LPNs in ICU - page 7

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   TI2Grr
    Goodness, that should be the extent of my comment here. But it won't be.. haha.. I have to say that the person exudes the title for the most part. Experience does as well, but facts remain facts and regulations remain regulations, LPN's are much greater restrictred in their care of patients versus RN's PERIOD. We all have our restrictions don't get me wrong, RN versus FNP, come on I don't want the responsibility to prescribe medications and diagnose patients, I enjoy offering my expert advise which is no different from the LPN's for whom I work with and also enjoy their input in the unit, but when I am expected to supervise and be responsible for their patients I want to know the capability of that particular LPN, and believe you me I know their capabilities, and I respect them totally so for that I am comfortable 95% of the time when I am responsible for their patients. (and heck 95% is my own comfort level at times, I am never 100% comfortable on my own---just the life of the ICU) I only care about the amount of support I must provide and I try to manage my time and make it the most effective possible in taking care of the amount of patient load and acuity. The unit is a complex place in which to work, I am very fortunate that I have a wonderful team where I work. We all look out for each other, we honestly don't care about titles there we do care about the patient that is the most important here. If something bad happens we all feel responsible, yes it is a singular responsibility in most cases, but none of us feel like we are left alone in our ICU. We are all a team and the LPN's are an intricate part of that cog in the wheel, but not any LPN, RN, Critical care aide, or tech are meant to be in the ICU. It does take a special person, pure and simple. Just think of some of the family practice MD's you have seen come in to your unit now and then, and just remember how out of place that most of them seem as well. So unless you belong in the Unit, and unless you are a member of a great team, don't criticize what your neighbor or partner is doing or not doing, because if they aren't doing it right they either need more training or don't belong there. Remeber don't judge the title, judge the person.

    RN who definitely has to much to say.. hahaha..
  2. by   Brownms46
    Originally posted by ITSJUSTMEZOE
    The limitations placed on a LPN in the ICU restrict the type of care needed in a Critical Care Unit, its nothing against the LPNs at all its the fact that they cant do what needs to be done in the critical care setting, its spectrum of care ,not LACK of care.
    You dragged yourself by your post. I didn't write it ....you did! I just responded to it. A little secret about posting here. You post and someone usually responds to that post! Just in case you didn't realize that fine point.

    This was never a cat fight! But maybe you're trying to make it one! ALL LPNs are not restricted in all states, and or facilities! Many places allow LPNs to do just as many skills as RNs...even being in Charge! But do I wish to be in charge?? NO! I have even been offered a head nurse position...by the head of an OB dept. But I turned it down...because one... I didn't have the knowledge base to do so, and I believe that position belong with an RN. Not that I didn't have the knowledge base to work in Ob...because I obviously did. And because the RN supervisor who was present when the position was offered....was so pissed he couldn't speak!!! But it was fun watching him stew ..:chuckle!
    Last edit by Brownms46 on Aug 5, '02
  3. by   StrawberryBSN
    brownms...doesn't it seem a little "enlightenning" to you, that your responses to posts, myself included, are toned a little (lot) harsh?. i'm really not trying to pick on you. i do appreciate that you are thinking out of the box and really trying to understand the complexity of it all. i'm impressed you've got us all thinking. you'd be great in battling policies and procedures. but some of your responses, to me and others are equivelent to a bull-dog attack with a smiley face at the end. calm down a little...you can attract more bees with honey than vinegar.

    i really hope you take this into consideration.

    take care.

    s_bsn

    ps...don't go there! i'm not trying to be sarcastic, mean, rude or otherwise
  4. by   Brownms46
    S_BSN...

    I have always been a very point blank in your face kind of person... ...just my style. Believe me...no harm intended. That is the reason I place the smiley faces at the end...so others will realize that also. I have been posting a long time here, and most here already know that. You don't see any other regular posters and myself disagreeing here. If I put a smiley face at the end of the post..it means I'm not going for the throat...just trying to make my point. But many of us on this BB, have long realized that it is difficult just by reading post to discern a person's feelings.

