unworthy of an RN

Nurses General Nursing

Published

Hey guys I have a question. I am an extern at one of the hospitals near my home, and I will be graduating from a BSN program in may. During my time as an extern I have witnessed a lot of acts done to patients that I feel are wrong, but I don't have a better way of handling the problem. I also have a LPN/RN issue if you guys could give me your help on these problems I would greatly appreciate it!

1. There is an LPN who has worked on my floor for probably 20 years. She does stuff that she is not allowed to do (IV push drugs, and so forth) as an LPN. I am new to the floor I have only been there 6 months. How do I handle this?

2. I was waiting to clock out, and I heard an RN ask a tech if she had turned someone in another room. The tech said she couldn't remember, and she went to go see who it was. The RN continued to say to me that she didn't turn the person because she has been in the same position since she came in! SO doesn't that make the RN just as bad?

3. We get a lot of Alzheimer patients. And we get our share of beatings and spitting and cursing at. Is there another way to settle these patients and not use restraints? I mean I understand when someone is hitting you with her cane and trying to break your arm you have to do what you have to do, but I feel that there are other options than to use restraints on some of these poor patients. Anyone have any ideas on how to calm a pt. or help them stay safe without the use of the restraints when they are in a rage?

Specializes in Med/Surg.

I am an LPN and do IV push meds, blood transfusions, start IV's, draw blood, do assessments, etc, etc, etc...about the only things I can not do at my hospital is charge, and push a few cardiac meds. Check and make sure that LPN is not allowed by state law to do the things she's doing. And if it is not in her scope of practice, then yes she is doing something wrong. I would talk to her about it and if it continues, report it to your manager. (I know what you mean by this though, we have a CNA/tech who starts IV's all the time, even though it is definitely not in her scope of practice...we are all just waiting for her to 'get caught' by management and get fired, since we have all talked to her and the manager about it and it still goes on.)

As for the tech/CNA not turning the patient, yes the RN is just as responsible for the patient being turned! A lot of RN's and LPN's do not feel like it is 'their job' to do the actual turning, but they are responsible to see that it gets done at least q2h, whether by delegating it to someone else or doing it themselves. So, yes the RN and/or LPN is ultimately responsible for that patient being turned.

Being a new nurse, you will encounter some people doing stuff wrong, or taking shortcuts, or simply not caring...by doing the right thing yourself, you can help set a good example for others. Or, if that doesn't do it, at least you can go home and sleep at night with a clear consience.

Hope this helps! :)

P.S....About your post above, lying about vitals!!! that is horrible! A nurse here in Indiana (RN) recently lost her license FOREVER for that! She is skating on some very thin ice!

1) Some LPNs are certified to push meds find out first. If she is not certified, you should stay out of it until you are an RN and are assigned an assignment with her. She's been pushing them for a long time and tell me the truth, how many RNs do you know that actually go back and check the pt they have pushed for an LPN? It's the LPN who assesses the pts action/reaction and that's the big issue with meds, not the physical task of administration. Be safe on this one, protect yourself first, protect the hospital last. The pts are very likely in no danger.

2) Yes, I think the nurse should have said something to the CNA after the first turn was missed and if still not done she should have done it herself.

3) They can be chemically restrained, but don't you thing a soft restraint is better than drugging them? Restraining an Alzs pt who has gotten feisty with the staff is preventing that which usually comes next... they hurt themselves.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

If the LPN is not allowed to do IV push meds, then he/she is not to do them. Simple as that.

The RN is ultimately liable that her pt. wasn't turned. (And i say that after numerous nights of being the only CNA/Tech/Extern on a filled 35 bed floor, and 20-25 of those people being turns. It's one thing if the person's lazy, but when they have the workload from hell, don't expect people to have the ability to be in 3 places at once.)

Restraints should be a last resort if possible. The goal is what's ultimately best for the pt.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

P.S. lying about accu-checks can kill someone.

