unworthy of an RN

  1. 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?
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  2. 41 Comments

  3. by   moia
    About restraints.....you need to not look at them as something we are ONLY doing to protect ourselves...restraint use can be used to protect the patient...when they get into a state they cannot calm themselves...they can harm themselves badly..they can break bones or fall..so a limited use of a temporary restraint until the storm passes can keep your patient safe from themselves...try to look at all the perspectives when restraints are used....restraints MUST be removed when the storm is over....


    I would rather use a temporary restraint that chemically sedate patients...a restraint can be removed when the behaviour stops but once the drug is given it could be many hours before it wears off and the patient must be closely monitored for side effects that could be fatal.

    The best way to prevent restraint use is to try to predict and prevent....if you know your patient hates something don't force it...if you know certain times of the day are really bad try to figure out why...look at provoking factors...what events lead up to the patients rage? In Alzheimers frustration is huge....patients can be aware that a skill has been lost ..that can be frustrating...they have dificulty remembering and recognizing..so they are constantly surprised and frightened by everyday people and things...this agitation needs to be lowered...you need to become a detective..

    Restraints are not evil if they are used with compassion and a purpose that helps the PATIENT.
  4. by   leslie :-D
    re: the lpn, are you certain they're not permitted to do these tasks? is there a nm you can ask gen'l questions re: scope of practice for lpns vs. rns?

    re: pt. not being turned; if the rn noticed that the pt. had been in the same position, i would have taken the 2 minutes to do it myself, then let the tech know what i had done. yes, the rn should have intervened...

    and alzheimer's pts in a new, unfamiliar, sterile environment....that's very tough. often the simplest interventions such as gentle reassurance can go a long way but presuming they're in the hospital because of a certain pathological process, their mental status is going to be even more confused, agitated and or paranoid. honestly that's a difficult one because you don't want them falling or injuring themselves yet i shudder to think of them so frightened and feeling abandoned.....

    leslie
  5. by   Tweety
    Over and over again you are going to see and find things that make you uncomfortable. Sad, but true. You are going to have to decide what you need to let go of and what needs your attention.

    You could always report the LPN and the hospital to the board of nursing for violating the nurse practice act, but be sure to have evidence documented that you used the chain of command. If the LPN is assigned to you as an RN, let the LPN know under no certain terms is he/she allowed to vioalte the nurse practice act under your license.

    Yes, the RN is negligant that her patient wasn't turned. The RN is always responsible for all outcomes be they positive or negative. Again, you could follow the chain of command and report her.

    I like the above answer about restraints. Some nurses are retraint happy. But these days of being short staffed, for patient safety we need to compassionately retrain sometimes.


    Good luck!
  6. by   OneChattyNurse
    re: the lpn...is it possible that she took an expanded iv therapy course for lpn's allowing her to perform the tasks in question.

    re: restraints...from a ltc standpoint, we are rarely allowed to use them, but we are in a "home" type environment, not an acute setting. we are always told the residents have the right to fall. there are alot of ways to try to de-escalate a situation, it really depends on the type of patient and the diagnosis.

    re: the rn...i agree with the other posters, if she knew the patient had not been turned the entire shift she should have either further instructed the cna/tech to do so or done it herself!
  7. by   Farkinott
    I'm with earle on all counts.
    I have had some success in the past with dementia/alzheimers clients by using "validation". Essentially this means that you don't discount the client's perception of a situation, but try to see it through their eyes and bring about a resolution.
    I remember working in a nursing home once and as I came onto day shift I got the story that this particular 80 odd yr old lady wouldn't go to bed because she was "afraid of the men in the towel rooms who were dragging women in and using them for their carnal pleasures". The night shift nurses had spent a lot of energy telling her that "there are no men in the towel rooms", to now avail.
    I told her (in an indignant tone of course) that I would sort it out, left for a few minutes and came back saying the police were on their way. She said "Good, I'll got to bed then".
    You can't reason with dementia clients but you can outsmart them without them losing dignity. Obviously this doesn't resolve the issue of restraints both physical and chemical. Unfortunately there is plenty of room for both. Aged care is one of the most challenging types of nursing and one of the most undervalued.
  8. by   Drysolong
    [QUOTE=LisaG21]. 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?

    [QUOTE=Drysolong] I have also been "told" that in my state LPN's can start IV's and give medication if they have taken appropriate courses.
  9. by   nursepenny
    I am an LPN, who starts IV's, gives push meds, hangs blood, etc. The only thing I cannot not do is charge. I work in ICU and SDU. I have also worked the ER. I am ACLS certified, and will soon be taking PALS. Then again, some LPN's in my facility do not even take report. They wait for the RN to spoon feed them.
    Some hospitals in this area, (So. Georgia) have a " clinical ladder" for LPN's, which allow the LPN to take on more challenging tasks. Maybe this is true in your situation.
  10. by   Drysolong
    Quote from nursepenny
    I am an LPN, who starts IV's, gives push meds, hangs blood, etc. The only thing I cannot not do is charge. I work in ICU and SDU. I have also worked the ER. I am ACLS certified, and will soon be taking PALS. Then again, some LPN's in my facility do not even take report. They wait for the RN to spoon feed them.
    Some hospitals in this area, (So. Georgia) have a " clinical ladder" for LPN's, which allow the LPN to take on more challenging tasks. Maybe this is true in your situation.
    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
  11. by   traumaRUs
    You sound like a very conscientious person and soon-to-be RN. We need so many more of you! However, as another poster alluded to - you will see things that aren't right. The LPN issue is one you can settle for yourself by using the board of nursing website and looking up the LPN nurse practice act. The RN who knew and didn't turn their own patient probably isn't going to change. There are good and bad nurses: some you will want to emulate while others you will disparage. Good luck...
  12. by   RN,BSN,MSN
    Quote from traumarus
    you sound like a very conscientious person and soon-to-be rn. we need so many more of you! however, as another poster alluded to - you will see things that aren't right. the lpn issue is one you can settle for yourself by using the board of nursing website and looking up the lpn nurse practice act. the rn who knew and didn't turn their own patient probably isn't going to change. there are good and bad nurses: some you will want to emulate while others you will disparage. good luck...
    i agree this post 100%....the bon is where the buck stops. there is a difference and a distance between what an lpn/lvn can do and what an rn can do and it will all be clearly stated by the bon. to the op...your doing the right thing by questioning....your good critical thinking skills is going to make you a great rn.

    good luck

    remember everyone......"its never to late to be what you might have been"
  13. by   LisaG21
    hey guys

    Thank you so much for your advice. The LPN def can't do the iv pushes. I talk to her frequently and I know for a fact that she can't. lol As for following the chain of command. The nurse manager is very close with her old employees. I am kind of scared that this is going to put a damper on her and I's relationship if I say something to her. Second, I understand what you guys are saying about the restraints, however I feel they are being used tooo much. In school I was taught that I would rarely see restraints, and I see some at least once a shift here. Am I just mis informed? What I was planning on doing was writing an annonymous letter to the nurse manager with a copy to the the nurse coordinator. There is just so much stuff going on on the floor people are wearing the same gloves from patient to patient, even contact precaution patients (whihc has been brought up to the nm but she hasn't done anything yet) there are people lieing about accu checks and vital signs! Which has also been expressed to the nm but nothing has been resolved. I mean come on the person lieing about the vitals is an extern also she is going to be an RN people lives are in her hands! If she is going to lie about vitals I am very scared for what she will do as a nurse. Who knows I am sorry I just talk in circles but I am very upset about a lot of things that go on this floor!
  14. by   KacyLynnRN
    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!

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