    So if I come off (lot) harsh...I will be glad to tone it down...but please do the same...K?? Starting with statements like
    really trying to understand the complexity of it all.
    . I understood the complexity of it all...from my first post. I have not changed my thinking since then. I hope I said that nice enough...I truly do..
    Last edit by Brownms46 on Aug 5, '02
  5. by   StrawberryBSN
    originally posted by rninicu


    i had to think about this a while before i responded. i am also not sure what you are suggesting. i don't see how floating er lpns to icu would help. they would be working under the same restrictions as the lpns currently working in our unit, and would be further hampered by the lack of icu training.. the problem right now is that our acuity has been so high, that there are no patients the lpns can handle without a lot of help from the rns, which just increases our workload.


    "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."

    i understand lvn's have restrictions. but does this stop them from anticipating a need? sure, you still have to carry out the duty. but it helps that everything is set up ready to go once you get to carrying out that order (task). i'm not confussed to think this simple suggestion solves everything. yeah..i know...being responsible covering those extra patients is trying to say the least. but you are on the right track solving small problems and saving the big overwhelming hurdles for later!

    i was not aware that your hospital does not have staff for a float pool. is there a referral program intact that you could refer a rn for possible employment? i know it sucks, but if recruiting/hr is not hiring fast enough or just plan ole "enough", maybe you can pull some of your trusted networks aboard. again, i realize time is a factor...and waiting it out is a bummer. if the situation is unbearable....move on.

    our er staff, even the rns could not handle a lot of our patients. the er staff stabilizes patients, and sends them to us. they do not manage iabps, vents, or dialysis. when they have a vent patient waiting for transfer to us, there is an rt there with the patient at all times. and our rn staffing is so low throughout the house that there is no one else to float into icu.


    i didn't understand your staffing is so low that no float pool could be created. management needs to do some recuiting! i do still believe:

    "the med-surg and er 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." the lpn's that are currently in your ccu may already be doing this. if so, great! they are doing at max waht they can do

    i disagree that er rn's can't transition to ccu. don't we start the care that you finish? we may not "manage" day-to-day nursing care interventions, but we know how to. we may appear like we don't know much about ccu, but in fact...we do.

    the original inquiry was for any suggestions on how to organize care and allow the rns and lpns to support each other, instead of resenting each other. i appreciate your very thoughtful response, but i don't think it can be applied in our unit.
    good luck to you...i hope things get better and eventually work out! please let us all know how this mammouth was tackled!

    s_bsn
  6. by   RNinICU
    originally posted by strawberrybsn


    "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."

    i understand lvn's have restrictions. but does this stop them from anticipating a need? sure, you still have to carry out the duty. but it helps that everything is set up ready to go once you get to carrying out that order (task). i'm not confussed to think this simple suggestion solves everything. yeah..i know...being responsible covering those extra patients is trying to say the least. but you are on the right track solving small problems and saving the big overwhelming hurdles for later!

    i was not aware that your hospital does not have staff for a float pool. is there a referral program intact that you could refer a rn for possible employment? i know it sucks, but if recruiting/hr is not hiring fast enough or just plan ole "enough", maybe you can pull some of your trusted networks aboard. again, i realize time is a factor...and waiting it out is a bummer. if the situation is unbearable....move on.

    [/b]

    i didn't understand your staffing is so low that no float pool could be created. management needs to do some recuiting! i do still believe:

    "the med-surg and er 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." the lpn's that are currently in your ccu may already be doing this. if so, great! they are doing at max waht they can do

    i disagree that er rn's can't transition to ccu. don't we start the care that you finish? we may not "manage" day-to-day nursing care interventions, but we know how to. we may appear like we don't know much about ccu, but in fact...we do.



    good luck to you...i hope things get better and eventually work out! please let us all know how this mammouth was tackled!

    s_bsn
    [/b]
    i don't mean to be sarcastic, but you admit you don't understand the situation, yet you seem to have all of the answers. my hospital, like so many others is making a major effort to recruit rns, but we are still very short staffed. but there is a major teaching hospital 20 minutes from us, and six other small community hospitals within a hundred mile radius. competition for rns is fierce. up until a few years ago, our hospital was considered one of the best to work at, but since we have become part of a larger health system, staff is not as happy here. retention is a real problem.

    you also seem to take a lot of what is posted here personally. i am not saying that lpns cannot function in icu, just that they are not allowed to in my state and facility. i do however believe that staff from other units, including the er cannot function independently in an icu. our staff goes through a one on one orientation, as well as critical care and dysrhythmia courses. have you ever managed a swan catheter or a balloon pump in the er? could you handle them if you are pulled to icu? without training in how to work with them, how could you "anticipate" what i need for these patients if you do not know anything about the equipment?

