LPN's in CCU, a vent - page 3

I've looked around and didn't see a thread discussing this problem so I started my own. Excuse me if it's been done to death. I just need to vent. :stone My anger is directed at the hospital not... Read More

  1. by   SmilingBluEyes
    Folks, "Capable" or not, law is law. If the BON does not permit LVN's to do certain things, it CAN place a HUGE burden on the RN who works with him or her. That is the crux of the matter in for the OP. Why do we always need to turn it into an LVN versus RN thing? Neither is "Better"----we can only do what the BON sanctions. LVNs' scopes *are* limited by varying degrees by state. They don't discuss "capabilities" much in their laws, just what will and will not be done as an LVN or RN. Truly, it behooves us all to know what the rules in OUR own state are and abide by them. The OPs situation is intolerable, to me. It IS a lawsuit waiting to happen.
  2. by   NYERNURSE
    Quote from SmilingBluEyes
    Folks, "Capable" or not, law is law. If the BON does not permit LVN's to do certain things, it CAN place a HUGE burden on the RN who works with him or her. That is the crux of the matter in for the OP. Why do we always need to turn it into an LVN versus RN thing? Neither is "Better"----we can only do what the BON sanctions. LVNs' scopes *are* limited by varying degrees by state. They don't discuss "capabilities" much in their laws, just what will and will not be done as an LVN or RN. Truly, it behooves us all to know what the rules in OUR own state are and abide by them. The OPs situation is intolerable, to me. It IS a lawsuit waiting to happen.

    Thank you for understanding my viewpoint. I am in no way belittling the profession of LPN but merely venting about the frustrating situation I find myself in. I am not exaggerating or whining about a miniscule irritation....it is a lawsuit waiting to happen. I did find another postion in an ICU which is RN only. Again, everyone's opinion is appreciated.
  3. by   mattsmom81
    I certainly don't view this as a RN vs LVN thing. I AM however worried about how staffing will be managed when Texas chases 1/2 their staffs away from ICU.
  4. by   RN34TX
    Quote from SmilingBluEyes
    Folks, "Capable" or not, law is law. If the BON does not permit LVN's to do certain things, it CAN place a HUGE burden on the RN who works with him or her. That is the crux of the matter in for the OP. Why do we always need to turn it into an LVN versus RN thing? Neither is "Better"----we can only do what the BON sanctions. LVNs' scopes *are* limited by varying degrees by state. They don't discuss "capabilities" much in their laws, just what will and will not be done as an LVN or RN. Truly, it behooves us all to know what the rules in OUR own state are and abide by them. The OPs situation is intolerable, to me. It IS a lawsuit waiting to happen.
    I agree that it is definitely a lawsuit waiting to happen in the OP's particular situation and that we must abide by the state practice acts. I also agree that LVN restrictions can place a huge burden on RN's and therefore in the OP's particular situation, placing LVN's in ICU would be inappropriate and unsafe.

    I was only pointing out that the comments following the OP were making blanket statements that LPN/LVN's never have a place in ICU and that all ICU's in every state should be staffed by RN's only. If any of these people are in TX, then that tells me that they do not understand the rules of their own state because I understand them quite well and have been in both roles in ICU.
    I was also pointing out that having an all RN staff in ICU does not necessarily solve the problem either because I've had RN's floated to my unit out of desparation who have never seen a swan, read a rhythm strip, or even opened a crash cart in their entire careers.
    Do they belong in ICU taking patients on their own just because they are RN's?
    In states that allow it, if you squeeze out well-trained LVN's just so that you can have all RN's regardless of their skill level would be counter-productive and unsafe, but in short staffing situations that's what you are going to get.
    Last edit by RN34TX on Apr 1, '05
  5. by   lee1
    In the ICUs at my hospital we regularly take new RNs just out of school. The last few have been from various programs. Their training takes about 3 months intense 1:1 preceptorship with classes being taught by our CNS. They do not float for approx 6 months and in some cases longer.
    Personally I think the responsiblity of having an LPN working in an ICU is too great. At all times the RNs would be responsible for their care. Critical thinking skills take time to learn. Assessments that provide proactive care immediately are the hallmark of prevention of complications. It is hard enough with inexperienced nurses/new nurses/floated nurses/traveler nurses in the mix.
  6. by   HazelLPN
    I have been an LPN for nearly 50 years, and most of that time has been spend in critical care. Fortunately, in the state and hospital I work in, LPNs have few restrictions. I can titrate my pressers, I give blood products, I draw gases, I can give pretty much any medication except chemo...and only a few of our RNs who have been hem/onc nurses can give that. I do not take new admissions, I do not take charge, and I can not serve as a patients primary nurse and write the care plan....though I can assist with it.

    I would strongly disagree with the posters who say than an LPN lacks the assessment or critical reasoning skills to work in ICU simply become one is an LPN. Sorry folks, we learn the most from experience on the job....not in nursing school. I went to school back in the 1950's....essentially nothing is the same these days. If there are not a lot of state restrictions on the LPN scope of practice and if she/he is bright and willing to learn....then why not? It depends on the individual...plain and simple. When one speaks in generalities....one usually gets themselves into trouble.
  7. by   RN34TX
    Quote from HazelLPN
    I have been an LPN for nearly 50 years, and most of that time has been spend in critical care. Fortunately, in the state and hospital I work in, LPNs have few restrictions. I can titrate my pressers, I give blood products, I draw gases, I can give pretty much any medication except chemo...and only a few of our RNs who have been hem/onc nurses can give that. I do not take new admissions, I do not take charge, and I can not serve as a patients primary nurse and write the care plan....though I can assist with it.

