Failure to Ensure RN Oversight of LVN Admission Assessments and Care Planning
Penalty
Summary
The facility failed to ensure that nursing staff, specifically an LVN, had and demonstrated the appropriate competencies and skill sets to provide nursing and related services in accordance with regulatory requirements. An LVN conducted an initial admission assessment, initiated a baseline care plan, and started the comprehensive care plan for a newly admitted resident with complex medical diagnoses, including acute on chronic combined systolic and diastolic heart failure, type 2 diabetes mellitus, and bilateral primary open-angle glaucoma. The LVN completed a head-to-toe assessment and care planning without the required review or oversight by an RN, as indicated by the absence of an RN signature on the assessment documentation. Interviews revealed that the LVN believed she was permitted to complete both the initial and baseline assessments and care plans independently, based on her training and facility practice, and was unaware that RN review was required. The Director of Nursing Services (DNS) and the new DON both confirmed that facility practice involved LVNs completing these assessments, with the expectation that an RN would review and sign off within 48-72 hours. However, in this instance, the RN review did not occur as required, and the baseline care plan and initial assessment were not signed by an RN. Record review and interviews further established that the facility had RNs on staff during the time of the admission, but the process for ensuring RN oversight was not followed. The Texas Board of Nursing LVN Scope of Practice specifies that LVNs must work under the supervision of an RN and are not permitted to perform independent comprehensive assessments or initiate care plans without RN involvement. The failure to ensure RN review and oversight of the LVN's assessments and care planning resulted in a deficiency related to nursing staff competencies and scope of practice.