LPNs in ICU - page 5
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
Aug 2, '02I took Brownies advise and checked my state's nurse Practice Act. I found out that some of the restrictions, in particular the one about taking verbal orders, was a hospital restriction, not a state one. I printed a copy to take in and show my manager, and she told me she was aware of this. She then offered the hospital's interpretation of this law, which in general states that an LPN can take a verbal order in an emergency, as long as she understands the order. She said that since there is always an RN present to take orders from MDs, even in the most emergent situation, that this law does not apply. If an RN is present, then the situation is not emergent enough for an LPN to take the order. Sounds like the kind of corporate doublespeak we've been hearing since our community hospital became part of a large healthcare system a few years ago. So, looks like this systemis going to continue until we refuse to do it, or something adverse happens to a patient. I did call the supervisor last night and told her I was calling off sick if I did not at least have one other strong RN there also. Amazingly, the guy who had been called off for a low census day was called back in.
Aug 2, '02mattsmom...I understood where you were coming from.... What I'm about is where S_BSN is coming from. Yes...I do beleive a hand is better than no hand. But floating untrained nurses into the critical care setting is accident waiting to happen IMHO.
And RNinICU...good for you! At least you're trying to do something about the problems you face! And you know...I had a feeling that your hospital would use exactly the interpretation they did. They just want to push the responsiblity onto the RNs, and could care less how this affects them! But I have to give it to you....for not just taking their crap lying down! And way to go in getting the help you needed! You hang in there, and keep making them do the right thing!
Aug 2, '02I would also like to know the reason why an LPN can hang blood and not abx?
I also have a hard time understanding why they can't take an order? I mean I understand that it's a law there but I just don't see what the reasoning would be.
Aug 2, '02From what i understand the not takeing verbal orders is a medicaid issue. It has to with, care haveing to be cordinated by an RN there for the RN must be the link between the Doctor and other staff ie LPN's
I have floated to SNF and I can take TO or VO orders there, as an LPN. I also hear the LPNs can take orders in rehab and in nursing homes.
Its very annoying to have to beg an RN to call a doc for you and even more so to have to run after a doc to wright down that order she gave you for MOM or something as silly.
Aug 2, '02I am a licensed RN in both Ohio and Pennsylvania. I know that in Ohio LPN's cannot give any IVP med's except to flush a saline lock. They can start IV's on Adults in Upper extremities only. They can initiate Iv therapy of regular fluids such as D5W, NSS and combinations of both. They can MAINTAIN an IV fluid with KCL as long as that infusion was initiated by an RN. LPN's in Ohio cannot by law hang blood, TPN or any other med(like Dopa, Dobuta, Heparin, Insulin drips). They are allowed to give certain IV antibiotics piggyback. LPNs in Ohio are allowed to take verbal and phone orders from Doctors but aren't allowed to note those orders(the last part is a facility restriction not a State one).
I think that the rules in PA are similar but I could be wrong so any PA LPN's out there please correct me.
So, because of the State of Ohio's restrictions on LPN's in regards to IV therapy, I personally wouldn't want to work with them in a Critical care setting. No flame throwing please.
Aug 3, '02We had a meeting with our director of medical services, and our emerg director about a new policy to hire two care aides instead of two LPN's in emerg. The emerg management read an exerpt from NENA (nation emergency nurses' affiliation) It is a long excerpt, but basically she read it to make her position known.(She is on the record for not liking LPN's-quoted as saying we would want to do too much.)Anyway the excerpt bascially stated that having LPN's in emergency departments increases the rate of patient mortality. We all left that meeting with their footprints on our butts. Now we are in correspondence with the provincial health minister, and our college of licensed practical nurses. I still feel sick to my stomach. Yes, we don have a different depth and breadth of knowledge, but it can be a viable partnership in the health care system. Why it works in some hospitals and not in others is a complete mystery to me.
Aug 3, '02Leeson, the attitude of your director could use an overhaul for sure...it angers me to hear stories like this. So unnecessary to belittle another.
Hang in there...maybe you can educate her about your value....if not, find a better place where you can get the appreciation you deserve!!
Aug 3, '02I guess it would be hard because RNS have to take care of their own pts and then cover the LPN. The LPN has to run around and find the RN to do the things the hospital doesn't permit them to do and then the RN gets resentful because they still have to take care of their own patients and the LPN gets resentful because they feel like they can't do their job. It seems like it can get a bit dangerous. Not because of incompetence , but because of too much thrown at one person. As for the mortality thing,did the director have research to back it up????Just curious.Last edit by Flo1216 on Aug 3, '02
Aug 3, '02No, she just read it off her copy. it was an american study so it wouldn't be applicable because canadian LPN's have a different scope of practice here. You're right though, to drop a bomb like that, it should be backed up by case studies. Our medical director did us a great disservice by letting that go through.
Aug 3, '02Originally posted by Dayray
From what i understand the not takeing verbal orders is a medicaid issue. It has to with, care haveing to be cordinated by an RN there for the RN must be the link between the Doctor and other staff ie LPN's
If it's a medicaid issue...why doesn't it effect all the other states, when LP/VNs can take verbal orders???
PA's nurse practice act does not that LPNs can't take verbal orders! That is the facilities interpretation of what it says!
And NO the practice act in PA is not similar to Ohio. The PA
practice act only states that LPNs can not do the following:
"The LPN is not authorized to administer the following intravenous fluids:
(A) Antineoplastic agents.
(B) Blood and blood products.
(C) Total parenteral nutrition.
(D) Titrated medications and intravenous push medications other than heparin flush. "
Last edit by Brownms46 on Aug 3, '02
Aug 3, '02originally posted 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???
i didn't say the plan was an end all to the situation. but instead of repeating past posts of frustration, i thought i'd offer another approach. the med-surg rn's won't be "new" forever...and it will take time to become familiar with ccu care. my suggestion for er lpn's was becuase it was mentioned the ccu manager wasn't willing to remove them completely. if i had to work with an lvn, i'd rather work with one that can "anticipate" what might come next after any given emergent procedure or treatment, as opposed to being ???lost???. they can grab treatment equipment and set it up without me having to do it myself. one less step i have to do.
a bigger issue here is that there aren't any ccu staff available. it's not like new nurses are jumping at the chance to train as ccu nurses, at least that's what i see in my neck of the woods. i myself don't care to strictly be a ccrn, though i'm occassionally floated to the unit. my suggestion with time would work, but the unfortunate thing about it all is staff gets burnt-out waiting for the "education" to kick in, let alone sub-standard patient care. i won't get into my frustrations, as i said, this had been addressed over and over again in previous posts. can't add anymore to what has already been said!
ps...lpn's can hang blood, not antibiotics in my state. why? you'll need to ask the state that question.
Aug 3, '02In California LPN's can take a verbal or telephone order that is within their scope of practice, (PO, IM, SQ meds or whatever is needed in their scope), but I have to sign (note) it off.