[RN34TX]

Originally Posted by HERNANDO-RN

I Certainly Hope So. In My Opinion, Lpn's Do Not Belong In The Acute Care Setting Due To Their Limited Scope Of Practice. There Are A Few Remaining Lpn's At My Hospital...and It Is A Burden Working With Them. They Cannot Take Telephone Orders, Do Admission Assessments Or Iv Pushes....that Gets Dumped On The Rn's Working With Them.

That "burden" rests on the shoulders of your state's nurse practice act and/or your individual facility policies, not the LPN's you have worked with.

LPN's indeed do belong in the acute care setting. The majority of their theory and clinical training is in the context of the med/surg hospital patient, even though many work in other areas as well. This is even reflected in the NCLEX-PN licensing examination. Most of the questions/material are based on acute care hospital patients.

I worked in states like Minnesota and Pennsylvania where LPN's could not even take a telephone order and the common belief in those areas was that if LPN's could push meds that they would not only kill patients due to their lack of education, that they would also take RN jobs away. The RN unions would constantly harp about that to instill paranoia in the RN's with regard to LPN's.

LVN's in Texas push IV meds every day and take telephone orders. Patients are not getting killed and RN job opportunities couldn't be better. So much for MN or PA theory on what LPN/LVN's should or should not be doing with regard to scope of practice.

Removing LPN's from the hospital setting is not going to make things better for RN's. Hospital administrations and even boards of nursing do not make decisions to make an RN's job easier or better.

[unitek1963]

The medical community is an interlocking set of hands, Hernando. We help each other as best we can, no matter our level of education, or the position we might hold within the hospital chain of command.

The tone of your posting seems overly-aggressive towards LPNs in your hospital (or LPNs in general), which makes me think that your grievance with LPNs runs deeper than simply their "scope of practice."

Do you also have grievances with the EMTs who bring the patients into the ER, lab techs who run the lab work for you, x-ray techs who get your patient's x-rays, etc. ad infinitum?

I think you need to re-evaluate where your aggression is coming FROM, rather than directing it a a group of professionals who are only ALLOWED to work within a specific scope of guidelines (much like yourself.)

Good Luck.

Michael

Originally Posted by HERNANDO-RN

I Certainly Hope So. In My Opinion, Lpn's Do Not Belong In The Acute Care Setting Due To Their Limited Scope Of Practice. There Are A Few Remaining Lpn's At My Hospital...and It Is A Burden Working With Them. They Cannot Take Telephone Orders, Do Admission Assessments Or Iv Pushes....that Gets Dumped On The Rn's Working With Them.

[herring_RN]

LVNs have mostly been transferred from our acute units.

They are working in outpatient clinics, the on site SNF, and "Fast Track" across from the ER where patients are treated after triage if they don't need to be assigned to an RN. The LVNs assist with procedures, collect and document data from vital signs to descriptions of a wound to subjective data, and notify the NP or doctor os changes in their condition.

I think it is a disservice to patients because our LVNs are great nurses.

I hate to say this but in the SNF they are sharper and more effective than most of the more apathetic RNs who work there. The patients benefit from the experienced nurses with acute care experience and skills.

[unitek1963]

I agree, Herring.

As I stated, in an earlier posting in this same thread, most of the LVNs here in Northern California have already been phased out.

Two of the big HMOs/Hospitals here (Kaiser Permanente and Mercy) have already done so just this year.

I do think that the old adage ("oh, they've been saying that for years about LVNs!") is finally coming home to roost. Kaiser and Mercy are fairly big players in the medical field, and others will look to, and possibly follow, their lead...and soon.

I believe that it won't be long before LTC facilities, doctor's offices and corner med clinics will be the only places left in which you will find LVNs in great numbers.

Good Luck.

Michael

Originally Posted by herring_RN

LVNs have mostly been transferred from our acute units.

They are working in outpatient clinics, the on site SNF, and "Fast Track" across from the ER where patients are treated after triage if they don't need to be assigned to an RN. The LVNs assist with procedures, collect and document data from vital signs to descriptions of a wound to subjective data, and notify the NP or doctor os changes in their condition.

I think it is a disservice to patients because our LVNs are great nurses.

I hate to say this but in the SNF they are sharper and more effective than most of the more apathetic RNs who work there. The patients benefit from the experienced nurses with acute care experience and skills.

[pagandeva2000]

First, I want to thank the RNs here that support having LPNs remain in acute care settings. It is true, depending on the facility and state we work in, the scope may be limited. One of the things that prudent RNs can do is advocate for our services and demonstrate how we can be of help. And, think about it-the titles of LPN and RN are NOT interchangable, and shouldn't be. If I was able to do everything, I mean EVERYTHING that RNs do, then, what would be the difference between the education? It would be senseless. CNAs are limited as well, even moreso than we are, so does that mean that they should be eliminated as well? Many of these disciplines are appendages to the RN, who is supposed to be the manager and delegator of care.

