LPNs in ICU - page 4

Our hospital recently brought LPNs into ICU, and we are having some trouble adjusting to the change. They were brought in to our units because we have lost so many RNs recently, and have not been... Read More

  1. by   Brownms46
    WOW....RNinICU...that's too much restrictions in my view to allow for safe care! Now let me get this straight...they can or can't do anything but hang maintaince flds? Or can they also hang IVPB? And what is the usual acurity in your unit? And exactly what state are you in? I find it very difficult to understand how the hospital decided that an LPN can't be trusted to take verbals orders or sign orders off...but can care for critical care pts!
  2. by   Brownms46
    No thanks needed here mattsmom...this is a no brainer!

    And LasVegasRN..."I" totally agree that LPNs can, and do work well in ICUs.... but not with all those restrictions, in today's higher acurity units! Ten years ago...Critical care was a different animal!

    And niteowl..I'm sure those nurses saw you as being a lifesaver! But from what I read in your post...those where RNs with their own assignments, not RNs covering your pts, and their pts also!

    Now I'm an LP/VN, and I'm totally with us being in critical care...but only where the practice act allows us to perform the skills needs in those units! And where LPNs have taken critical care courses, or have that experience, and knowledge! But in the state RNinICU is describing...I see the LPNs there as being in a situation where they're performing as nothing more than "glorified aides" already! If they can't take verbal orders, than the RNs are having the call the MDs, and they can't titrate drips..then the RNs are actually the ones managing the pts! And that to me is very scary...when the acurity is high, and you're having to measure/monitor the hemo on your pts, do the IVPs...and God knows what else!

    Am I wrong...or did I miss something??

    RNinICU...are the LPNs allowed to access Central/Art or PICC lines? Do they draw blood/ABGs, start IVs, do assessments, EKGS...read strips?? I mean what can they do???
  3. by   LasVegasRN
    Originally posted by Brownms46
    And LasVegasRN..."I" totally agree that LPNs can, and do work well in ICUs.... but not with all those restrictions, in today's higher acurity units! Ten years ago...Critical care was a different animal!
    Boy, you aren't kidding! And I don't have a way of finding out if that pilot program is still in existence today. Wish I knew so I could contribute more to this thread.
  4. by   Brownms46
    No problem here LasVegasRN...you're input is always well received with me..!
  5. by   RNinICU
    Originally posted by Brownms46

    RNinICU...are the LPNs allowed to access Central/Art or PICC lines? Do they draw blood/ABGs, start IVs, do assessments, EKGS...read strips?? I mean what can they do???
    They can and do perform all of these tasks. They can hang maintenance fluids as long as the concentration of KCL is less than 40 mEq/L, and they can hang replacement bags of heparin, but cannot initiate heparin therapy. They attended the same Critical Care Course as the RNs, but are still not allowed to perform some of the tasks they learned there, such as hemodynamics. They can give all PO, SC, and IM meds They can insert foley catheters, but not NG tubes, although thay can give meds through them. They can suction and perform trach care, but not make any vent changes. They can assess their patients, but our hospital does not allow them to do the admission paperwork.
  6. by   fab4fan
    We have a similar situation in the ED where I work; the charge nurse has to co-sign LPN's charts, cover meds that can't be given. Assignments have to be adjusted because LPN's are limited BY HOSPITAL POLICY as to type of pts. they can take, so the RN staff has to take the more critical pts. Despite the conditions placed on the LPN's practice, the LPN still counts in the staffing matrix as a full nurse.

    It can get very frustrating. I certainly appreciate the talents everyone brings to the table, so to speak, but it's just getting to be too much lately, trying to keep your head above water with pt assignments, charge, handling the docs, and picking up the work that someone else can't do because of limitations in that person's nurse practice act.

    RNinICU: I can sympathize with you.
  7. by   mattsmom81
    I know this is cliche, but this business of asking the RN to accept more and more responsibility on her license is another reason for the shortage.....it's getting scarier and scarier out there.....the ICU patients I cared for 10 years ago are now on PCU...rule out and uncomplicated MI's and dysrhythmias like nonsustained Vtach and heart block don't come to ICU much anymore...they now go to PCU with a 4:1 patient nurse ratio in my facility. Any nontitrating drip can go to PCU too...

