[Nurse-o-Matic]

I am an RN in a 24-bed ICU. Currently, we have 1-2 LPN's scheduled per shift. Our policy is no more than 2 patients per RN unless you have an LPN working along with you, in which case you may have 3 patients. My experience with LPN's in citical care is that they seem to want to step outside of thier role-for example, push meds or draw off picc lines. Also, when the patient is crashing and I'm starting a new drip, calling the doc, etc., they will sometimes go off on break?!? Because RN's are paid more, some they feel they shouldn't do as much work and will bring a book to read while I run around at the end of the shift getting I&O's, restocking, or boosting patients.
I have worked in other departments with LPN's where each of us did our role and got the job done. In ICU it's different because our LPN's do have additional skills and want to function at a higher level. 10 years ago our ICU had LPN's taking care of thier own patients including IV pushes, IV's, and calling docs. There are a few of these LPN's left who practiced under those conditions and are now bitter to the rules. They feel they are stepping backwards in thier profession, but don't wish to pursue the RN degree.
Does your ICU employ LPN's?

[grannynurse FNP student]

Originally Posted by Nurse-o-Matic

I am an RN in a 24-bed ICU. Currently, we have 1-2 LPN's scheduled per shift. Our policy is no more than 2 patients per RN unless you have an LPN working along with you, in which case you may have 3 patients. My experience with LPN's in citical care is that they seem to want to step outside of thier role-for example, push meds or draw off picc lines. Also, when the patient is crashing and I'm starting a new drip, calling the doc, etc., they will sometimes go off on break?!? Because RN's are paid more, some they feel they shouldn't do as much work and will bring a book to read while I run around at the end of the shift getting I&O's, restocking, or boosting patients.
I have worked in other departments with LPN's where each of us did our role and got the job done. In ICU it's different because our LPN's do have additional skills and want to function at a higher level. 10 years ago our ICU had LPN's taking care of thier own patients including IV pushes, IV's, and calling docs. There are a few of these LPN's left who practiced under those conditions and are now bitter to the rules. They feel they are stepping backwards in thier profession, but don't wish to pursue the RN degree.
Does your ICU employ LPN's?

I haven't worked in an ICU for some years, haven't worked at all. I have been a patient in ICU several times and had family members in them. LPNs were given more responsibilities and roles in the 80s and early 90s. However, in certain facilities, who have a higher number of RNs, they roles have lessened. Roles expand and contract. Education does not. If one wants to function as an RN, one needs to obtain the additional education and license.

Grannynurse

[LoraLou]

my hospital system does not hire LPN's at all in critical care, and very few on the floors

[helpinghands]

We have LPN's on our MICU and SICU. We do team nursing with the team taking on 4 patients. This is a very difficult load to handle! I'm starting to understand why my unit has such a high turnover rate. The LPN's aren't allowed to do assessments, take orders, push meds, or titrate drips. Basically they handle the PO meds, VS, I&O's and help bath patients. Usually the RN runs around like crazy and the LPN's sit around bored. This doesn't help the already poor working relations between the two. LPN's last an even shorter time period because so many of the RN's are nasty to the LPN's.

[lindarn]

Originally Posted by helpinghands

We have LPN's on our MICU and SICU. We do team nursing with the team taking on 4 patients. This is a very difficult load to handle! I'm starting to understand why my unit has such a high turnover rate. The LPN's aren't allowed to do assessments, take orders, push meds, or titrate drips. Basically they handle the PO meds, VS, I&O's and help bath patients. Usually the RN runs around like crazy and the LPN's sit around bored. This doesn't help the already poor working relations between the two. LPN's last an even shorter time period because so many of the RN's are nasty to the LPN's.

LPNs have no place in critical care. They make for very unsafe conditions for the patients and the RN's who are ultimately responsible for their work. I have never worked in an ICU that employed LPN's nad I would refuse to have the respoNsibility for their work. They are a liability, not a heLping hand in ICU. Period. The hospital that I worked in here in Spokane, laid off ALL OF THEIR LPNS ABOUT TWO YEARS AGO. The writing is on the wall, all of you LPNs out there. Go back for your RN degree if yu want to work in ICU, and the nurses who are stuck having to work with LPNs in ICU should get together with administration, and yOur union, if you have one, and change the policy. I would refuse to work with an LPN in ICU. Period. And you should too. I was under the impression that it was decided years ago to go with an all RN staff in the ICUs. What happened? It is very definately AACN policy for an all RN staff in the ICU. JMHO. and $0.02.

