LPN practicing outside of scope

Nurses General Nursing

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Hi, I work in an ICU. We are fully staffed with RN's, with the exception of one LPN. In my unit, this LPN is treated like an RN and assumes total patient care for 2 patients, just like all the other RN's. She has worked there for many years and is good friends with one of the ICU managers. She not only assumes total care of two patients, but she also gives medicines through central lines, hangs blood, and titrates pressors on a routine basis. Our manager has recently decided that it would be okay for her to start doing CRRT as well. We are a level one trauma center and this is definitely a patient safety issue. I am also concerned that the RN's who work with her, especially the Charge RN who makes patient assignments is at risk of getting in trouble. There are only 6 nurses on any given shift and she is scheduled as the 6th nurse every time she works. This forces the charge RN to give her 2 patients and there is no way around it. I need to know the best way to go about reporting her. Obviously since she is good friends with some of management, I need to go outside the hierarchy at work. How do I report this to the state board. Thanks for your help.

Specializes in Peds Homecare.

New York State regs:NYS Nursing:Practice Alerts LPN Practice Issues:Blood Component Administration

"An LPN may participate in any phase of blood component administration after satisfactory completion of a training program that includes didactic instruction, supervised clinical experiences that incorporate each phase of the transfusion process for each of the types of components for which the LPN will be authorized to administer, and clinical competency validation.

NYS Nursing:Practice Alerts LPN Practice Issues:Practice of IV Therapy Acute Care

An LPN MAY:

- Identify and set up equipment and solutions for infusion through any venous access device (peripheral or central line).

An LPN MAY:

- Start most peripheral IV lines Except that: An LPN MAY NOT:

- Start any central venous line including PICC lines.

- Start a venous line using a midline catheter.

An LPN MAY:

- Monitor and adjust flow rates of any venous access device/line.

An LPN MAY:

- Administer medicated and unmedicated intravenous solutions through most venous access lines including midline catheters.

An LPN MAY:

- Administer intermittent IV medicated or unmedicated solutions through most venous access lines including midline catheters.

An LPN MAY:

- Administer ONLY saline and/or heparin flushes through a peripheral IV line by the direct IV push technique

An LPN MAY:

- Flush venous access lines for patency using the SASH or SAS flush procedure.

An LPN MAY:

- Change dressings on peripheral venous IV lines not directly connected to the central venous system.

An LPN MAY:

- Draw blood from peripheral venous lines not d not directly connected to the central venous system.

An LPN MAY:

- Discontinue and remove peripheral venous lines.

NYS Nursing:Practice Alerts LPN Practice Issues

Just an idea of the scope of practice of LPN's in NYS.

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Specializes in Cardiac, ER.

We are having a similar issue in the ER where I work. Have any of you actually tried to read your nurse practice act? I have,...it's very vague,..and full of so much legal jumbo I felt I needed an attorney to interpret for me. It is also 100's of pages long and constantly refers to other sections of the act,..so that I really need the whole thing in writing and hours to refer back and forth to figure out what is being said.

I had almost as much trouble getting through my hospital policies!! I will be interested in how this all works out. Before I moved to ER,..policy stated that an RN must do all assessments, discharge teaching, IV push meds, hang blood and be in control of any titratable IV meds. This left the charge nurse (RN) essentially responsible for the pt's the LPN was assigned to. It's very frustrating for this to be so difficult to figure out!

Keep us posted!

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Specializes in Adult ICU/PICU/NICU.
Hi, I work in an ICU. We are fully staffed with RN's, with the exception of one LPN. In my unit, this LPN is treated like an RN and assumes total patient care for 2 patients, just like all the other RN's. She has worked there for many years and is good friends with one of the ICU managers. She not only assumes total care of two patients, but she also gives medicines through central lines, hangs blood, and titrates pressors on a routine basis. Our manager has recently decided that it would be okay for her to start doing CRRT as well. We are a level one trauma center and this is definitely a patient safety issue. I am also concerned that the RN's who work with her, especially the Charge RN who makes patient assignments is at risk of getting in trouble. There are only 6 nurses on any given shift and she is scheduled as the 6th nurse every time she works. This forces the charge RN to give her 2 patients and there is no way around it. I need to know the best way to go about reporting her. Obviously since she is good friends with some of management, I need to go outside the hierarchy at work. How do I report this to the state board. Thanks for your help.

I recently retired after 54 years as an LPN working most of my career in various ICUs and the things you mentioned were all in my scope of practice according to the state board of nursing and hospital where I worked. In some states, the LPN scope is vague on purpose and others its very specific. Some states the scope is very similar to that of an RN, others the LPN scope is much more restrictive. It is possible, depending on the state you live in, that she is practicing within her scope.

Reading your post, it seems that you either

1. Know for a fact that the LPN scope in your state does not include these things

(" ie how can I report her" )or

2. You do not feel that an LPN is capable of caring for critically ill patients (ie "we are a level one trauma center and this is a patient safety issue").

Not knowing what state you live in, I can not speak for number one other than you must check with your state BON. I would find it very odd if management had not done that already as they are very careful about lawsuits. As for number 2, I also worked in a large level one trauma center. I took care of very sick patients and there was nothing unsafe about the care that I or my other LPN colleagues provided. If this was not the case, my former manager would not still call me and ask me to return to work contingent despite that I will be turning 77 years old next week and have been fully retired for nearly a year and a half.

Best to you,

Mrs H

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Specializes in NICU, Post-partum.
just call them.

They may have an email address too. All reports should be considered confidential, but ask anyway.

I believe you have an obligation to do this.

I agree...I live in a state where LPN's cannot access a central line or hang blood, but they can be a second signature for verification. My facility does not permit even IV access, but this does vary by state.

However, in the meantime, if I was the charge nurse, I would make it CLEAR to the LPN that she is not to things that are outside of her scope of practice and would assign her patients to where it should not be an issue, if possible. If she insisted on ie. accessing central lines, the charge nurse should write her up because I would guarantee it is against facility policy.

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Specializes in Adult ICU/PICU/NICU.
I agree...I live in a state where LPN's cannot access a central line or hang blood, but they can be a second signature for verification. My facility does not permit even IV access, but this does vary by state.

However, in the meantime, if I was the charge nurse, I would make it CLEAR to the LPN that she is not to things that are outside of her scope of practice and would assign her patients to where it should not be an issue, if possible. If she insisted on ie. accessing central lines, the charge nurse should write her up because I would guarantee it is against facility policy.

It seems that these posts fail to recognize that it is very possible that this veteran LPN is practicing within her scope of practice simply because their own states or hospital does not permit these things. I think its a bit foolish that a nurse manager would allow an LPN to practice outside her scope and that the veteran LPN somehow does not know her own scope. More than just a few states allow LPNs to perform whatever they have been trained to do. In today's age of lawsuits, I find it very unlikely that any facility, especially a level one trauma center that certainly has a department of legal services, would be so reckless.

When one mentions "in my state or hospital LPNs can't do (insert comments about IV push meds or titration of pressors or anything else you want)" ..its a moot point and does not need to be mentioned because each state and facility is different in terms of LPN scope.

I think the bigger issue is that the OP belives that LPNs should NOT work in critical care as her (or his) languages seems to suggest that. This has been debated extensively in the critical care nursing forum and the conclusion is this: States that alllow LPNs a broad scope of practice....LPNs can and do work very well in critical care areas...in states that the scope is restricted...it does not work as well.

Best to you,

Mrs H.

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