I am a student in the Atlanta area - I and my classmates have been discussing that the nursing opportunities (LPN) outside of Atlanta are more numerous and better paid. What is your opinion:coollook:

I make $14+ and hour with time and half for anything over 40 hours, $1.00 hr shift diff, paid holidays, accrued vacation and sick time, free dental and reduced cost health insurance, and $100.00 bonus for any extra shift work above reg. scheduled hours.

I just worked a bonus day and the rate of pay was approx $29+ for the extra 12 hour shift. This is not the norm though. I normally work 48 hrs. one week and 36 the next. Which equals 8 hours overtime per pay period. I admit the money is not great, but this is So. Ga. LOL. The benefits are fair and i guess when you average eveything out I make a decent living. The cost of living is not as high here as in some other places.

Hope this helps :p

Specializes in Vents, Telemetry, Home Care, Home infusion.

pa lpn scope of practice re infusion therapy

(f) the lpn may perform venipuncture and administer and withdraw intravenous fluids only if the following conditions are met:

(1) the lpn has received and satisfactorily completed a board approved educational program which requires study and supervised clinical practice intended to provide training necessary for the performance of venipuncture and the administration and withdrawal of intravenous fluids as authorized by this section. (2) a specific written order has been issued by a licensed physician for an individual patient under the care of a licensed physician.

(3) the lpn complies with written policies and procedures which are established by a committee of nurses, physicians, pharmacists and the administration of the agency or institution employing or having jurisdiction over the lpn and which set forth standards, requirements and guidelines for the performance of venipuncture by the lpn and for the administration and withdrawal of intravenous fluids by the lpn. a current copy of the policies and procedures shall be provided to the lpn at least once every 12 months. the policies and procedures shall include standards, requirements and guidelines which:

(i) list, identify and describe the intravenous fluids which may be administered by the lpn. the lpn is not authorized to administer the following intravenous fluids:

(a) antineoplastic agents.

(b) blood and blood products.

© total parenteral nutrition.

(d) titrated medications and intravenous push medications other than heparin flush.

(ii) list, identify and describe the circumstances under which venipuncture may be performed, including technical and clinical indications. (iii) list, identify, describe and explain principles, including technical and clinical indications, necessary for the identification and treatment of possible adverse reactions.

http://www.pacode.com/secure/data/049/chapter21/s21.145.html

part of becoming a professional rn is to always keep patient safety in mind and knowing when to use the chain of command.

i would approach the nm with an open mind re exploring "hospitals policy on who can administer iv pushmeds" and read the policy "as trying to prepare for when i graduate"

did you actually read the kardex and see the nurse give an iv med, was s/he just flushing the iv with nss/heparin or was this a self statement from the lpn?? answers may give you clues how to proceed.

pa rn law states:

21.18. standards of nursing conduct.

(a) a registered nurse shall:

(1) undertake a specific practice only if the registered nurse has the necessary knowledge, preparation, experience and competency to properly execute the practice.

(2) respect and consider, while providing nursing care, the individual's right to freedom from psychological and physical abuse.

(3) act to safeguard the patient from the incompetent, abusive or illegal practice of any individual.

(4) safeguard the patient's dignity, the right to privacy and the confidentiality of patient information. this standard does not prohibit or affect reporting responsibilities under 23 pa.c.s. chapter 63 (relating to the child protective services law), the older adults protective services act (35 p. s. 10211--10224) and other statutes which may mandate reporting of this information.

(5) document and maintain accurate records.