    we have been told that the lpns are in our unit to stay. two of our rns have left within the past three months because they do not want the responsibility of four high acuity patients. i have been employed here for 25 years, and i am seriously thinking about leaving also. i don't want to give up the benefits i have now and the time i have accrued, but i don't want to be a part of this situation.
    Last edit by RNinICU on Aug 6, '02
  7. by   Teshiee
    Again the powers that be arent seeing the big picture. It seems they just said, "Let's start using LVN/LPN's but leave it up to the staff to find out how to utilize them in a critical setting. It is so political. It is unfair for both nurses. RN's have enough to contend with then to come behind another nurse making his or her work load much more difficult and the LVN who feels like he or she can't perform their job because of the stipulations of their scope. I know LVN/LPN are capable of doing a lot but their scope is limited I can see LVN\LPN being utilize in a step down unit and or team up with a RN to share duties that is in their scope but I see potential abuse in that too. I know there are no easy answers I just wish administrations would do the research and plan it thorougly before throwing them out to the wolves.
  8. by   nkny
    I have been an LPN for 27 years, I worked for 10 years in ICU. I am cccu certified, ekg,iv certified,have my acls,and pals certifications. Granted Iknow there are some things I can't do that an RN can, but don't I deserve the respect for what I do know. There are many LPN's out there with alot of knowledge, shouldn't we be respected for that. I am close to finishing my RN, but donot know if I want to anymore, a nursing instructor once told me " you can learn something new everyday from anyone, be it an rn,lpn, aide, md, cleaning person ,or faimly member" I have always tried to remember this. It seems that the rn's coming out of school think they have all the answers, we are beneath them, they would rather make a mistake than ask an lpn for advice. With the nursing shortage why doesn't someone look to the lpn with years of experience and find a way to get them there rn's?
  9. by   fadingyouth
    [quote]originally posted by strawberrybsn
    [b]brownms...doesn't it seem a little "enlightenning" to you, that your responses to posts, myself included, are toned a little (lot) harsh?. i'm really not trying to pick on you. i do appreciate that you are thinking out of the box and really trying to understand the complexity of it all. i'm impressed you've got us all thinking. you'd be great in battling policies and procedures. but some of your responses, to me and others are equivelent to a bull-dog attack with a smiley face at the end. calm down a little...you can attract more bees with honey than vinegar.
    -----------------------------------------------------------------------------
    hmmmmmmmmm, is there then the assumption that lvn's cannot think, that they cannot perform complex tasks, cannot assist with care plans or critical care management?
    personally speaking, a lot of lvn's( and yes i am one) are able to and often asked to provide input into the total care of the critical care patient. in some cases, physicians who have known you for years would rather have your input then a young rn's that they do not know.
    i'm not sure, but i think that it's known as a matter of respect.
    i have new grads that come to this "seasoned" lvn to ask about drugs ( how to give it, side reactions, the effects), ask about the primary and secondary diagnoses and possible interventions so that they can write their care plans adequately.
    do i ,or anyone else, have all the answers---of course not.
    we have all at some time has a "i don't know" from someone who was supposed tobe our resource person.
    i, like brownms, have been offerred positions that we kindly bow out of. i do , however, love the look on the face of someone who has shunned you when a particular physician or supervisor comes to give you a hug and talk.
    perhaps you might consider taking your own advice and place a little sugar around your comment.
    being an rn does not equal a genius level iq and we can always equate strawberry to something else.
    good thinking!!
  10. by   Brownms46
    EXCELLENT POSTS RNinICU,Teshiee,nkny, and
    fadingyouth! BRAVO!
    !

