unworthy of an RN - page 3

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
    Quote from 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
    I am still allowed to change G-tubes, trachs (that's bout all I ever run into to) so it may just be a facility policy. I your turn-over rate high? Could be they just got tired of not having anybody on duty with the experience. Ask. Could be they are just waiting for somebody with experience. I read the Ohio Scope of Practice not too long ago and don't remember anything the prohibits us from changing these things.
    I don't think I will ever get over how much they think we are incapable of these days. Yes, acute care has changed a lot and the pts are far more "ill" than they used to be - in acute care - but changing the above is required routinely in LTC and who do the states think have been changing them for years? Sounds to me like the ANA is simply ensuring the need for RNs and pushing the BON into making us look like idiots who shouldn't do more than empty a bedpan in LTC facilities - you know, after the pt has lots of experience themselves! LOL
  2. by   leslie :-D
    i so strongly agree that lpns are underutilized. that would help our shortage right there, if we could extend our responsibilities to lpns.
  3. by   Tweety
    Quote from earle58
    i so strongly agree that lpns are underutilized. that would help our shortage right there, if we could extend our responsibilities to lpns.

    And then of course we need to pay them for what they do.
  4. by   PaulMedik
    As an extern and nursing student, if you witness illegal medical practice you are obligated to file a written report of your observations to your state board of nursing. Before you file such a report, you need to be 100% certain that your assumptions are correct concerning the LPN scope of practice in your facility and in your state.

    As an employee of your facility, you are also most likely obligated to notify, in writing, your immediate department manager or the hospital nursing supervisor.

    Do keep in mind the fact that your silence may be held against you if the feces hits the orbital air circulator. Make sure you're right then do what's right.
  5. by   Drysolong
    Quote from earle58
    i so strongly agree that lpns are underutilized. that would help our shortage right there, if we could extend our responsibilities to lpns.
    In my state, there is also a shortage of LPN's
  6. by   pickledpepperRN
    Quote from 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
    Each state seems to have a different practice act. Here is Louisiana:
    http://www.lsbpne.com/scope_of_practice.htm

    The practice of practical nursing is defined in Section 961 of Chapter 11, Louisiana Revised Statutes of 1950. According to this law, practical nursing is the performance, for pay, of acts in the care, treatment or observation of the ill and for the maintenance of the health of others and the promotion of health care. Practical nurses may train and/or supervise other nurses, and subordinate personnel. They may also instruct patients.

    A licensed practical nurse must practice under the direction of one of the following: licensed physician, optometrist, dentist, psychologist, or registered nurse. A licensed practical nurse may perform duties consistent with his/her educational preparation. The licensed practical nurse may also, with appropriate training (which is approved by this Board, and documented), perform additional specified acts which are authorized by the Board of Practical Nurse Examiners when directed to do so by the licensed physician, optometrist, dentist, psychologist, or registered nurse.

    The Louisiana State Board of Practical Nurse Examiners (LSBPNE) has no "laundry list" of tasks/skills an LPN can perform. Such lists tend to limit practice. Scope of practice is a fluid concept. It changes as knowledge and technology expand. LPNs must possess the knowledge, skill, and ability to perform their duties, therefore, scope of practice comes down to the competency of the individual LPN.
    Following are some of the tasks (those most frequently inquired about) an LPN may perform when the above conditions are met (NOTE: THIS LIST IS NOT INCLUSIVE OF ALL OF LPN PRACTICE AND SHOULD NOT BE USED TO DEFINE OR LIMIT PRACTICE):

    Initiate and maintain IV therapy and administer IV medications by IVPB and/or IVP (including hyperalimentation, blood and blood products)
    Reinsertion of suprapubic catheters
    Accept verbal/phone orders directly from the prescriber (an optometrist, advanced practice registered nurse, physician, dentist, or psychologist)
    Perform heparinization during hemodialysis
    Serve as first surgical assistant (but may not suture, dissect or cauterize)
    Maintain and administer meds via heparin locks
    Pap smears/GC cultures/IUD string checks/Fundal heart tones/Leopolds Maneuvers
    Apply Unna Boots
    Load/monitor PCA machines
    Care for clients with external venous catheters (including Hickman, Groshong, Brovia) and specifically: obtain blood specimens/connect and monitor IV fluids/connect IVPB, provide site care (including dressing changes)
    Care for clients with internal venous access devices (including port-a-cath, life port) and specifically: access with and/or remove Huber needle/draw blood/connect and monitor IV fluids and provide site care (including dressing changes)
    Insert a feeding tube in a neonate
    Reinsert a tracheostomy tube in an established tract
    Remove sheaths in a cardiac cath lab and later D/C these lines
    Perform tasks which promote pulmonary health and hygiene (administer oxygen, aerosol and IPPB treatments, suction, perform CPT, etc.). LPNs MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS.
    Perform "head to toe" physical assessments