(b) a registered nurse may not: (1) knowingly aid, abet or assist another person to violate or circumvent a law or board regulation.

if you directly observed the lpn giving an iv medication it is your responsibility to bring this to the nurse manager's attention. a discussion should take place that the manager will investigate and speak with the nurse.

if nothing changes, document and send your concern up the chain of command. is there a medication hotline or compliance# you can call?

you are protecting both patients and the facility this way....however be aware some may view it as "interference" and your externship come to a quick end. we are here to support you in your decision.

there is nothing more discouraging and disheartening in the nsg. profession, as to witnessing shabby and illegal nursing practice, i.e., faking vs, accuchecks etc. you are correct in being so bothered by what you are observing...just keep in mind, like karen stated, it might be the end of your externship. some of us are perceived as 'trouble' and often times the employer will regard the whistleblowing employee as the liability, and not the perpetrators themselves. take if from someone whose been there. and inspite of this 'inconvenience' currently in my life, i would have never done anything differently. please feel free to pm me, if you wish.

leslie

Thank You guys again!

First off let me say that the LPN is not to push medication. I know for a fact she is not certified to do so. Also it was not a heparin flush it was pain medication on two patients (morphine that was supposed to be put in a syringe pump) and I am not sure of the other medication. On one other occasion the lpn told me if the person was on comfort measures it did not matter if she pushed it or hung it. I didn't question it until I saw the other pushes.

Secondly I know that this cuold mean the end of my externship if I say something, however do I really want to work for a place that allows such behavior to go on?

Thirdly I think I have diecided that I am oging to write a letter annonymously to the nm. I will include everything - I know writting a letter will help me get everything out because if I just talked to the nm I will forget stuff because I would be so nervous. Should I put general ideas, or make it specific and put names and so forth in it?

Lastly I think I am going to start speaking up. When an RN has a problem with the work of another and it is just the RN being lazy. I will say well, she works under your liscense so maybe you should have done it.

Thanks again you made me think on another level about the situation

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

You probably don't want to work at such a place. Sounds like a lot of unprofressional behavior.

I would think about the anonymous letter, that's not all too profressional IMO. If you feel strongly about instituting change in this place then you should be able to say what you have to say with intregity in person. But I don't know it all and maybe someone can advise you on that.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

What's non-professional is already going on. I've wrote letters complaining about charge nurses when i worked in nursing home, and one time i signed my name at the bottom before i turned it in to the NM. And i was pretty much treated like a backstabber, which can make a work environment pure hell. Yes, this should be a situation where you should be able to put the name on the paper, and not seen as the enemy, but it doesn't always happen that way. That's why I like our facility's "Anonymous Option" on the complaint forms. The forms are filled out a lot more often, and a survery "in house" showed that people were more comfortable doing it this way, because they felt burned at the stake before.

I graduated from the vocational nursing program at a community college that was six months longer than many area programs. We did learn, and practice in clinicals, IV starts and IV pushes. I am always surprised when an lvn at our hospital has not learned these things in school. Our facility sends the nurses from these programs through a course at the hospital to qualify them to perform these functions. I work on a telemetry unit, have had ACLS, and we have a charge nurse with as many pts as we have. When a pt requires blood products, the RN starts the infusion and stays for the first 15 minutes. It is our responsibility to observe vitals and assess for rxns. I guess it all depends on where you are.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
What's non-professional is already going on. I've wrote letters complaining about charge nurses when i worked in nursing home, and one time i signed my name at the bottom before i turned it in to the NM. And i was pretty much treated like a backstabber, which can make a work environment pure hell. Yes, this should be a situation where you should be able to put the name on the paper, and not seen as the enemy, but it doesn't always happen that way. That's why I like our facility's "Anonymous Option" on the complaint forms. The forms are filled out a lot more often, and a survery "in house" showed that people were more comfortable doing it this way, because they felt burned at the stake before.

Probably this is true. We have an anonymous line, but it's a phone line. Where we report concerns. Recently my unit was investigated by a report of favortism. So it does have it's advantages.

I would use something like that rather than write an anonymous letter and slip it into my manager's box. If I can't talk to my manager face to face about my concerns and be respected, then I'm outta there. I'm fortunate that I've always had manager's that I felt that I could go to with my concerns and not feel "punished" for it. I realize that not everybody is that lucky. Not that my managers were all that great either. :)

+ Add a Comment