What my DON said about getting rid of LPN's - page 2

She said, in 1985 she started as an LPN, and when she was in school, they were told they would Graduate without a job! That was 1985, she is now an RN. She said "LPN's are licensed by the state!!... Read More

  1. by   CEN35
    Ok I always seem not to be ale to comprehend this stupid rivalry between LPN's and RN's. What a joke! Like there is any reason for rude replies and outragious statements?
    I have met some stupid, I mean worm IQ RN's! I have also met some LPNs that are just unbeleivable....I mean way beyond some RN's in knowledge. Just like many of you have met or dealt with what appears to be an incompetent doc? or a doc that does not have his thinking cap on straight.

    Anyways Sheryl, In Ohio if you are an LPN already, the requirements are less. You only have to go through one 1st year class. That class is pharmacology, and drug dosage, administrationa and calculation. The you only have to take the second year of the ADN program.

    Have a nice day all, whether your rude or not! Somebody has tp spread the sunshine!

    Rick
  2. by   Jason-ACNP
    Ladies, ladies.... go easy here

    I agree that LPNs should not take certain courses that teach skills they have mastered as an LPN (i.e. making beds, inserting foley caths, giving injections, etc).

    However, I also feel that they should NOT spend any less time in the ADN program than what the current standards call for. While a LPNs experiences will enhance their education, these experiences should not be regarded as a ticket to an "easier" or "faster" track. Why? One word: STANDARDS.

    Many have said (including myself) that nursing is viewed as a vocational job (vs. a professional career), because the majority of RNs in this country do not hold the BSN degree. Unfortunate? Of course. Yet, education is the standard by which nurses are measured. The concept of the “slippery slope” is introduced when standards are manipulated. If we stray from the principles of the RN educational track, where to we stop? It opens the gate for more and more manipulation.

    Furthermore, there are significant differences in the education of the LPN and the RN that gives support to the LPNs adhering to a two- year track. The scope of practice of the RN is considerably wider than the LPN (i.e. ER, critical care). Thus, the LPN could take alternative courses that would further enhance their career. It would certainly make them a more viable candidate for a coveted position (vs. a new-grad RN).

    There is no question that some LPNs outperform some RNs every day of the week. Furthermore, I value the contributions that LPNs make. But again, education is the standard by which nurses are measured. When the LPN graduates from the RN program, she/he can say with confidence, “I faced the trials and tribulations of nursing school (including the sacrificed of time), instead of saying, “I fast tracked my way through school”. Anything less than a solid, two-year curriculum (minimum) further undermines the legitimacy of a career whose image has been tarnished greatly.
  3. by   realnursealso/LPN
    ok everybody calm down, please. I went to LPN school in 1979..In the next year after I graduated it was mentioned that they wanted to do away with LPN's. I was also told that the plan was to grandfather the current LPN's to the equvilant of a 2yr. degree RN and from then on the requirement to be a nurse would be a four yr. degree. This was a thing being pushed by the ana. Alot of the hospitals did try to go totally RN, but it was an experiment in futility. In my state it just didn't work. And guess it was a flop alot of other places too. The reasoning behind the grandfathering was to do something with us LPN's that would technically be written, regulated, out of a job. Because it was an idea from the ana, and not from the powers that be it never happened. I've been an LPN for 21yrs and have never had any problems finding a job. I don't know if this will ever happen since the ana is not the guiding force of the nursing profession. The ana seems to do alot of things that make our fellow nurses,RN's mad. I have seen numerous posts on this bb from RN's that want nothing to do with the ana. On the other hand some RN's think it is wonderful. They don't even recgnize my profession as existing, so I have nothing good or bad to say about them. But please don't everybody start fighting again..
  4. by   realnursealso/LPN
    Sorry I left something out. Every nurse would be an RN...either a 2yr. degree RN or a 4yr. degree RN. LPN's would no longer exist. Sorry I screwed it up in my other post. It has been so long and it never happened I forgot some of the details. So anyway lets all stop being angry and stick together...God knows we all need all the friends and support we can to get through this mess that the ceo's and insurance companies made.
  5. by   chrn
    I don't know about where you are, but in Ma from what I've been told, there are no credits for the knowledge an LPN has, you have to start from scratch and do the 2 year program.

    Most colleges now have "ladder programs". A practicing LPN will have to take the general education requirements (English, sociology, etc.) and then go into the RN track clinicals-so you don't have to start with "bedmaking 101". Many LPN's feel as you do -that after many years of practice they know as much as any RN. This may be very true regarding clinical activities. If you haven't taken the other college courses in general education, you may not realize how much that kind of knowledge affects your work and your practice. Just my 2 cents...as an LPN for 13 years who went on for ADN and now looking at BSN. Cindy
  6. by   Q.
    Originally posted by Future LPN Sheryl:
    <STRONG>fiestynurse, I got this info from my DON at the Nursing Home where I work.

