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
I am not sure from your post if the prescribing LPN works at your facility for the doc of if she's an employee of the LTC you are working for.
I had a recent situation similar by a doctor who acts as a clearing house. His name's on the letter head but his ARNP's do all the prescribing care. Except for coumading dosing that is done by his MA... yes that's right an MA.
I was given an order by an MA for coumadin dosing and expected to follow it. In Washington state MA's have no pharmacology training. Yes she was working from a nomagram, but still... I gave the phone to my nursing manager because the MA declined to give me her last name when giving the TO. My nurse manager took the order but I have MAJOR issues with that order.
Specializes in mds coordinator, DSD, Vent Nurse, Rehab.
Bottom line ......
A nurse can not "TAKE CALL" for an MD. Every MD must have a "ON CALL" replacement MD or take the call him/herself.
I would get management involved and they need to clarify with this doctor the expectations with caring for the residents in your facility.
Second note, this nurse, be it LVN or RN, should be written up if not terminated. This is a very clear stepping outside of the scope of practice. This person should also be reported to the board.
I wouldn't want to be one of the family members of these patients.
crazdmomof4
74 Posts
I am not sure from your post if the prescribing LPN works at your facility for the doc of if she's an employee of the LTC you are working for.
I had a recent situation similar by a doctor who acts as a clearing house. His name's on the letter head but his ARNP's do all the prescribing care. Except for coumading dosing that is done by his MA... yes that's right an MA.
I was given an order by an MA for coumadin dosing and expected to follow it. In Washington state MA's have no pharmacology training. Yes she was working from a nomagram, but still... I gave the phone to my nursing manager because the MA declined to give me her last name when giving the TO. My nurse manager took the order but I have MAJOR issues with that order.