Culture of LPNs and RNs in Team Nursing

Team nursing is a model of care that has persisted for many years. In this model, RNs act as the coordinator of patient care, delegating tasks to LPNs as well as other members of the healthcare team. LPNs perform tasks under the direction and supervision of an RN, such as medication administration and procedures. The team may have a higher number of patients together, and each member of the healthcare team has specific duties.

In theory, this seems clear. In reality, the team may or may not work cohesively. As in any profession, there are good and bad apples. Practice styles differ among nurses (both RNs and LPNs) and can make or break a strong care team. LPNs who are very familiar with their scope of practice know when to report abnormal findings to the RN. Conversely, some LPNs are experts in their specialty area and sometimes act before reporting to the RN. This mindset places both the LPN and RN in danger of making medical errors and opens them up to liability. Some experienced LPNs have a tough time reporting to an RN, especially if the RN is new to the field or new to a particular care area.

Sometimes RNs take the role of “director of the care team” literally. They can act like a military general, ordering LPNs and other staff around. There are also some RNs who do not support team nursing and refuse to work in organizations which implements this model. Some dislike working with LPNs because of wanting control of the care of their patients, or possibly feeling threatened by the presence of LPNs.

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However, there are both LPNs and RNs who recognize the value in each other's roles. By setting aside personal feelings and focusing on the care of patients, the team can work together to get the job done. Recognizing (and periodically brushing up on) scope of practice can help the team work like a well-oiled machine, which ultimately leads to excellence in nursing.