The document outlines the roles and responsibilities of different members of a nursing team in a mental health and addiction facility. It defines the head nurse as the overall leader who supervises nurses, paraprofessionals, and other staff. The head nurse is responsible for patient care planning, staff assignments, and evaluations. Registered nurses can assess patients, develop care plans, and initiate restraints, while licensed practical nurses provide care under RN supervision. The lead mental health assistant oversees other assistants and reports to the head nurse, with duties including patient observation and escorting to activities.

1. Effective Nursing Teams
Who is in Charge Here?
Role Clarification
Myths and Facts
by Janice Bergin, MSN & Charmaine Coombs, MSN

2. GOAL
To build an effective team each team
member must first know all participants
scope of practice and capabilities and be
able to quickly ascertain who is in charge

3. OBJECTIVE
Clarify the roles of
nursing team members in
a mental health &
addiction facility
Head Nurse (HN)
Charge Nurse
Licensed Practical
Nurse (LPN)
Lead Mental Health
Assistant(LMHA)

4. Connecticut Nurse Practice Act
RN
The practice of nursing by a registered nurse is defined as the process of
diagnosing human responses to actual or potential health problems,
providing supportive and restorative care, health counseling and teaching,
case finding and referral, collaborating in the implementation of the total
health care regimen, and executing the medical regimen under the
direction of a physician, dentist or APRN.

5. Head Nurse
Who is in charge here?
a nurse who has the
overall accountability
for the supervision of
the administrative and
clinical aspects of
nursing care

6. Head Nurse
The Head Nurse is responsible for the
supervision of professional nurses,
paraprofessionals and other staff
involved in direct nursing care of
patients

7. Head Nurse Responsibilities
Leads the planning of care
Implements the nursing process
Plans unit workload
Determines priorities
Approves assignments
Oversees and reviews work

8. Head Nurse
Implements the Nursing Process
Assessment(what is the
situation?)
Diagnosis(what is the
problem?)
Plan(how do we fix the
problem?)
Implementation/Intervention
(putting the plan into action)
Evaluation (did plan work?)e
Responsibility

9. Head Nurse Responsibilities
Assess the acuity
& staffing needs of
the unit.
Notify supervisors
Are all assigned
staff present at
the beginning of
the shift for
inter-shift report?

10. Head Nurse
Communicates with Supervisors,
APRNs & MDs, Pharmacist
Initiates and/or responds
to a medical emergency
May initiate restraint or
seclusion procedure
Completes assessments
and admission paperwork

11. Head Nurse Responsibilities
Identifies staff development needs and provides
for staff training and assistance
Attends & participate in the interdisciplinary meetings
to promote and ensure adjustment and continuity of
patient care programs

12. Head Nurse Responsibilities
Maintains a safe and therapeutic milieu
Completes performance appraisals
Complete individual staff supervision
Conducts staff meeting

13. The Role of the
Licensed Practical
Nurse(LPN)
LPN works under the Supervision of the RN

14. The Connecticut Nurse Practice Act:
LPN
The practice of nursing by a licensed practical
nurse is defined as the performing of selected
tasks and sharing of responsibility under the
direction of a registered nurse and within the
framework of supportive and restorative care,
health counseling and teaching, case finding and
referral.

15. Shared Responsibilities
RN & LPN
Medication
Administration
Treatment
Application
Medication
Transcription
Participation in
the treatment
planning process
Documenting
incidental notes

16. Shared Responsibilities
RN & LPN
Assist MD/APRN with patient physicals
Communicate clinical issues with the
MD/APRN
Facilitate patient care oriented groups
Assists in medical & psychiatric
emergencies

17. Shared Responsibilities
RN & LPN
Provide therapeutic and emotional support to
patients and their family members
Educate patients on prescribed medications
Ensures least restrictive therapeutic patient
interventions during stressful times

18. RN Differences LPN
The RN needs to pass the
NCLEX-RN to become licensed.
A minimum of 2-4 years of
nursing education is required.
The RN can assess and make
independent decisions.
The LPN needs to pass the
NCLEX-PN to become licensed.
A minimum of 1 year of nursing
education is required.
The LPN can not assess or make
independent decisions but can relay
observations to the RN.

19. RN Differences LPN
The RN assesses and initiates
restraints and seclusion
procedures
Completes patient assessments
and monthly RN summaries
The RN can take charge of a unit
& can take telephone orders from
the MD / APRN.
The LPN cannot assess or initiate
restraint and seclusion procedures.
The LPN cannot complete patient
assessments or monthly summaries.
The LPN can not take charge of a
unit & cannot take telephone orders
from the MD / APRN.

20. RN Differences LPN
The RN is a essential
participate in the integrated
patient treatment planning
process.
The RN is responsible for
patient admissions, transfers
and discharge paperwork.
The LPN can contribute to but is
not an essential participate in the
treatment planning process.
The LPN is not responsible for
patient admissions, transfers and
discharge paperwork although,
can assist in other areas.

21. The Role of the
Lead Mental
Health Assistant
(LMHA)

22. LMHA
PARAPROFESSIONAL
LMHA supervises Mental
Health Assistant (MHA1).
LMHA reports directly to
Head Nurse / Charge
Nurse

23. Role of the Lead Mental Health Assistant(LMHA)
Does not float off the unit. Does maintain a float
book for Mental Health Assistant(MHA1).
Completes environmental rounds for previous and
oncoming shifts.
Is present for shift report and for inter-shift report.

24. Role of the Lead Mental Health Assistant(LMHA)
Completes daily assignment sheet. Meets with all
MHA1’s concerning their daily assignment and their
assigned break.
Ensures that a MHA is scheduled for attendance and
participation in patient treatment plan meetings.

25. Role of the Lead Mental Health Assistant(LMHA)
Reports to the Head Nurse/Charge Nurse
inappropriate staff behavior or incidents and
documents accordingly.
Assigns weekly/shift notes to MHA’s and
follow thru with completion of notes.

26. Role of the Lead Mental Health Assistant(LMHA)
Assigns weekly/shift notes to MHA’s and
follow thru with completion of notes.
Completes or collaborates with Head Nurse
on annual staff Performance Appraisals.

27. Role of the Lead Mental Health Assistant(LMHA)
Maintains a therapeutic and safe milieu
Responds to fire drills and/or psychiatric
emergencies.
Reports to the Head Nurse clients behavior
or incidents and documents accordingly.

28. Assignment Sheet Duties
Escorting clients to group, activities,
meals and medical appointments.
Observation of patients on Special
observations(Q15,Continuous
observations, 1:1).

29. Assignment Sheet Duties
Completing the daily census.
Attendance at treatment plans.
Assisting with patient admissions,
transfers and discharges.

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