    Please call or write the Board if you require further clarification.
    Louisiana State Board of Practical Nurse Examiners
    3421 North Causeway Blvd., Suite 505
    Metairie, La 70002
    (504) 838-5791 FAX (504) 838-5279
  7. by   Godswill
    Quote from 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
    I am not a LPN yet, (I am 2005 lpn graduate) but i do believe this is allowed in louisiana, since it states that the Practice act is not use to define or limit practice. I am guessing if are truly trained or certified to do the task, u probaly could do it if it's allowed at the place u work.
    Last edit by Godswill on Jul 1, '04
  8. by   pickledpepperRN
    Quote from Godswill
    I am not a LPN yet, (I am 2005 lpn graduate) but i do believe this is allowed in louisiana, since it states that the Practice act is not use to define or limit practice. I am guessing if are truly trained or certified to do the task, u probaly could do it if it's allowed at the place u work.
    I never went to law school but it seems the reasons in Louisiana for an LPN not to perform a procedure are:
    1. I not directed to do the task.
    2. If the policy at the facility does not allow it.
    3. If you are not competent to perform the procedure.
    3. If additional certification beyond the LPN license is required. (and you don't have it.)


    Don't take my word for it but I think you are right.
  9. by   Rick-Wood
    Quote from LisaG21
    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?
    Reply to Question #1. Hands down, I would want to talk to the Standards Committee in my hospital about this, or to the DON, or the Risk Assessment Team, or someone who will listen. There are legal ramifications which need to be brought to the attention of those who deal with the legalities of how nursing is practiced in the hospital and in the state. If there is no positive response, it might be well to take a look at what your 'exposure' is... in California, as an LVN I work under the license of my supervising RN, hence if I work outside my scope of practice, I jeopardize an RN's license as well. Something to think about.

    Reply to Question #2. First off, it's a HIPAA violation to be talking about patients where you might be overheard. Hushed tones at the nursing station is how the idea was presented to me. Never at time clock, elevator, or cafeteria. But that wasn't the question. The RN bears some of the blame in my view, since she is a supervisory person on the floor. The RN has the right and the duty to insure that adequate care is given. She risks her license if a legal action proves that anyone she supervises has, with the RN's knowledge, given less than adequate care. In my area of practice, we turn our patients at least every 2 hours. Less than that is negligent. It doesn't matter who does the turning either; I've turned other nurses' patients and they've turned mine. I'll turn a CNA's patient if it helps get the work load done. RN might do well to have a similar attitude.

    Reply to Question #3. Alzheimer's is a hard one to deal with. So often they seem to be hallucinating to the point that they are literally living somewhere else and are interacting with someone else when we have contact. Yet, I don't see restraints used, nor do I use restraints very much. What we do use is anything that works. I had one patient who went ballistic when the TV was turned on. Calmed down when Beethoven or Mozart was played. We played classical music. Another was brought to relaxing with nature sounds, others with tapes of favorite movies, and so on. There are things short of restraints that work, provided we can find them in the limited time we have at hand sometimes.

    This stuff is off the top of my head, more than anything else. As is said in the car commercials, "Your Mileage May Vary" to which I add, "and it probably does, and that's OK."
  10. by   ERHack
    As a nursing extern, youre going to be exposed to a lot of new things, experiences, personalities. People in the medical field are not perfect, after all, they are people. Your job is to act like a filter at this point in your career, and take the good stuff that you find as your own (professional behavior, caring, knowledge, coping mechanisms), while making it a point to exclude the bad stuff (unprofessional behavior, negligent habits, etc). Remember, things unfortunately do not change. Wherever you go in your career, there will be good and bad. Remember, it is YOUR responsibility to do the right thing.
  11. by   LisaG21
    Reply to Question #2. First off, it's a HIPAA violation to be talking about patients where you might be overheard. Hushed tones at the nursing station is how the idea was presented to me. Never at time clock, elevator, or cafeteria. But that wasn't the question. The RN bears some of the blame in my view, since she is a supervisory person on the floor. The RN has the right and the duty to insure that adequate care is given. She risks her license if a legal action proves that anyone she supervises has, with the RN's knowledge, given less than adequate care. In my area of practice, we turn our patients at least every 2 hours. Less than that is negligent. It doesn't matter who does the turning either; I've turned other nurses' patients and they've turned mine. I'll turn a CNA's patient if it helps get the work load done. RN might do well to have a similar attitude.

    Just so you know...the time clock is in the nurses station And it was midnight so there were no visitors around!!
  12. by   Dr. Scully
    I defintely agree w/ ERhack when she said "it was simple"... Each and every day we are faced w/ major decisions and minor decisions. I know that I have had my share of worries over what is right for the patients, and what is NOT right. We have all had to work w/ bad nurses...the ones where you knew they were doing things wrong, and not by the book. I tried to confront the nurse involved in a non-threatening way about what they did; and made it known that I would be there if they needed my help or had any questions. Of course, this did not always work, and I have had to go to the nurse manager or higher when necessary.
    I have worked with wonderful LPNs that knew so much more than I when I began nursing, and taught me so many things. AS RNs; we must be responsible for the staff we work with, and that means giving the best care to our patients.
    I always wanted to go home at the end of my shift and Know that I did all that I could to help and care for people in my care. I may have been upset, frustrated, angry, etc.; but....."what mattered most where the good things I did during the shift."
  13. by   brenzgrove
    find out whether the lpn is able to perform these tasks...there should be a manual on the floor for these policies, but if not ask charge or another lpn. Definitely report this person. You shouldn't think twice if they are practicing out of their scope.

close