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Can LPNs supervise RNs or sign off on RNs’ assessments?

Wednesday August 5, 2009
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Question:

Dear Nancy,

Can LPNs supervise RNs? Can an LPN advise and sign off on an RN’s assessment? I work as UR RN for workers comp and there are several LPN supervisors with RNs under them. There have been occasions when the LPN has directed an RN to change his or her claim determination, stating the LPN’s assessment is more accurate/correct than the RN. Many RNs are very uncomfortable with this and need to know if this is legal and within the scope of an LPN.

Evelyn



Nancy Brent replies:

Dear Evelyn,

The legal regulation of nursing practice, which occurs at the state level through the nurse practice act and its rules/regulations, includes the scope of practice of the LPN and the RN. There is no question that LPN practice is a dependent one. That is, the provision of patient care by the LPN is overseen in some way by a healthcare professional with more comprehensive educational requirements and therefore different scopes of practice. In state nurse practice acts, the LPN works under the direction or supervision of an RN, physician, or dentist, as examples.

An LPN’s assessment cannot, nor should it, take the place of an RN assessment. If there is a disagreement about the accuracy or correctness of an assessment, one done by an RN and one by an LPN, neither should be required to change a claim because one of the parties believes he or she is superior to the other. Rather, there should be a mechanism in place where such conflicts can be taken to an objective third party who then makes a decision about which assessment will be used for the workers compensation claim. Under no circumstances, however, can an LPN provide an assessment that is only to be done by an RN.

Additionally, LPNs should not be supervisors of RNs. Direction for this prohibition can be found in the state nurse practice act. The act and rules would be a good resource for you to review in order to obtain the legal requirements of LPN and RN practice in your state.

It would be a good idea to bring this issue to the attention of the administration of the organization where you work. Additionally, in your role as UR RN, this concern needs to be clarified. Neither you nor the company you work for need to have problems concerning how LPNs are utilized in the decision-making process concerning claimants’ coverage. No claimant should have to question this either, but he or she might, with his or her lawyer’s advice, if the decision-making process is flawed due to the improper use of LPNs.

Your concern should not be construed to support a belief that LPNs are not capable healthcare providers. They are, and they have contributed to quality patient care in many settings for many years. Rather, your concern, which should include a consultation with a nurse attorney or attorney in your state, may help you clarify exactly how LPNs can be utilized in the company with an eye toward compliance with the state nurse practice act.

Cordially,
Nancy




Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.