new rules

[tiger]

ok. let me ask ya'll a question. i have worked at a hospital for 12 yrs on an inpatient rehab unit. first we did team nursing, which worked well. then we went to primary care which was ok, didn't like it as much as team nursing. i am an lpn and was allowed to do everything the rn did except iv push and blood and tele orders-but we don't do blood on our unit and the floor rns don't call the doc. a while back, maybe a little over a year, they started making the rns cosign our assessments. no problem at first. recently they decided that only rns can do assessments. therefore i get way more pts than the rn cause they have to do my assessments(and any iv push med which is rare.) we can do our own ivpb. ok. so i have 9 pts. and the rn has three. i am still responsible for all care, EXCEPT assessment. and the rn usually asks me what to put down on the assessment.also the floor rn does not call the doc, check labs, or take off orders. the charge does all this. so, when a pt starts to go bad--who should be documenting and checking everything. i still do it cause i have always done it. but i'm thinking maybe the rn should, since i have so many more pts--cause they don't want me to do assessments. these rns are my friends though, and i don't want to put a strain on our friendship either. it had never been a problem before. just wondering what you guys thought.

[Tweety, BSN, RN]

That's always a tricky question. I usually ask the LPN do to the documenting when a patient goes bad. We assess the situation together, collaborate and decide on a plan of action, the LPN stays with the patient, while I call the MD, take off the orders, arrange for transfer if patient is upgraded, etc. But the LPN does the documentation. Usually, if I have been involved I will cosign the notes.

The LPNs scope of practice here includes documenation, so I "delegate" (if you will) the documenation to the LPN. Then again here, I "delegate" (and I don't mean that in any sort of derogatory or superior manner) the assessments. It is only when the LPN comes to me with his/her assessment problems that I assess the patient and cosign notes. Sometimes on the floor, it's all LPNs and myself (with the RNs in the intermediate part of our unit doing their own thing), so I don't assess every single patient head to toe, only the one's they come to me with. Then I own the assessment.

11 patients is quite a lot of patients for the RN to assess. Plus nine patients for you to be responsible is a bit much too, and I can see your point.

[P_RN, ADN, RN]

In my state the BON ruled only RNs may "assess."

LPNs may "collect information."We'd trade off. I'd do the initial assessments on a pod of ten. The LPN would do the 9 am routine meds with the exception of any direct bolus meds. Then about 10AM we'd both catch up and double team, each one documenting as they go and anything else that needed doing. Each team had a tech for bathing and toileting.

[renerian, BSN, RN]

Here my the laws of nursing only an RN can assess. If an LPN finds anything unusual the RN has to assess it. The LPN can document it.

That is what I usually did and I also was required to cosign her notations.

renerian

[ptnurse]

In my unit the LPNs work completely on their own. And it is quite a rip off for them. They do exactly the same job I do, but make a whole lot less for it. Talk about incentive to go back to school. And the only LPN we have on staff at the moment is in the progess of doing just that.

[Dr. Kate, BSN, RN]

The major difference in practice between LP/VNs and RNs is the assessment of patients.

An RN cannot delegate assessment to anyone else. Assessment is more than just collecting information. It involves analyzing the information and making decisions regarding the immediate and future care of the patient base on that analysis.

I am the first to say, I know and have known LV/PNs who are able to assess and analyze as well as most RNs, and who I'd rather have working with me than a lot of RNs I know. But, that doesn't make them RNs and it doesn't give me the right to ask them to practice outside of their scope of practice. By doing that I jeopardize the LP/VNs license if he or she does what I ask and I jeopardize my own. It's a technicality. But, I for one, worked hard for my license and I protect it.

As we get closer and closer to staffing ratios for all areas of nursing, we are going to see the legal technicalities of scope of practice be a bigger and bigger issue. Because the reality is, in many areas there simply are not enough RNs to fill the spots. LV/PNs will be used. How is going to be creative and interesting, and a new world for many of us.