unworthy of an RN - page 2

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... Read More

  1. by   Dixiedi
    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.
  2. by   Marie_LPN, RN
    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.
    Last edit by Marie_LPN, RN on Jun 28, '04
  3. by   Marie_LPN, RN
    P.S. lying about accu-checks can kill someone.
  4. by   nursepenny
    Quote from Drysolong
    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
    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
  5. by   NRSKarenRN
    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.

    (c) 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/04...1/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.
  6. by   leslie :-D
    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
  7. by   LisaG21
    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
  8. by   Tweety
    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.
  9. by   Marie_LPN, RN
    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.
  10. by   tommycher
    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.
  11. by   Tweety
    Quote from LPN2Be2004
    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.
    Last edit by Tweety on Jun 29, '04
  12. by   Dixiedi
    Quote from LisaG21
    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
    Oh gees, again, I will say the pts are probably in no danger, however, that LPNs license is!
    I would first talk to the charge nurse. The person who is actually responsible for assigning an RN to the LPNs pushes. (Hell, you said the pain med was meant for a pump and she pushed it... yea, they are in danger. Darn, (and that's not what I was thinking, hehehe) you need to take this to the charge nurse immediately.
    Keep yourself out of rear approaching bullets by asking a question like, I was unaware of parameters in which we are allowed to push pain meds when the order is for pump, can you point me into the correct direction to read that standing order policy?
    Yea, the question itself makes you sound as if you have one of your three heads on upside down but at the same time you aren't attacking anybody or accusing anybody. My guess is somebody (one of the other RNs) is initially that med. Then it's your word against hers. You REALLY don't want to go there.
    Years ago I pushed meds (hung in a drained nearly dry piggyback bag - ya got to clear the line of air don't ya? - of NS so they infused in about 3 minutes, technically they were not pushed) also hung TPN and blood and changed the dsgs on central lines all quite legally. But the rules they are a changin' and even if you were dong it at one time the new laws say you can't. Bummer, but that's how it is.
  13. by   CHATSDALE
    as an lpn we have in the past reinserted g-tubes and suprapubic catherters...a one point in time we began sending residents to er (from ltc) for these procedures.....i don't know if this was the company policy or if it was mandated from state..recently one of my co-workers has been doing the reinsertions and i am not sure if this is within the scope of what we should be doing...i know how and have done so many times in the past but i don't want to risk my license in doing so now...by the way the ownership of the the ltc is not the same....i do not want to go to don if this will get co-worker in trouble..kind of between a rock and a hard place

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