LPNs in ICU

  1. 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 able to replace them. Please don't think I am putting LPNS down, I am not. I was an LPN for four years before I was an RN, and I have a great deal of respect for them. The two that have come in to the unit are sweet wonderful girls with a lot of knowledge and they work very hard. The real problem is the limitations placed on them In our state LPNs are not allowed to give IV pushes, hang blood, or hang and titrate drips. They cannot measure hemodynamics, and cannot take verbal orders from a physician. So an RN must do all of these tasks for them, as well as take on a full patient load of her own. The LPNs get very frustrated too when they need something done for their patient and the RN who is supposed to be covering her can't get away from her own patient to handle a problem. We have tried to have an LPN and an RN share four patients, with the LPN doing meds and treatments, and the RN doing assessments, drips and the like, but this has not worked out either. To make matters worse, some of the RNs are hostile to the LPNs, and give them a hard time. Most of us have been supportive of them, but a small number of the RNs have made things difficult in numerous ways. Most of it is very subtle, and is difficult to take anything specific to our unit manager. A few of the docs have also expressed discomfort with the LPNs being in a critical care area. Again, I am not complaining about the LPNs, I am just looking for some feedback and advise on ways to organize care and make this situation a little easier on everyone.
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  2. 134 Comments

  3. by   stressedlpn
    I am an Lpn who wks in critical care our system wks pretty well because we all wk togther. LPN take as much of the load off our RNs as we can. It gets rather hetic at times however the RNs really dont want to be alone or short staffed so they are grateful that we are there. we wk togther and it turns out great. Lots of luck to ya.
  4. by   live4today
    I think Brownie would have a lot of helpful hints for you, RNinICU. Brownie......where are you??? Uuuuuhoooo??? :kiss

    When I "floated to ICU", and BRIEFLY trained in an ICU unit prior to realizing it wasn't my cup of nursing, I do not remember any situations where LPNs were allowed to do the things in ICU that RNs do either, but I'm sure there are plenty of ICU units who do have a workable solution that would help you. I hope your unit staff is able to come up with something agreeable to all involved since it seems as if the LPNs are on your unit to stay...otherwise management....gotta love 'em, eh?....anyhoo...management would not have placed the LPNs on your ICU unit.
  5. by   mattsmom81
    Wow. I LOVE my good LPN coworkers in my ICU.....BUT I have to say I'd be very concerned working with LPN's in ICU in your state. I can't imagine accepting responsibility for 4 patients in ICU...sounds more like a 'delegation' relationship with these LPN's.... and that concerns me.

    My state of Texas is very liberal with LPN's practice...and many facilities here only limit them in terms of charge capability, so I don't mind LPN's caring for ICU patients at all, (as long as they are competent ICU nurses.)

    I know sometimes we do the best we can with what we've got, but if this practice were to become a regular staffing plan (like yours) I would probably feel uneasy. I feel that if my LPN's are NOT ICU QUALIFIED, I must then have some PCU- type patients(ie ready to move out) they can safely care for... or it becomes unsafe staffing in my mind.

    Now my facility pushes to the limit, so we have to stand them down...perhaps yours works with the nurses more diplomatically...(I hope!)

    Another concern I would have is since these LPN's are NOT all clinically competent in ICU, what will the hospital do when you have an exceptionally high acuity group your LPN's can't help you much with?? Will the RN's be hung out to dry, taking responsibility for 4 high acuity patients?

    Keep us updated and best wishes as you try to work this out...you may wish to consider consulting with your state BON for their opinion on this. Good luck...I would be concerned too!
  6. by   adrienurse
    I decline to comment. Whenever I say anything about LPNs I get the flamethrower treatment.
  7. by   rebelwaclause
    Patient care comes first in my book, so I agree that RN's are better suited for CCU settings. Here in California, an RN would "cover" an LVN in situations that the nursing care ordered is out of the LVN's scope of practice. But I can see that as being burdensome in the ICU, an RN would probably rather just resume care of the patient or have another RN who can totally care for the patient.
  8. by   Dayray
    I am an LPN, I dont work in ICU but as a Telemtry tech/ CNA I did work there.

    What I do on my floor is volenteer to take 1 or 2 more patients then the RN's or to take the first admit. I also let them know its okay to aks me to do things for them ie pass their meds, start IV's place foleys, help patient to the BR. It works out pretty well although I have been told that some RN's complain about LPN'S when Im not around.

    I dont think I would want to work ICU as an LPN too many things I cant do.
  9. by   Flo1216
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    Last edit by Flo1216 on Jul 30, '02
  10. by   mattcastens
    Originally posted by adrienurse
    I decline to comment. Whenever I say anything about LPNs I get the flamethrower treatment.
    Me too. I am soooooooo staying out of this one.
  11. by   BBFRN
    I'm an LPN, and I would never work on a unit. I agree that there are too many things I can't do there, and it is NOT in my scope of practice. Since I'm currently working on my RN, I understand that I have much more to learn to be able to do this. Hang in there RNin ICU, and try not to blame the LPN's- the facilities are using us for cheaper labor and to fill critical staffing shortages. I'm wondering why these LPN's didn't refuse to go to a unit. I would!
  12. by   RNinICU
    Originally posted by mattsmom81


    Another concern I would have is since these LPN's are NOT all clinically competent in ICU, what will the hospital do when you have an exceptionally high acuity group your LPN's can't help you much with?? Will the RN's be hung out to dry, taking responsibility for 4 high acuity patients?

    Yes.
  13. by   rebelwaclause
    originally posted by adrienurse
    i decline to comment. whenever i say anything about lpns i get the flamethrower treatment.
    originally posted by mattcastens
    me too. i am soooooooo staying out of this one.
    soooo....if you're feeling the flame coming back to you...maybe you lit the match? respect our discipline, and you'll get respect in return.

    rebel, with a clause.
  14. by   rebelwaclause
    Dearest Registered Nurses,

    When you negatively comment on us Licensed Vocational/Practical Nurses with the undertone of "uneducated dumb-dumbs", we feel humiliated and disrespected. It's a tired and presumptuous thought that we aren't good for anything. I hear the resentment of LV/PN's so often. "They have their place", "They can't do"...Blah-blah-blah. The resentment builds towards LV/PN's when RN's want another RN to work along side of them because those RN's don't require "covering" for nursing care out of scope of practice.

    Fellow RN's, LV/PN's, the patient, doc's...EVERYONE would feel better if those of you who are resentful of our discipline, simply put, just got the h*ll over it. LV/PN's aren't going anywhere, you might as well learn to deal. Remember the word "teamwork?"

    Some of the negativity towards LV/PN's is deep, DEEP bedded and not budging. However, I-4-1 feel better venting it out, instead of looking at RN's, my fellow nursing peers as prejudiced, narrow minded, maturity deprived and inept towards our discipline, and I don't want to feel this way. (I really don't).

    I get the feeling that if it wasn't LV/PN's, some of you would find something else to gripe about and boycott until the world is painted a dull gray. I like variety...How about you?

    Love to you,

    The LV/PN to your right who you just mean-mugged.

    Rebel....With a Clause.
    "One cannot help many, but many can help one"

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