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

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

By | 2009-08-05T00:00:00+00:00 August 5th, 2009|Categories: Blogs, Nursing careers and jobs|3 Comments

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  1. Avatar
    Proud LPN February 15, 2019 at 6:39 am - Reply

    No where in the nurse practice acts is it written Anywhere that LPNS cant implement an assessment not one state nurse practice act I read states this
    This would be absolutely stupid and silly since LPNS assess when taking vitals,prior to giving certain medications,admission charts, prior to giving Insulin
    Etc, this is silly LPNS are trained and most importantly educated on how to assess all systems of the human body

  2. Avatar
    Gigirose February 16, 2019 at 11:41 pm - Reply

    These were the first four states that showed up when I googled RN LPN Perform Assessment Nurse Practice Act, hope this helps.

    Iowa:

    Pursuant to 655 IAC, Chapter 6, 6.3(152), a Licensed Practical Nurse (LPN) may not perform an initial assessment. Initial assessments are to be performed by a Registered Nurse (RN). The initial assessment is to be used to determine a patient’s baseline and develop an initial nursing plan of care.

    Once the initial assessment has been completed and the nursing plan of care has been developed, the LPN may assist the RN in the nursing process, consistent with accepted and prevailing practice. The LPN is to communicate any change of a patient’s status to the RN.

    https://nursing.iowa.gov/practice/licensed-practical-nurse-scope-practice-assessment-information

    Virginia:

    Assessments: RN vs. LPN
    • LPN – focused assessment
    – gathers data to contribute to assessment
    – reports findings/results to RN
    • RN – comprehensive, initial & ongoing
    – synthesizes the information
    – based on professional nursing judgment and knowledge base

    https://www.headstartva.org/assets/docs/Dept-of-Health-Professions-Nursing-Scope-of-Practice-Health-Institute-2015.pdf

    Texas:

    Licensed vocational nurses may only conduct focused health assessments .A focused assessment is An appraisal of an individual client’s status and situation at hand [what is occurring at that moment], contributing to the comprehensive assessment by the RN, supporting on-going data collection, and deciding who needs to be informed of the information and when to inform (§217.11 (2) (A) (i) and the Position Statement 15.27 LVN Scope of Practice.)

    https://www.bon.texas.gov/faq_nursing_practice.asp#a22

    North Carolina:

    The “practice of nursing by a registered nurse” consists of the following 10 components:

    a. Assessing the patient’s physical and mental health, including the patient’s reaction to illnesses and treatment regimens.

    b. Recording and reporting the results of the nursing assessment.

    c. Planning, initiating, delivering, and evaluating appropriate nursing acts.

    The “practice of nursing by a licensed practical nurse” consists of the following seven components:

    a. Participating in the assessment of the patient’s physical and mental health, including the patient’s reaction to illnesses and treatment regimens.

    b. Recording and reporting the results of the nursing assessment.

    https://www.ncbon.com/laws-rules-nursing-practice-act-nursing-practice-act

  3. Avatar
    Tammy Lindelien RN, BHS April 30, 2019 at 6:54 am - Reply

    It has been a long running controversy but the experience of an LVN/LPN differs in different states. In the State of California an LVN’s nursing experience does mot trump the RN’s education. Assessment in its depth of diseases and their impact on the psychological and emotional status is more fully considered in a client’s overall health status. RN.is more qualified to Assess patient’s because that was the focus of their learning and verified by the passing of their passing.State board exams. It is not within an LVN/LPN scope of practice in our State of CA. The LVN is expected as a primary patient caregiver to advise the RN what changes they see in their patient for a reassessment be the RN to evaluate any further adjustments to a patient’s care needs to be discussed with the attending physician. I have taught both theory an Clinical practice for CNA’s, LVN’s and RN’s in preparation for their Certification and License for State Board Exams and it is clear they reinforce who is legally responsible for the Nursing Process steps. I recommend the CA State begin to evaluate what hospitals risk legal action and fines if they have permitted nursing staff to function outside their scope of practice!

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