    Why does it seem impossible? Let's say an LPN who has been one for many years, has the same knowledge as an RN except for the few things LPN's can't do that an RN can. Why can't the LPN just take the courses that she/he needs to know to be an RN?

    I don't know about where you are, but in Ma from what I've been told, there are no credits for the knowledge an LPN has, you have to start from scratch and do the 2 year program.

    I want everyone to know that I'm not trying to start a fight, I'm just wondering why? I think anything is possible, laws change all the time. </STRONG>
    I see what you are saying - but really, being an RN is alot more than the technical skills, even if you know all there is to know about them - there is still alot more to an RN than just psychomotor skills - I would have to agree that to be an RN from an LPN you need to take the whole course of study. They are very different.
  7. by   Brownms46
    Originally posted by Jason-ACNP:
    <STRONG>Ladies, ladies.... go easy here

    I agree that LPNs should not take certain courses that teach skills they have mastered as an LPN (i.e. making beds, inserting foley caths, giving injections, etc).

    However, I also feel that they should NOT spend any less time in the ADN program than what the current standards call for. While a LPNs experiences will enhance their education, these experiences should not be regarded as a ticket to an "easier" or "faster" track. Why? One word: STANDARDS.

    Many have said (including myself) that nursing is viewed as a vocational job (vs. a professional career), because the majority of RNs in this country do not hold the BSN degree. Unfortunate? Of course. Yet, education is the standard by which nurses are measured. The concept of the “slippery slope” is introduced when standards are manipulated. If we stray from the principles of the RN educational track, where to we stop? It opens the gate for more and more manipulation.

    Furthermore, there are significant differences in the education of the LPN and the RN that gives support to the LPNs adhering to a two- year track. The scope of practice of the RN is considerably wider than the LPN (i.e. ER, critical care). Thus, the LPN could take alternative courses that would further enhance their career. It would certainly make them a more viable candidate for a coveted position (vs. a new-grad RN).

    There is no question that some LPNs outperform some RNs every day of the week. Furthermore, I value the contributions that LPNs make. But again, education is the standard by which nurses are measured. When the LPN graduates from the RN program, she/he can say with confidence, “I faced the trials and tribulations of nursing school (including the sacrificed of time), instead of saying, “I fast tracked my way through school”. Anything less than a solid, two-year curriculum (minimum) further undermines the legitimacy of a career whose image has been tarnished greatly.</STRONG>

    Man...man...first, LPN/VN, DO work in NICU,ICU, CCU, MICU. SICU,Trauma ER, L&D, and many other areas! They preform well in these areas, and DO serve as resources for less experienced RNs! There are many fast track programs out there, for LPN to RN, and ADN to BSN! I THINK, theses programs provide a needed, and welcome way to obtain your ADN, or BSN, or anything else! Why does everyone have to fit the mold, just because this is the route the majority took??


    It seems to me, no matter what, there will always be something for someone, to stand up, and point out, how someone didn't do it this or that way, so they can't have learned as much as someone else! Geeze...thank God, that everyone doesn't hold on to the this is the way it was done, and this is the way it should always BE done! No wonder progress in so slow! It's like the doctors, who continued the practice of having new docs, continue to work 36 straight hours, because this is the way, they had to do it! I guess there are probably many of those who survived those rigors of training, who feel they are the better trained! Lord save us from the primitive thinkers, who seek to hold back progress, because their's is the only way!

    Brownie
  8. by   Jason-ACNP
    Okay, look. I have not the time, the will, nor the desire to argue


    Yet, I find hilarious the number of LPNs who THINK they have what it takes to be an RN. Everyone wants to be considered a professional, BUT VERY FEW are willing to put forth the effort to reach that level. There are DISTINCT DIFFEERNCES in the education of an LPN vs. an ADN. And the BSN? The differences in education are incomparable. Okay, okay…..so you are better at making beds, inserting foleys, or other “technical” duties. So is a highly trained monkey. But can you think critically? Let me answer that for you….NO. 90% of LPNs don’t know the meaning of critical thinking, much less have the ability to apply it. I think that it is safe to say that 99.9% of LPNs CANNOT take a critical situation and apply knowledge learned from physiology, pathophysiology, pharmacology etc. and apply it to that situation. It’s possible to memorize a ton of information, but NOT UNDERSTAND ANY OF IT. That is precisely the reason why your scope of practice is limited, as well as why advanced practice nursing requires the BSN as a prerequisite.

