[SKM-NURSIEPOOH]

Originally Posted by mac23

I don't think this was meant as a knock on LPN's. In our hospital we have a few that have been there for 15+ years but they don't hire LPN's to the unit anymore. For us, it's because of hospital policies, scope of practice issues that say an RN has to do certain things. It varies from state to state. For example in my state an Rn has to do all IV meds, has to do all initial assessments (so even though our LPN's were perfectly capable of doing those things, an RN had to come behind them and do it again), if an LPN was assigned to the patient an RN had to be assigned to that patient after the LPN so that two LPN's couldn't be assigned to the same patient back to back, an RN had to hang blood etc etc.
I've done both NICU and PICU and often these kids can turn on a dime and need IV meds, blood etc stat. I could see it being an issue if an LPN is assigned to a crashing patient and can't do those things (hospital won't allow it; not they aren't capable) it could be a problem. Just my observations.

LPN scope of practice unfortunately varies from state to state...but many will allow LPNs to do more advance nursing procedures as long as said LPNs have been educated & oriented to those advance tasks as well as being directly supervised by (either a RN or MD) while doing them. Many SBON have left LPN's scope of practice vague in order to make allowances as needed....institutions who want to keep JACHO certification/accreditation, for example, will follow suggested regulations from that entity & write policies accordingly. I'm don't quite follow the rationale for having UAPs in the units but not LPNs. Seems like in this day & age of the *nursing shortage*, hospital would take another look at the large, untapped LPN pool of nurses. Perhaps the 'shortage' isn't that bad yet, but one day soon, LPNs may make a come back in the units.......heck....LPNs are already slowly making a come back in acute/hospital settings...it'll only be a matter of time.

Cheers!
Moe

[xmaxiex]

Oh definately no dispute here . I was curious because as an LPN who is persuing her RN I would eventually like to go into NICU and was wondering what skills were required that were different .

[DelightRN]

I don't work PICU anymore, but when we did, we didn't have LPNs. In fact, I've never seen LPNs in any critical care setting. Not because LPNs are not valuable members of the health team (of course, they are), but because many of our skills (initial assessments, IV bolus meds, accessing/deaccessing central lines, etc.) are things that are not within an LPN's scope of practice.
Now I work on a neurobehavioral unit with several wonderful LPNs.

[babynurseapril]

We used to have LPN's but our hospital made them all become RN's to work PICU, or they had to go to the floor.

[DelightRN]

Did they all become RNs? Were they allowed to remain in the PICU while they were in school?

[DeniseRNBSN]

Originally Posted by janfrn

In Alberta, the following common skills required in our PICU are not within the scope of practice of LPNs:

IV drug administration (particularly cytotoxics and anaesthetic agents)
IV starts
short-term central line care
arterial and intracardiac line care
care of the patient with an open sternum
administration and monitoring of vasoactive drugs
monitoring and care of the patient on ECMO
endotracheal tube suctioning and maintenance
monitoring and care of intraventricular drains
monitoring and care of intracranial pressure monitoring devices
bladder catheterization
small bowel feeding tube placement
and probably several others I can't think of off the top of my head.

Assessment skills are also extremely important. The depth of assessment taught to LPNs just isn't the same.

Many of these skills are not acquired in nursing school but through a lengthy orientation to PICU. There are courses available across the continent for nurses wishing to learn the theoretical and practical skills required to care for the critically ill child, but the individual will still require an orientation and gradual introduction to more complex skills.

I work in a level one trauma center and we do not have LPN's in the units or emergency room.

In our hospital LPN's are valuable in certain situations but when it comes to trauma medicine they are not utilized.

I work in a cardio-vascular surgery ICU and we have a lot of hemodynamic interpretation and quick thinking life saving decisions that are made quickly.

I'm not saying that LPN's don't have those skills but in Florida they need someone to hang blood and push IV push meds as well as other things.
In the ICU setting things happen quick and you don't have time to hang someone elses drips, start CVVHD, handle Swan-Ganz catheters and other procedures.

Before I start getting the hate email, I used to be an LPN and there was quite a few things that I could not do. I gained experience clinically as an LPN but gained more knowledge as an RN and studying for the CCRN exam while working in the ICU.

Denise RN, BSN, CCRN

[babynurseapril]

Originally Posted by DelightRN

Did they all become RNs? Were they allowed to remain in the PICU while they were in school?

They were allowed to stay in the PICU, however, this happened before I came on staff a few years ago. I only know of one nurse in our unit who stayed and is now a RN.

[HazelLPN]

We do, but not many. We enjoy a full scope of practice in the critical care units, but the NMs will only hire an LPN if she/he is enrolled in school to be an RN or has some sort of "in." The last LPN the PICU hired used to be their unit clerk.

LPNs are able to fuction in the critical care setting with the right training if they are bright and willing to learn .....as long as the hospital and state allow them a full scope of practice. Its about the individual person vs the type of education as to who should and should not work in ICU

[skemergirl]

Our Children's Hospital does not hire LPN's. We do have a very few LPN's on the med-surg floors but they can not float to the ICU's. They are there because they got in under the "grandfather clause" before Children's stopped hiring LPN's. I use to be a LPN before I got my RN and I believe LPN's are a vital part of the healthcare team. However, having said that, we do not have LPN's in the ICU because their scope of practice does not allow them to carry out the neccessary nursing skills needed for the ICU, such as blood administration, passing narcotics, ng insertions...this would require an RN to go behind them an do these things and it is just not beneficial to the unit especially in an emergent case such as a very busy admission or a code situation. We routinely perform these functions and I can say if I had my own patient load ad had to do these things for other patients because an LPN couldn't..I would be more frustrated than ever. Patients come first! I really enjoyed working with LPN's in the Drs office I use to work in but not for an ICU.