Adapting to Change: Navigating the Evolving Role of LPNs in Assisted Living Centers
By Heidi LaMeyer, RN, LALD - Regional Director of Assisted Living - MN
In August 2021, significant changes were introduced to Assisted Living Regulations, which have had a profound impact on the roles and responsibilities of Licensed Practical Nurses (LPNs). These changes have led to a shift in LPNs' ability to conduct certain assessments, specifically every other 90-day assessment, which were previously delegated by Registered Nurses (RNs). This alteration now mandates that all assessment duties fall squarely under the purview of Registered Nurses.
Adding to the complexity, the guidance on the extent to which LPNs can participate in training and competency for Unlicensed Personnel (ULP) appears to reflect the broader confusion within the industry. This legislative overhaul has spurred a trend where LPNs are finding themselves utilized less frequently within the Assisted Living environment.
Compounded by the nursing shortage exacerbated by the aftermath of the Covid-19 pandemic, we now find ourselves in a precarious situation concerning resident care. However, before prematurely dismissing the potential contributions of LPNs, it's essential to recognize the range of tasks that LPNs can indeed perform within their defined scope of practice while adhering to the statutes and rules outlined in 144G and 4659.
In this context, it's imperative to highlight the vital role that LPNs can still play within Assisted Living Centers. While some aspects of their involvement have shifted, LPNs possess a wealth of expertise and competencies that can significantly contribute to maintaining the quality of care for residents. Let's explore some of the various tasks and responsibilities that LPNs can undertake while remaining in compliance with the revised regulations.
Assessments
Resident Assessments Support: While LPNs cannot perform comprehensive assessments, they can contribute by gathering data, documenting condition-related information for formal assessments by RNs and conduct focused health assessments for communication to RNs/providers.
Medication/ Resource Management
Medication Management: In addition to administering medications, LPNs can assist in medication management tasks, such as medication reconciliation, ensuring proper storage of medications, reordering medications, or reaching out to the primary physician to obtain a new physician order, and helping residents with medication adherence. They can also Provide support to unlicensed personnel when questions arise.
Resource Management: LPNs can assist in managing and ordering medical supplies, ensuring that the facility is adequately equipped to provide care.
Processing Orders from Providers: LPNs can receive and process orders from healthcare providers, such as medication changes or treatments, ensuring they are accurately implemented and documented.
Medication Disposition and Destruction: LPNs oversee proper disposal of medications, following guidelines and documenting the process in assisted living settings.
Narcotic Supply Monitoring and Diversion Concerns: LPNs audit and track narcotic supplies, promptly reporting any discrepancies to prevent diversion, ensuring resident safety in assisted living facilities.
Treatments
Wound Care: LPNs can provide basic wound care, including cleaning, dressing changes, and monitoring healing progress.
INR Checks: LPNs can perform International Normalized Ratio (INR) checks for residents on anticoagulant therapy, under the supervision of a registered nurse.
Pacemaker Checks: LPNs can assist with basic pacemaker checks and assessments, reporting any abnormalities to the appropriate healthcare professionals.
Skin Care Management: LPNs can monitor residents' skin integrity, implement preventive measures, and provide guidance on proper skincare to prevent pressure ulcers.
Staffing/ Staff Relations
Staff Supervision: LPNs can monitor and provide support to Unlicensed Personnel (ULP’s) and other support staff, ensuring that care is delivered effectively and efficiently.
Effective Shift Collaboration: LPNs assist RNs in scheduling, staffing, and seamless shift handoffs, ensuring comprehensive care coordination within assisted living.
Performance Evaluations: LPNs can provide input to the RN/nurse on the performance of CNAs and other support staff for performance evaluations.
Training & Education
In-Service Training: LPNs can assist in providing in-service training to ULP’s and other staff members, ensuring that everyone is updated on the latest care protocols and policies.
Providing Health Education: LPNs can educate residents and their families about health conditions, medications, and self-care strategies.
Assistance with Training and Education: LPNs can assist in providing training to staff, ensuring compliance with approved training materials and the involvement of registered nurses in competency evaluations
Health Promotion Initiatives: LPNs can assist in organizing and promoting wellness programs, screenings, and educational events for residents and staff.
Documentation/ Records
Documentation Review: LPNs can review and verify the accuracy of documentation completed by ULP’s ensuring that it aligns with residents' care plans and facility policies.
Documenting: LPNs are responsible for maintaining accurate and up-to-date medical records, including residents' health status and care provided.
Electronic Health Record Management: LPNs can contribute to maintaining accurate electronic health records, ensuring documentation compliance and easy access to residents' medical information.
Clinical Support
Collaboration: LPNs collaborate with registered nurses, physicians, and other healthcare professionals to ensure comprehensive care for residents.
Care Plan Updates: LPNs can assist in updating residents' service plans based on changes in their health status or care needs.
Provider Rounding: LPNs can participate in provider rounding, providing necessary information about residents' conditions, and assisting with care coordination during rounds.
Pain Management: LPNs can monitor residents' pain levels, administer prescribed pain medications, and provide comfort measures while reporting any changes to registered nurses.
Infection Control: LPNs can assist in implementing infection control measures, ensuring proper hand hygiene, isolation precautions, and cleanliness within the facility.
Nutritional Support: LPNs can collaborate with dietitians and food services to ensure residents' nutritional needs are met, including monitoring dietary restrictions and preferences.
Communication: LPNs play a crucial role in communicating with residents, families, case managers/care coordinators and other healthcare team members, relaying important information about residents' conditions and care plans.
Risk Management
Quality Assurance: LPNs can participate in quality assurance activities, such as audits, assessments, and performance improvement initiatives to maintain high standards of care.
Emergency Preparedness: LPNs can be involved in emergency preparedness plans and drills, helping to ensure that staff and residents are well-prepared for various scenarios.
Fall Prevention and Safety Measures: LPNs can contribute to fall risk assessments, implement safety protocols, and educate residents and staff about fall prevention strategies.
Psychosocial Nursing Support
Behavioral Health Support: LPNs can provide emotional support to residents with behavioral health concerns, using active listening and communication techniques to promote well-being.
Transition of Care: LPNs can facilitate smooth transitions when residents move between different levels of care within the facility or when they are discharged to other healthcare settings.
Collaboration with Families: LPNs can work closely with residents' families to ensure open communication, address concerns, and provide updates on their loved ones' health status.
End-of-Life Care Support: LPNs can provide emotional and physical support to residents and families during end-of-life care, collaborating with hospice services as needed.
Remember, LPNs should always adhere to the guidelines outlined in the Nurse Practice Act, facility policies/procedures, and the scope of their practice and regulatory statutes. They should work in collaboration with registered nurses and other healthcare professionals to ensure comprehensive and safe care for residents in the assisted living facility.