    I agree, with much of what you all have written! It a darn shame, that mangement can't see the complexity of what they have done to this unit! But soon they will discover, that have helped their remaining RNs and possibly the LPNs, they have thrown into this unworkable situation, to take their toys elsewhere. And who will suffer the most? The pts.! Maybe it's time for administrations across the country, to join with the Nursing Boards across the country, and develop realistic guidelines for the LPN, just as the LVN boards have. It has been proved that an LVN can and does work well in the critical care setting. But you can't put an LPN in that setting, and then tell them they can't do any of the skills needed! And then expect the RNs to assume the skills, the LPN can't do! I agree...that admin should have worked out this problem, before throwing these nurses into this mess

    RNinICU....I'm afraid....the only thing your administration will listen to, is the patter of feet exiting the building. Sad...very sad.
  11. by   Teshiee
    Hi Brownie! I know there are a lot of very knowledgeable LVN/LPN'S and I think they can work out a solution but wont just keep nurses badgering against one another when both can contribute to giving best care possible. I know now that our powers that be do not have nurses in general our best interest at heart if they did this wouldn't even be an issue. It is a shame because we can learn from each other instead of disrespecting each other's title. :-) just my nickel's worth.
  12. by   mattsmom81
    [quote]originally posted by strawberrybsn


    i disagree that er rn's can't transition to ccu. don't we start the care that you finish? we may not "manage" day-to-day nursing care interventions, but we know how to. we may appear like we don't know much about ccu, but in fact...we do.


    sbsn, please refer back to various posts by brownie, rninicu, myself where we describe in detail some of critical care patients. please ask yourself honestly.." do i as an er nurse really posess the competence to be responsible for these patients?" now be honest here....we're talkin' on the basis of your er experience alone.

    i will repeat...er and icu are two different areas...i have done both so i feel justified. 'starting' the care does not equivocate 'providing critcal care'. i've had er nurses run not walk out of my unit when they realize what goes on there...and most of my er pals hate working icu...they prefer their 'in and out' world of er....with a doctor or two readily available to them. icu doesn't do 'in and out' nor do we have docs constantly available on the premesis. there's also nowhere else to go for our patients in icu....we have to handle whatever comes and stays....quite different than er who can turf 'em.

    now i sense you're feeling a bit angry because brownie is confronting some of the things you are saying...i have to say i question some of your comments as well. perhaps you aren't realizing it, but some of your comments have come off like "what's the big deal here?" you've done this in other threads too...like the one about the cna calling herself "nurse judy" ...maybe you have not intended this attitude, as the written word doesn't always translate well...

    whether an er nurse, lpn or rn is sent to be my 'helper' on a short icu shift, there comes a time when 'helpers' in lieau of competent practitioners will create an unsafe environment...critical care nurses can only be stretched so far in providing supervision to helpers. most of the critical care nurses in this forum have felt 4:1 carries an unacceptable liability and safety risk, and we are concerned for rninicu.

    we need both competent icu nurses, and safe icu nurse-patient (2:1 core) ratios to provide today's level of icu care!

    now...no more fightin', chilluns, can we talk????:kiss
    Last edit by mattsmom81 on Aug 6, '02
  13. by   Brownms46
    Hi Teshiee..,

    Your input is a lot more valuable than a nickel.... You hit the nail on the head. No they don't have the nurse's best interest in mind, when they make situations like this. But in RNinICU's unit, they have made this mess, and now refused to admit it. They're trying to make it an RN/LPN problem...but it's not. It's fact that they're tying the hands of those LPNs in that unit, and want the RNs to take up the slack. And it's not fair to any of the nurses in that unit. Just like their interpretation of an LPN not being able to take verbal orders. They misintrepreted the boards statement, that LPNs can only take orders in emergent situations. Being in a ICU is emergent situation!

    I think just as CA has modified the practice of LVNs, the state RNinICU is in...should do the same. If you're going to have LPNS in the unit...they should be able to do the skills in that unit. And not depend on overstretched, overburdened RNs. If they're there to stay...make it possible for them to do what is needed!

    I can't even imagine the stress of being an RN in that unit! I would be sick from just thinking about going to work. On pins and needles wondering just how bad it might be! RNinICU wrote, that right now....there are no pts, that the LPNs could take, without a lot of assistance from the RNs. Now I have had pts. in the ICU, that had me running the whole time I was in the unit. I have walked and had pts, with so many lines, I had to follow them from the pt., and tag them. I couldn't imagine being an RN, with these pts, and covering for an LPNs with the same kinds of pts!!! Talk about overwhelming I have to appauld RNinICU for walking into that unit, everyday...knowing what is to come! But I also have to wonder...how long...will it be...before the pressure becomes too much to deal with???
    Last edit by Brownms46 on Aug 6, '02

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