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My nurse manager has assigned me (an RN) to supervise an experienced LPN I'll call Mary. The charge nurse says I need only write the care plan and review it with Mary, plus perform any duties outside her scope of practice (such as administering I.V. drugs). She says that because Mary is experienced, she can safely practice under her own license without me "looking over her shoulder." My manager used the RN/MD relationship as an analogy: Physicians leave us alone to do our work and expect us to report anything unusual.


Mary has an excellent reputation, but I've never worked with her before. I'm concerned about patient safety and my own liability if she fails to notice a significant change. Should I be worried about this? - A.C. N.J.


Our consultant, a nurse-attorney, says that you're right to be concerned. Most state nurse practice acts say that LPNs and LVNs must be supervised by an RN. If an LPN's actions or omissions harm a patient, the supervising RN could be held vicariously liable for neglecting to supervise the LPN properly. The RN/MD analogy isn't valid because physicians aren't legally responsible for supervising RNs.

Figure. Photo credit... - Click to enlarge in new windowFigure. Photo credit by VIOLET LEMAY

You can fulfill your duty by supervising Mary in a supportive way-not by "looking over her shoulder," but by emphasizing your commitment to teamwork and quality patient care. As you become better acquainted with Mary and her abilities, you can make an informed judgment about how much time you need to spend overseeing her work.


Meanwhile, your employer owes you a better response to your concerns. The facility's policies and procedures should address your obligations when supervising an LPN.