Lindarn RN, BSN, CCRN
Spokane, Washington

[helpinghands]

lindarn

You're completely right it is unsafe. Especially if you have to remind them to let you know about VS and I&O's not WNL. Unfortunately I signed an 18 month contract and have 12 months to go. I really don't think I'll last that long. I'm just waiting for the $$ I will owe them for breaking my contract to go down some.

Ok, I'm going to get on my soap box here.....

I am an LVN, and have worked in ICU/CCU...taking my OWN patient load and doing my own IV pushes, IV meds, drips, calling docs, everything. I had no RN working with my patient's and sure never had an RN display an attitude towards me. It is VERY stereotypical to be making these comments about LVN's. Excuse me, but I know how to assess my patient's and was responsible for a full head to toe shift assessment on each patient. FYI - I'll run circles around some RN's and leave them spinning, and I'm guessing me and some other LVN's could do the same for some of you with your attitudes. Get over your BSn (b*llsh*t nurse) if you're going to have an attitude like that. RN's are technically considered Professional Nurses, but in your cases, I would have to beg to differ. Now, don't get me wrong, there are some LVN's who lack critical care skills, but HELLO - there are RN's that lack critical care skills also!

You're nursing degree does not testify to what type of a nurse you are, how good you are, how crisp your assessment skills are or anything, it just states how long you went to school. I know everyone can attest that nursing school does not define a person as what type of nurse they will be. That's my 2 cents, some of your attitudes just FLOOR me!

[mstigerlily]

I thought LVNs had to work under an RN, couldn't do assessments and can't do IV push meds? Does this differ from state to state?

Originally Posted by CV_LVN

Ok, I'm going to get on my soap box here.....

I am an LVN, and have worked in ICU/CCU...taking my OWN patient load and doing my own IV pushes, IV meds, drips, calling docs, everything. I had no RN working with my patient's and sure never had an RN display an attitude towards me. It is VERY stereotypical to be making these comments about LVN's. Excuse me, but I know how to assess my patient's and was responsible for a full head to toe shift assessment on each patient. FYI - I'll run circles around some RN's and leave them spinning, and I'm guessing me and some other LVN's could do the same for some of you with your attitudes. Get over your BSn (b*llsh*t nurse) if you're going to have an attitude like that. RN's are technically considered Professional Nurses, but in your cases, I would have to beg to differ. Now, don't get me wrong, there are some LVN's who lack critical care skills, but HELLO - there are RN's that lack critical care skills also!

You're nursing degree does not testify to what type of a nurse you are, how good you are, how crisp your assessment skills are or anything, it just states how long you went to school. I know everyone can attest that nursing school does not define a person as what type of nurse they will be. That's my 2 cents, some of your attitudes just FLOOR me!

[RN34TX]

Originally Posted by mstigerlily

I thought LVNs had to work under an RN, couldn't do assessments and can't do IV push meds? Does this differ from state to state?

Yes it can and does differ widely from state to state and many of you here are forgetting that.
CV LVN is in TX where there are very few restrictions on LVN practice, so titrating drips and IV push meds are everyday practice for LVN's in TX.

Blanket statements such as LVN's creating an unsafe environment in the ICU, particularly from those of you who have admitted to have never worked with LVN's, need to get some experience actually working with them before making statements about things you've never experienced yourself.
Many RN's I've worked with create an unsafe environment as well and yet they continue to work in ICU and really shouldn't be there.

I worked in ICU as an LVN and it was overall a good experience and the RN and LVN worked well together.
But for states that have a relatively restricted LVN/LPN practice act, I too would question LVN's working in ICU.
After all, how many PO meds or drips that don't need to be titrated does the average ICU patient have? Probably next to none in most cases.

Now that the tables have turned and I'm now the RN, my hospital does not use LVN's in any critical care area so I really don't know what it would be like to have the role in reverse.
But I often wish that my hospital would change this policy as I've spent many shifts babysitting clueless RN's who I'd gladly trade for a solid ICU trained LVN any day.

[Dinith88]

At my place of employment we do not utilize LPN's in ICU. We do have several on the floors and a few in ER.

As has probably been stated, the biggest issue with LPN's in ICU is that they're limited in their scope of practice (which drips they can titrate, blood administration, procedures, etc.) Therefore, it'd put a huge burden on the RN's in ICU if they're having to hover around or otherwise do the 'stuff' the LPN's arent supposed to. I think it's a shame because i know a few LPN's who can run circles around several RN's i've worked with. At any rate, i suppose it's different depending on state, institution, etc. (like someone else said.. )