    I would strongly disagree with the posters who say than an LPN lacks the assessment or critical reasoning skills to work in ICU simply become one is an LPN. Sorry folks, we learn the most from experience on the job....not in nursing school. I went to school back in the 1950's....essentially nothing is the same these days. If there are not a lot of state restrictions on the LPN scope of practice and if she/he is bright and willing to learn....then why not? It depends on the individual...plain and simple. When one speaks in generalities....one usually gets themselves into trouble.
    Thank you HazelLPN!
    It's about time this discussion gets some input from LPN's who work in critical care.
    They are out there, and in states without too many practice restrictions, it works.
    My hospital only hires LPN's to work in outpatient settings, not even in Med/Surg which is where I spent most of my time as an LPN.
    Meanwhile, we are working on new RN grad #3 to be to be moved to another area after 6-9 months and still just not "getting it" in the ICU setting.
  8. by   mattsmom81
    [QUOTE=RN34TX]. If any of these people are in TX, then that tells me that they do not understand the rules of their own state because I understand them quite well and have been in both roles in ICU. QUOTE]

    I worked in Texas ICU's with LVN's for 25 yrs and always thought LPN's could work wherever they are deemed competent. As I read the statement below, I cannot help but feel facilities have been taking a surprising risk and need to rethink this practice.

    ftp://www.bne.state.tx.us/lvn-guide.pdf

    This applies only to Texas of course, and the document appeared to be formed last fall, (october 2004) so maybe not every nurse has seen this...I don't know.

    Just goes to show how important it is to read the NPA and be aware of updates, IMO.
    __________________
    Last edit by mattsmom81 on Apr 9, '05
  9. by   Nicki_RN
    Well where I work as an LPN, being IV certified is a requirement for the job, which is why I am currently taking the course. I can't wait to be cert. because I hate having to go to another Nurse to shut the darn pump off if it's going off for some reason, and then getting them to give my meds. I can do initial assessments as long as another nurse signs off that I correctly did the assessment. And, I usually do something else for the RN that is doing my IV stuff, so that she isn't behind in her work. Although, remember most LPNs are getting their RN, so don't scare em off!!
  10. by   RNforLongTime
    Although, remember most LPNs are getting their RN, so don't scare em off!!
    Really? I know a lot of LPN's that are perfectly happen as an LPN.

    That said, the ICU that I used to work in did not utilize LPN's. In PA, LPN's are NOT allowed to give IVP meds except abx, they aren't allowed to titrate pressors, hang blood, hang TPN, perform admission assessments or initiate nursing care plans.

    The ICU that I now work in has an LPN that's worked in the unit for 15 yrs and believe me, she's a darn good one and is better than some of the RN's in this particular unit. She's pursuing her RN through Excelsior College. I LOVE working with this lady! She's wonderful. We work in a low key ICU. But an ICU none-the-less. Not too many pressors to be titrated here.

    ----Kelly RN, CCRN (as of 3/28/06)!!!!!!!!!!!!!!!!
  11. by   dorimar
    In defense of the OP, she was not knocking LPNs, but the added responsibility their scope of practice places on the RN when they are working in the ICU. I whole heartedly agree with her, and I have to say that I absolutely would not be responsible for someone else's assessment no matter how much i trusted them ,without going in and assessing the patient myself (especially in the ICU). Everything she described sounds extremely unsafe, and not because the LPN's aren't competent, but because the RN has so much more responsibility that her patients aren't getting the attention they need. Because the LPN with a limited scope of practice is given patient assignments in the ICU, the RN's patient ratio is increased (as the LPN cannot admit) , her patient acuity is increased, and she is still ultimately responsible for the LPN's assignment as well (i mean in a liabilty sense). I know many of you will say the RN is not responsible for the LPN's patient, but if there is a deposition for any reason on an LPN's patient you better believe the RN will be deposed. Now in the case of RN's going to work in the ICU right after nursing school, I have some opinions about that as well, but it is an apples & oranges issue here. Once a new RN finishes her orientation, she is not working under another RN's license. Also she can admit patients, titrate her own drugs, and is responsible for her own assessments etc. If she screws up it is terrible, but I am not responsible -she & her employer are.

    Doris
  12. by   suebella
    I have 10 years ICU experience and have taken and passed all of the same test the RN's have to take in order to work here. I was the first nurse in our facility to complete the ECCO class required here to work in either ICU or PCU. I take all patients except the one's with a swan ganz catheter. They prefer that the RN's take these patients. We are also not allowed to hang blood in my facility. We can monitor it, but can't spike the bag. I do agree that all LPN's can't work in the units but if they have proven themselves capable then I don't see a problem.
  13. by   ZASHAGALKA
    I've worked in several CCUs in TX and everyone of them had converted to RN only staffing years ago, although a few grandfathered the LVNs that were working there at the time of the change.

    So, I've worked w/ LVNs in CCU, but only ones that had been critical care nurses for a long period of time.

    In my experience, they were given the same level of pts and did everything for those pts, titrating gtts, hanging blood etc.

    I didn't pay enough attn to see if some of the more complex stuff, like CABGs and Swans were assigned, but I also know that they didn't just get 'stable vents'.

    And I also know that a critical care nurse with several years experience is, surprise, a critical care nurse.

    But, and I want to point this out: nursing school, RN or otherwise, didn't teach a single CCU nurse how to be a CCU nurse. We all learned that in critical care courses and/or OJT. I'm not by any means saying that there isn't a difference between LVN and RN school. I've been to both, and the difference is large. But, experience is a fairly decent leveler - and lots of experience is even more so.

    I would trust an LVN with multi-year critical care experience over a new RN in CCU with my family members in a heartbeat.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Apr 2, '06

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