I'm a home health care RN who's visiting a bedridden cancer patient 3 days a week. I've just learned that an LPN from the same agency will be coming in on alternate days to help my patient. Am I legally responsible for what he does, as I would be if he were working under my supervision in a hospital unit?-J.M., N.M.

Get clarification right away on your agency's policies and procedures, as well as your own job description regarding supervision of LPNs and unlicensed assistive personnel. If your agency requires you to supervise all others who care for your patient, you'd better evaluate how well you can reasonably oversee their caregiving when you're not present to observe it.

If you're expected to supervise this LPN, you'll evaluate the quality of care he provides by his documentation and by the outcomes you observe when you care for the patient. So insist on thorough and timely documentation; otherwise, you won't know what care he has (or hasn't) provided. Also make sure you clearly communicate your expectations and routinely follow up on the care he provides.

As a supervisor, you're vulnerable to vicarious liability, which holds supervisors responsible for harm caused by those under her supervision. The law evaluates malpractice claims in home health care by the same standards applied in other nursing negligence situations.