LPN role in the Infirmary

[HIPPIECHIKRN]

I work in a 21 bed infirmary in a state prison as an RN. On my shift there are 2 RN's and 2 LPN's. Until recently we divided the patients into 3 groups with the other RN floating to assist with care on the floor plus handling paperwork for consults, making appointments, supplies etc. In effect, she acted as a charge person,per se.

Recently it was decided by our DON, sho has never worked in our unit (I have only seen her in the unit twice, walking through), that the floor should be divided in half with a "team" of 1 RN and 1 LPN per team. The RN is to do all documentation, assessments etc. Which leaves the LPNs to do vital signs and adm. meds. Prior to the DON visit the LPN would have her own team and be responsible for all care for her patients and write her own notes. Of course, the RN would do assessments on any admissions to the unit.

The LPN's had become pretty independent with patient care and documentation. Now the only thing they do is vitals and pass meds and sit and talk to each other in their language. One is on the phone constantly with personal calls. When I asked her to transcribe orders from an admission I had she hit the roof and became very upset.

For what they now do I would rather have a CNA to help with patients who need bathing and changing (we have a few total care, long term type patients). They can do vital signs and finger sticks and I can pass my own meds! Our current LPN's won't even answer the phone if they are sitting right next to it!

Any help with making the "team" more cohesive and not just making the RN run even more during the shift?

[ulbalrite]

Here's what I do as an LPN at the prison that I work . First of all I work night shift. I do med pass for approximately 90 to 100 i/m's upon entering the facility (alone). Then I do what is called the ward which houses anywhere from 8 to 11 i'm's, the other lpn may or may not have time to do this, as she is busy with dressing changes and blood pressure checks along with the rn. The ward consists of taking vital signs and dfressing changes if there are any.usually about 11p by this time, start taking orders off with the lpn (rn will occasionally help, but is not really wild about doing it), pre-segs, medical emergencies are handled by all of us. 2:00a pill call which lasts until 6a -- sometimes not as long. 6 a. ward needs their medication. I have no idea what the rn is doing -- god help me, i've tried to teach her, but she is absolutely, positively unteachable -- gets mad at you when you tell her anything. my lpn co-worker put her resignation in and I'm sooooo close. Between 2 and 6a I have no idea what she is doing -- sleeping I guess or smoking. I don't know.

[HIPPIECHIKRN]

ulbalrite, you guys sound really busy. I would love to work as the RN with you. I work day shift and my LPN will go to sleep in a chair when she is done with vitals and meds. We only have 21 pts but some are acutely ill and require attention. By the way, is your RN a newer nurse than you? IDoes she know that she is ultimately responsible and you guys are working on her license? At least that is how it is here. If something is not done or messed up the RN is responsible.

[katkonk, BSN, RN]

I think I would ask the DON for the job description of an LPN and review it with her, just to make sure you are "on the same page". Then, assuming that you and the DON agree on responsibilities, I would review the job description with the LPN's, and just tell them you want to be sure that everyone is aware of what the job duties are. Most job descriptions state that the description is "not all-inclusive" and there may be other duties not specifically outlined on the JD. It would give you the opportunity to open the "counseling" conversation with the LPN, in which you can say...hey, I also need your help when I am busy to do...this and that, etc. Take it from there.

[HIPPIECHIKRN]

You are so right Katkonk. I will approach the ADON at our site to help with the matter. She is usually hands off, but it is her job to counsel and discipline staff. I know that when you are hired you sign the job description. I know sleeping is not on the list. :)

[military spouse]

I think we have 17 beds or maybe 19, depending on how you look at it :) The RN typically does VS and assessments and the computer charting (takes FOREVER). The LPN does the meds, dressings, and most labs. Admissions/discharges are generally done by the RN, but the LPN will help if she has time. We are always busy because they have been running a full-house. A few years ago, we might only have 5-7 patients and it was much easier and we could provide better care. We also didn't have computerized charting and the charting was MUCH faster!! The LPN can hang bags, but can't do IV push.