    There's been plenty of nights I've been SO VERY thankful to have a medsurg nurse brave enough to help me in ICU in a pinch!! Like those rare nights when there's nobody else available on call, and there's a late sick call nurse, etc...if there was a less complicated patient I could help her with and still supervise the rest of the staff, I'd grumble but make it work.

    Because it was an unusual situation, we all made the best of it, and we're glad to' punt'... occasionally....but it's the idea that RNinICU and Fab4Fan are being expected to stretch themselves day after day like this that disturbs me. I'm hearing more and more of this.

    And I can visualize what will happen if things start going bad...it all falls on the charge nurse's head...I've been there.

    I'm so thankful my LPN coworkers are so self sufficient and don't have such restrictions placed on them.!! I could not imagine working in RNinICU's situation with the acuities she describes, with the limits imposed on her coworkers.

    No doubt the LPN's are as frustrated as the RN's.....I'm sure they WANT to do more and are CAPABLE of much more....but are being held back by state and facility. (which is a whole 'nuther another thread topic, right??)

    God bless ya'll!!!
  8. by   Brownms46
    I can sympathize with you both. But need to clarify...that although the practice act in many states, may limit what LPNs can or can't do....many times it is NOT that state's practice act, that limits the LPNs...but the hospitals themselves!

    I have read many practices acts, that don't place half the limits on LPNs that the hospitals try and make you believe!

    I think more RNs need to start advocating for themselves with administration....and stop making the LPNs the scapegoat for their being overwhelmed! Counting an LPN as the same as an RN in settings where they're so restricted is totally stupid!

    And LPNs who don't see the problem with them being counted the same as RNs in these settings....are walking around with their eyes closed...IMHO! In plain english...if you can't do half the skills needed...then you need to be willing to try something else...to help the RNs their working with! But in NO way should the LPNs feel guilty or at fault for what administrated dictates!

    Instead of focusing on what LPNs can't do...look at what they can do. If you're not ready to lay the buck at the door of those making the decisions...then you have two choices. Figure out a way for LPNs to utilize the skills they can do, and a way for the RNs to receive a break in what they're responsible for. Or you can pick up your cookies and play elsewhere! I think if enough folks put their foot down, as to how much their going to allow themselves to be abused...management will get the idea...especially if it means closing a few beds...and going on divert!!

    As for me...I steer clear of places like this!

    I wish you all the best out there....in dealing with some really challenging problems..
  9. by   mattsmom81
    Well balanced post Brownie....well said!

    One thing we did in our ICU was to create specific UNIT BASED policies....so that our competent LPN's could practice to the limits of their skills ...unencumbered. We all LOVED it!

    Funny thing...when our LPN's floated out to the general floors...THEN they were restricted by THAT unit's policy and hospital general policy, which did not allow them to spike blood, or do the admission asessment, and a few other silly things...

    Perhaps this is something to explore with your unit manager, RN inICU....a unit specific policy allowing the competent ICU trained LPN to assume more duties than other areas of the hospital...a 'special' policy just for ICU...worked well for us.
  10. by   StrawberryBSN
    rn inicu,

    i've been a lpn and now bsn (12 years). i currently work in the er where there are lpn's who are acls and pals certified. they can start an iv, hang ns & lr ivf's, transfuse blood and im, sq & po meds. they can't do initial assessments, triage, iv antibiotics or pushes. there are also other things they cannot do, but what they can do, they do very well.