In my clinic, LPNs do the best we can to work around some of the scopes to get the work done and assist our overburdened RN counterparts. We are not as limited, but there are a few things that we can't do; accept telephone orders, abnormal and critical labs, administer flu shots without RN screening and pain assessments. But, because we have shown competency, RNs have counted on us to ask the pain questions, write them on a piece of paper and give it to the RN we are working with to document on bad days. We do daily checks of the crash cart, but the RN is supposed to open and check the crash cart once a month. I volunteered to learn the crash cart myself, and will do it, replace the items immediately, and the RNs trust me and sign off. On the units, they collect data for the pain assessments for pain meds (heck, we are giving them, so, the patient will call upon the medication nurse first if they are hurting), and we check the labs/vitals, etc... to see if it is safe to give the medications. We tell the RNs. We have to work together to save the team.

I work per diem as a vaccination nurse for the US Army. This is through a federal government agency who determines what sort of staff is to be delegated to the sites. Just the other day, the agency requested that an RN and a clerical person be sent to an all day assignment at a base. I am an LPN working for this agency, and we have a crew of people that includes a clerical person, LPNs and RNs. The agency decides what sort of staff should go based on the volume of people and what services to be rendered. The RN told her boss, I want PaganDeva (not what they know me as), as the clerical, and pay me more than what they would the average admit/clerk. Why, because I can help her moreso than an admit. She told them that if she is seeing more than 100 officers, she would accept that I came as a 'non-nursing personnel' person for that one day, because not only can I get the voluminous amount of paperwork done, but I can also check the medical records in order to see exactly what is due, teach them about side effects of the vaccines and check the expiration dates of the vaccines so she can just 'shoot and move'. Why? Because I am a nurse. Normally, I get paid $30 per hour (tax-free money). I told them that to take this assignment, I want $25 per hour as working as a clerk that day, because they will still be using my nursing brain in the process of getting that work done. If a solider has a reaction, faints, gets sick or whatever else, the clerk can do nothing...but I can. And, if she gets backed up, there is no way that as a fellow nurse, would I watch her get overloaded and overwhelmed. They found a way to get me on board with them for this assignment because they know the value of a good LPN, I will not be as stressed that day, will have a change of role function, but it showed that we nurses are a TEAM, if we allow ourselves to be.

I am sorry for the RNs that are overloaded, and those that work with LPNs that are argumentative and unethical. But, hey, we are nurses, we can can help you to work around this stuff if you let us. Let's learn from each other, encourage each other and stand together. Because at the end of the day, the powers that be could care less about any of us, really.

[Fiona59]

And here's a tidbit that will upset a few. In my health authority up here in Canada, the only person that can push IV meds are RN in ICU, ER, and Dialysis. The floor RN is not permitted to. If a patient requires IV push meds they are deemed to be too ill to be on an acute floor. I think I've seen one doctor do it in the last ten years.

So, the IV push argument is worth nothing in my world.

[pagandeva2000]

Originally Posted by Fiona59

And here's a tidbit that will upset a few. In my health authority up here in Canada, the only person that can push IV meds are RN in ICU, ER, and Dialysis. The floor RN is not permitted to. If a patient requires IV push meds they are deemed to be too ill to be on an acute floor. I think I've seen one doctor do it in the last ten years.

So, the IV push argument is worth nothing in my world.

It works the exact same way in my hospital in New York. Only ICU and ER Registered Nurses can do IV push. If a patient on med surg needs one, the doctor has to do it, and then, the patient is immediately transferred to ICU.

[elizabells]

The hospital where I work phased out LPNs ages ago. We have ONE left on our floor, and they changed her title to "ICU tech". The only patient care she is permitted is to assist the NP with PICC dressing changes. It's a darn shame. She straight up RUNS the unit. She knows everything about everything, where to get supplies the depot says they're out of, how all the politics work, everything.

[vamedic4]

Sad but true fact at my facility. I know of only 2 left where I work. They're wonderful, competent, and have a great deal of responsibility and their scope of practice is (almost) the same as the RNs they work with.
I think more and more it's a movement by hospitals to make themselves more "marketable" by alienating a good portion of the healthcare sector. LVNs fill a need in healthcare, but are being shut out at major facilities without rhyme or reason.

[unitek1963]

I have heard stories like this time and time again.

There are competent and incompetent nurses in both camps; however, I believe the dividing line here is that RNs have gathered together and consolidated their power in unions.

LVNs have not.

Best of Luck.

Michael

Originally Posted by elizabells

The hospital where I work phased out LPNs ages ago. We have ONE left on our floor, and they changed her title to "ICU tech". The only patient care she is permitted is to assist the NP with PICC dressing changes. It's a darn shame. She straight up RUNS the unit. She knows everything about everything, where to get supplies the depot says they're out of, how all the politics work, everything.