[Rascal]

I have been employed in a long-term care facility for 2-1/2 years now. I began as an LPN and am now working as an RN since Sept. "04, having completed my 2nd year while still working.

Recently our facility hired an MDS Coordinator who is an LPN. No problem there but she has also been named in effect the Assistant DON. Again that in and of itself is not a problem, but her manner of supervision is.

Last week I was working night shift as the charge nurse, just myself and 2 aides. The new ADON came in early, about 0430, "just to see how the aides were performing" etc.

I was in the middle of addressing an emergency with a new resident whose pulse ox had abruptly dropped to the 60's after first becoming cyanotic following exertion. She came to the room to see what was going on (my first knowlege of her presense) and saw part of the event but not all.

During the course of my response I had O2 initiated by the aides at my direction. They asked me about the rate, and I told them I wanted it a liter per minute higher than what they asked. As they walked back to the room the ADON made the remark that "she" was going to start the O2 at a higher rate yet since the patient had been (but now was not) cyanotic. One of the aides, herself just graduated from her LPN year and awaiting her boards, asked her if she was an LPN or an RN, to which she replied, "I'm the ADON." IOW it doesn't matter, in effect.

My question for readers here is she entitled by virtue of her supervisory position alone to override my clinical decisions? I might add that previous to nursing I spent 24 years as a career EMS provider and am at least competetant at managing such emergencies. The situation was no longer emergent but rather in the management phase while awaiting physician-ordered transport to ER for evaluation of the possible underlying cause.

I do not doubt her authority regards administrative matters but what about clinical matters?

Rascal

[lam]

No, an LPN can not tell an RN what to do in clinical matters.

[Old_School]

However, another way to look at this is the ADON is working under the direction of the DON who is an RN. I think that you've been trumped. You better hang back and see how this situation matures before you make too many waves. IMHO.

O_S

[Old_School]

BTW . . . welcome to the forums Rascal.

[lam]

[ QUOTE ]
Old_School said:
However, another way to look at this is the ADON is working under the direction of the DON who is an RN. I think that you've been trumped. You better hang back and see how this situation matures before you make too many waves. IMHO.

O_S

[/ QUOTE ]Even so if an RN takes advice from an LPN regarding a nursing judgment and some thing happens the RN will be held accountable. If the DON is an RN and she tells the ADON to tell the RN something it will still be the RN's license that is on the line. This has been one of my biggest beefs in LTC. Management needs to be aware and direct it's staff accordingly. I have had assisstant administrators trying to tell me what to do. I have no problem with an LPN being in management but I will take their suggestions and make my own decisions. This is how it needs to be done period.

[Old_School]

I'm quite sure that Rascal is aware of the implications to his/her license. The question is more or less of a political nature. My advice is to pick your battles wisely.

[lam]

[ QUOTE ]
Old_School said:
I'm quite sure that Rascal is aware of the implications to his/her license. The question is more or less of a political nature. My advice is to pick your battles wisely.

[/ QUOTE ]I agree, and this is not a good situation. I have had LPN's in this position and they are quite nasty to the RN's for no reason other than a power trip. Yes it is politics. and some times I think the DON does this for that very reason. lol oh why can't we all just get along????
a good DON and or ADON would be aware of this and not want to put their RN's in jeporady. But, in the real world, people are nasty, vindictive and power seeking fools. Was I politically correct when I said that? LOL at this pont I have nothing to lose. for some reason some fool is keeping me from working and a fool they are. lol

[Rascal]

The plot thickens.

Today I began working evening shifts a couple times a week rahter than straight nights (a whole 'nother story). When I got to work the administrator and the DON called me in and apologized for the actions of the "ADON." Seems one of my aides sort of told on her.

Seems the "ADON" is not. She has no such authority and in fact (whether according to Iowa Code or corporate policy I dunno) only an RN may hold an Assistant DON position in a long-term care facility.

So happens that Saturday she also fired an aide (who probably deserved it just for her mouth). Another exercise of authority she does not have. The aide was rehired inside of 2 hours.

State inspectors are here now for our annual so attentions are focused elsewhere but I was told straight out that Wed. the "ADON" is going to be set to rights. My guess is she will be told to stick to care plans or stick her resume in the mail.

Rascal

[lam]

It is nice to see that some one woke up to this problem before any more damage is done. Good luck Rascal. Always remeber you are the RN and in charge of your patients. There have been times when an LPN might know a procedure that I didn't and showed me how to do it, but that never meant that she had authority over me and my patients.

[Old_School]

Holy cow, that situation matured rather quickly wouldn't you say?

O_S