LPNs Working in LTC Without an RN On-Site

This practice scenario has been developed to help LPNs in long-term care understand their accountabilities when working without an RN on-site.

I am an LPN working in a Long-Term Care facility and at times, there may be no RN on-site. What is my accountability?

The Homes for Special Care Act and the Homes for Special Care Regulations are the legislation governing the designation and operation of nursing homes, residential care or long-term care facilities. The Act provides specifics about how many registered staff are required in relation to the number of beds in the home or facility.

According to this legislation, in every nursing home and nursing care section of a home for special care where there are less than 30 residents, there must be at least one RN on duty for no less than eight hours every day. Where there are 30 or more residents, there must be at least one RN on duty at all times. 

The employer may define on duty within their capacity, resources, and client needs. On duty may mean the RN is in the facility,  on call, or available via phone. It is up to the facility to outline their process in policy.

You are accountable to collaborate with the appropriate health care provider identified by the employer when the needs of your client exceeds your individual competence or professional scope of practice. The level of collaboration required will depend on the needs of the client, supports in the practice context and your individual capacity.  Collaboration can take place in-person, via telephone or other technology as defined in the employer policy. Collaboration by text can lack context and nuance and is not recommended.

When working without an RN on site, LPNs are accountable to know:

  • The name and designation of the health care provider assigned to provide you collaborative support;
  • How and when to contact this individual, and;
  • Pertinent details of the policy or established organizational process.

For further information on anything contained within this practice support tool, please contact an NSCN Practice Consultant at practice@nscn.ca.

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