    i would not have been comfortable working as a lpn in the ccu, but i think lpn's can work in the ccu. as a rn, i would be more comfortable with an experienced er lpn or an experienced med-surg rn with credentials (acls). i'd start by figuring out and documenting what your lpn's can do per your state laws, versus what your med-surg rn's can do per your hospital protocols, versus what your ccrn's can do per your hospital protocols. (this will make sense in a minute). you'll have to determine how staff is budgeted in your unit. is it by $$, acuity or patient specific scores that determine acuity? why? because one of the reasons lpn's are considered in the ccu is their lower salary. they can fill the shortage need at a cheaper rate. your manager is lpn "friendly" so show her that by creating an alliance with the er, she can float er lpn's to your unit based on your current patient census and acuity's. if your hospital "calls off" med-surg rn staff for low census, find out who's experienced with credentials and float those nurses to other needed departments (i.e. your ccu). your lead or charge would determine day-to-day acuity's based on your manager's direction (she'll need to make guidelines) and determine if staffing an er lpn to pick up patients that need less rn specific care is appropriate. or, if a rn is more suited for your census acutity. since your manager is lpn "friendly" no use in never saying a lpn is appropriate. her guidelines should clearly validate when to staff a lpn or rn from the float or call off pool. and i know, "float" staff can sometimes be burdensome too. but once specific staff is floated to your department, but after time they become familiar and its not so bad.

    this solution has holes to fill in too, but it's a blueprint start. you and your management's decision for lpn's can gain from it. let me know if you need clarity on something i might not have elaborated on -and- if it's considered and works for you!

    s_bsn
  11. by   Brownms46
    I'm totally lost here...and I don't understand your reasoning at all!!! I mean...did you read the post from RNinICU...where she wrote that the LPNs in her unit have taken critical care courses...which include ACLS??? And that the problem wasn't that the LPNs couldn't do the skills needed...but were restricted from doing so??? And why would an experienced ER LPN be more effective in an ICU or CCU for that matter??? In your ER...the only thing the LPNs can do...that the ones in RNinICU's unit can't is give blood!! No where did RNinICU..express that she or the other RNs in her unit...weren't comfortable with LPNs that are in their unit!

    Also what makes you think that an experienced med-surg RN would make a good float to a CCU...just because they are ACLS?? Sure they can give IVPs, hang blood, and titrate drips. But who is going to assist them in managing those drips, the pts with hemodynamic monitoring, manage the vents, assist with line placements. Titrating drips require more knowledge than can be gained by completing an ACLS course! Will that med-surg RN with ACLS know what that 12 lead EKG is saying, what that waveform is telling them, what LVEDP is...when waveform calculations are done, what drug needs to be ready when inserting a SWAN...understand the correlation of PAD and PCWP, what IRV is, and when it can be applied...or why...or what a VQ mismatch means???

    Please...enlighten me...as I'm sitting here totally!!!

    And please help me understand why an LPN can give blood, and not ABXs???
    Last edit by Brownms46 on Aug 2, '02
  12. by   Brownms46
    Originally posted by mattsmom81
    Well balanced post Brownie....well said!

    One thing we did in our ICU was to create specific UNIT BASED policies....so that our competent LPN's could practice to the limits of their skills ...unencumbered. We all LOVED it!

    Funny thing...when our LPN's floated out to the general floors...THEN they were restricted by THAT unit's policy and hospital general policy, which did not allow them to spike blood, or do the admission asessment, and a few other silly things...

    Perhaps this is something to explore with your unit manager, RN inICU....a unit specific policy allowing the competent ICU trained LPN to assume more duties than other areas of the hospital...a 'special' policy just for ICU...worked well for us.
    Thanks mattsmom... And I must say..I totally agree with your solution. I think if their going to have LPNs in the ICU...that the those who made that decision should have realized...they were going to have to relax some of the restrictions. Because of the nurse practice act...they may not be able to do that on some of the restrictions...but anything would be better than what they had now!
  13. by   mattsmom81
    We had to stay within out State Practice Act with our unit based policy, this is true. If RNinICU's STATE restrictions are behind this, a unit policy may not help.

    Texas, luckily, has few restrictions on the competent LPN.

    RNinICU may have a very limiting LPN Nurse Practice Act. Some states (and facilities) treat LPN's more like aides than nurses..which is ridiculous, IMO.

    When I said sometimes I was happy to get a brave Med Surg nurse to help me in a pinch, it was just that...a pinch! Sometimes we take any help we can get in a bad situation.....but I sure would not want to work like that on a REGULAR BASIS.

    If it's a question of a medsurg helper or 'nobody', sometimes we punt...on occasion....sorry for any misunderstanding there.

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