RN's precepting with an LPN...

Mags4711, RN · Feb 20, 2007

I think what LPN's can and cannot do is state, and even institution dependent.

Every ICU I've been in has had at least 1 LPN. I was also an LPN for four and a half years on the floor and regularly took the sicker patients. In my institution the four things LPN's cannot do is:

1) Spike and hang blood (they can monitor and take it down)

2) Take a verbal order, but no one is supposed to be doing that any longer. (In units such as Dialysis, they are allowed to in an urgent situation.)

3) Do the initial assessment on an admission and care plans, but they can take a transfer, or an RN can co-sign their admit assessment and care plans.

4) Do the A and P on a SOAP note, but again, an RN can co-sign that as well.

Other than that, they can do it all where I work, push meds, hang meds, etc... There used to be about 7 meds they weren't supposed to push, but most LPN's are NAPNES certified so that covered them for med admin. They can certainly do ongoing assessments of the patient (and by ongoing, I mean after the very initial admission assessment) and chart their findings.

I oriented as an RN with two LPN's in ICU's for a bit, and let me tell you, they were a couple of the most knowledgeable nurses I've ever known. Every nurse is different.

Anjann, RN · Feb 20, 2007

thanks for the clarification! I'm sure we will be a great match.

Anjann, RN · Feb 23, 2007

Hi FaithMD,

I wanted to let you know that it's working out very well, I LOVE my preceptor. She did tell me that at our facility as an LPN she can not do new pt. assessments. Strangely, I have to do them with a 3rd nurse, even though I don't feel like I should be assessing anyone in place of her vast wisdom and knowledge. But I would not want to be assigned to anyone else (except maybe one other RN) because we get along so well and she is such a great teacher!

BBFRN, BSN, PhD · Feb 23, 2007

I precepted when I was a LPN, but I had more experience than most of the RNs on my floor at the time.

Good luck in your orientation- I'm glad you have a good match!

caliotter3 · Feb 23, 2007

Glad to hear that things are going well w/your preceptor. At one place I worked at, an LPN stated very loudly, "I am not going to orient an RN!" when a new hire was placed with her one morning. I suspect a lot of the poor attitude was due to the fact that the LPN worked 2 full time jobs, back to back shifts, at two facilities across the street from each other. She was always grouchy and visibly tired. The poor RN left very fast. It was obvious that she was not impressed by the lack of acceptance she got from her new co-workers.

Mags4711, RN · Feb 23, 2007

Hi FaithMD,
I wanted to let you know that it's working out very well, I LOVE my preceptor. She did tell me that at our facility as an LPN she can not do new pt. assessments. Strangely, I have to do them with a 3rd nurse, even though I don't feel like I should be assessing anyone in place of her vast wisdom and knowledge. But I would not want to be assigned to anyone else (except maybe one other RN) because we get along so well and she is such a great teacher!

I too am very glad to hear how well it's going! I think the most important thing in your orientation (especially since you are really new) is that you feel you are learning a lot from your preceptor and that you trust and have a good rapport with her/him. Sounds like this certainly is the case with the two of you.

How many threads do we all read where someone has the preceptor from Hades? I'm so glad to read one where things are going well! Thank you, Anjann, for posting this and for keeping us updated.

kenesha212002 · Feb 27, 2007

I may be mistaken but I thought that you have to be an RN to work in ICU or any monitored unit for that matter. Also, LPNs can not work in Labor and Delivery, ER, or Public Health. It might be different in each state but I currently work in Florida on a Critical Care Unit and LPNs can not work on our floor. There are two left in the hospital and they are on Med-surg.

Mags4711, RN · Feb 27, 2007

I may be mistaken but I thought that you have to be an RN to work in ICU or any monitored unit for that matter. Also, LPNs can not work in Labor and Delivery, ER, or Public Health. It might be different in each state but I currently work in Florida on a Critical Care Unit and LPNs can not work on our floor. There are two left in the hospital and they are on Med-surg.

Hello Kenesha, the "no LPN in the ICU" may be the case in FL, or in your institution.

As I said above, I am a critical care nurse who does/has worked with LPN's in ICU's. In my institution, we do have LPN's who do take critical care patients in our ICU's. I believe our L&D has at least one as well. I do not know about ER and to work Public Health usually requires a BSN so that is by default, an RN position.

LPN schools are very few and far between these days so I think that has something to do with the lack of them around. Also many institutions have 80/20% staffing ratios between RN/non-RN personnel, so to increase RN dollars, they'll make the non-RN positions be a tech/aide position. LPN's usually cost more than aides/techs. Except in my hospital where the Nurse Aides are unionized and actually make MORE than the non-union LPN's. That really burned my ass when I was an LPN.

kenesha212002 · Feb 27, 2007

Thanks for the clarification......that could be in my institution or just in the state of Florida