several patients in the facility. The LVN scope of practice prohibits independent nursing judgment and limits them to focus assessments. There by limiting their ability to evaluate an acute change in condition, take action to repair the condition by executing orders for medication, labs or tests without directly consulting the APN, PA or MD. So, when the MD is called, the service directs me to the LVN standing next to me. (Yes, she is taking call while she is working the floor!! Huge conflict). Then she actually gives me an order, based on her interpretation of labs or other vital signs, for additional labs, x-rays to confirm her suspected diagnosis, antiemetics, antipyretics, PPI's etc. All without checking a chart for possible drug interactions (like she would recognize one) or allergies to medications!!. The DON and ADM are fully aware of this "Practice of medicine" and I am curious, should I notify the BON, on both LVN and DON, the Dept of Age/Dis to intervene for potential immediate harm to a patient, and the Board of Med for delegation violations on the MD's part? I know I hold responsibility for direct report for practice violations on the LVN's part at least to cover my license as a mandated reporter!! Just curious. Have my NPA, Occ Codes and all the necessary doc's to move forward, just don't want to destroy any careers. But, she is obviously in over her head, but orders with complete disregard to patient safety. Thanks
this post is confusing me. just to point that out! :) lol
the lpn role in ltc confuses me because in my state they have more autonomy than an lpn in a hospital setting. i have searched for many of these answers in my texts and on the bon website but really, their role is as clear as mud in ltc (for me anyways).
although the lpn is not allowed to practice professional nursing, they still are allowed to take orders from practitioners. an lpn must work under the rn or under the direction of the practitioner. if a md calls and tells the lpn to do something, that would not be considered wrong (within reason) in my state because the lpn is still technically being generally supervised.
now if the lpn thinks something is going wrong on an acute patient, then yes, he/she should alert the rn for an assessment. the rn should assess and report to the practitioner.
(yes, she is taking call while she is working the floor!! huge conflict).
i don't understand why it is wrong for an lpn to take calls...could someone clarify this for me?
That is not in the scope of practice for either an RN or an LPN. We cannot indendently give orders without the backup of a NP or a Dr. That Doctor and LPN both need some serious legal counciling. That's just asking for trouble IMHO. I've had many a doctor ask me what I think a patient should have and then they agreed and it becomes a written order.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
If the LPN is taking call for the doc and just giving advice off the top of her head without having any written protocols, then she's putting her license at risk.
If she's giving orders as delegated from the physician, then she should have some sort of written protocols in place, for her own protection.
If she doesn't and something bad happens to a patient, then the doctor will almost surely hang her out to dry.
I worked with an LPN who had worked in a doctor's office and "took call" for him. He didn't want to be bothered so basically she just responded based on her own judgement. After I'd worked with her a while and saw what her judgement was like, I'd say she was lucky not to have had a really bad outcome. (He also had her doing things in the office she was not educated nor trained to do.) To all appearances, he just did not care what happened as long as he didn't have to deal with anything after-hours.
I've worked telephone triage as an RN and we had very specific, detailed protocols to follow. Records were kept of the calls and sent to the pediatricians. We also always had physicians available to call if we needed to.
Specializes in Acute/ICU/LTC/Advocate/Hospice/HH/.
Thanks for the JACHO clarification.
The problem with the LVN taking call is it distracts from her current duties as an employee at the LTC facility. She takes call after 5 and on weekends all day. So when she is doing her assessments or doing treatments, she has to stop and answer her cell phone (in a patients room and in front of other staff who are prohibited from carrying cell phones while at work). It even interrupts patient care meetings and inservices. So, my DON told me this morning when I asked for clarification, "So if you are uncomfortable, don't take any orders from her" and the FNP that works over her told me that she is working under his direction and following specific protocols and guidelines. I asked for copies and was told to ask the LVN and expect to get slapped for questioning her actions. Really. So, I have sent my questions to the BON for clarification and will wait on their reply. Will keep everyone posted. Thanks for the response.
So what you're really angry about is that this LVN is charge off-hours. She's taking orders from legitimately licensed personnel and then passing them on as per protocol. And about this you're going to call the BON.
I think the reason I am confused is because this is a thread with multiple topics and I must not understand the gist of them. The problem I think that might occur is that we have 50 states and 50 BONs.
But the main question seems to be… can you take a verbal order from an LPN?
In Wisconsin the answer is yes… you can actually take a verbal order from anyone who is acting as an agent for a practitioner. This is not a nursing act but a medical one and it needs to be treated differently than a nursing one. In the nursing realm, delegation does not flow up, but down. A LPN can not delegate to an RN. However, if the LPN is giving an order to the RN on behalf of the practitioner, then it is acceptable. This is why a practitioner must sign the order, because it is their act and not the LPN. Now if the RN disagrees with the order, they are the ones to re-contact the practitioner to either clarify or refute. It does not go back through the LPN. The RN has the right and legal obligation to talk with the practitioner by phone or in person before implementing an act should the RN have concerns.
Specializes in Acute/ICU/LTC/Advocate/Hospice/HH/.
Per the Texas BON "The nurse performing triage or similar tasks must have specific educational preparation. .....the BON believes on-call duties, telephonic nursing or being on-call to handle emergent issues are all beyond the cope of practice for LVN's. It is in settings where the LVN would be required to independently engage in assessment for purposes of triaging a patient that are of concern to the Board." Theses standards supersede any doctor's order or facility policy. It also specifically states that verbal orders may only be received from an APN, PA, DO, MD or DDS. We can't even write therapy orders as they practice under different statutes. So, pending further clarification from the Board, I am holding my concerns, but at least I have documentation that I have initiated an inquiry. The Board requires all Nurses to report suspected violations of the NPA, suspected. They can clear it up in the investigation. I am just watching out for my patients safety and competent nursing care.
Don't want to impose my standards on any other professional.
SuesquatchRN, BSN, RN
10,263 Posts
We've worked in different places.
I didn't address taking verbal oders. And in LTC we were not covered by JCAHO.