    Yet, as always, nursing continues to seek the least common denominator – that which is easiest. What is the easiest and fastest way I can obtain my AND? That is no different than me stating, “How many classes can I skip in medical school? After all, I have eight years of full-time college education (and every prerequisite for medical school). I hold a BSN (4.0 G.P.A.) as well as a Masc. (3.95 G.P.A), in conjunction to years of VALUBLE experience. Don’t forget!!! I already have prescriptive privileges, and I’ve tutored many of your medical students over the past two years in physical assessment skills! That should count for something!!!!! Pu-leeeaassseeee. Do you think they give a damn? Of course not. It is called S-T-A-N-D-A-R-D-S. Get it? One more time…
    S-T-A-N-D-A-R-D-S. By all means…pursue an AND (or whatever) in the fast track, but please…PLEASE – don’t whine and moan because you aren’t deemed a professional.

    Furthermore, the longstanding conviction that the BSN should be the entry level into nursing will never be adhered to. Thus, I am an advocate of having LPNs join the ANA in a limited capacity. There clearly needs to be unity within this field. But make no mistake. While unity is imperative for nursing to progress, there is a reason for the hierarchy. All nurses ARE NOT the same.

    As always, this is not meant to be construed as insensitive or rude. However, the issue has apparently become cloudy, and the need for clarification is quite evident. I am done with this issue. Take care.
  9. by   Brownms46
    Originally posted by Jason-ACNP:
    <STRONG>Okay, look. I have not the time, the will, nor the desire to argue


    Yet, I find hilarious the number of LPNs who THINK they have what it takes to be an RN. Everyone wants to be considered a professional, BUT VERY FEW are willing to put forth the effort to reach that level. There are DISTINCT DIFFEERNCES in the education of an LPN vs. an ADN. And the BSN? The differences in education are incomparable. Okay, okay…..so you are better at making beds, inserting foleys, or other “technical” duties. So is a highly trained monkey. But can you think critically? Let me answer that for you….NO. 90% of LPNs don’t know the meaning of critical thinking, much less have the ability to apply it. I think that it is safe to say that 99.9% of LPNs CANNOT take a critical situation and apply knowledge learned from physiology, pathophysiology, pharmacology etc. and apply it to that situation. It’s possible to memorize a ton of information, but NOT UNDERSTAND ANY OF IT. That is precisely the reason why your scope of practice is limited, as well as why advanced practice nursing requires the BSN as a prerequisite.

    Yet, as always, nursing continues to seek the least common denominator – that which is easiest. What is the easiest and fastest way I can obtain my AND? That is no different than me stating, “How many classes can I skip in medical school? After all, I have eight years of full-time college education (and every prerequisite for medical school). I hold a BSN (4.0 G.P.A.) as well as a Masc. (3.95 G.P.A), in conjunction to years of VALUBLE experience. Don’t forget!!! I already have prescriptive privileges, and I’ve tutored many of your medical students over the past two years in physical assessment skills! That should count for something!!!!! Pu-leeeaassseeee. Do you think they give a damn? Of course not. It is called S-T-A-N-D-A-R-D-S. Get it? One more time…
    S-T-A-N-D-A-R-D-S. By all means…pursue an AND (or whatever) in the fast track, but please…PLEASE – don’t whine and moan because you aren’t deemed a professional.

    Furthermore, the longstanding conviction that the BSN should be the entry level into nursing will never be adhered to. Thus, I am an advocate of having LPNs join the ANA in a limited capacity. There clearly needs to be unity within this field. But make no mistake. While unity is imperative for nursing to progress, there is a reason for the hierarchy. All nurses ARE NOT the same.

    As always, this is not meant to be construed as insensitive or rude. However, the issue has apparently become cloudy, and the need for clarification is quite evident. I am done with this issue. Take care.
    </STRONG>
    I find your response absolutely hilarious!!! What a crock of manure! Mr. "I'm too intelligent to even agrue"...LOL! What a joke your response was! Why aren't you a DOCTOR?? Couldn't get into medical school?? Why you did cheapen your educational prusuits, and fail to become a "real Practioner??? Couldn't hack it?? Couldn't critcally think, or just didn't have what it took?? HUH?? Your response shows the kind of narrow minded, insensitive, holier than thou attitude, that permeates too many "real nurses" now! You're soooooo busy looking down your noses at those with a lesser education, that you're a no earthly good to anyone! And your teaching new med students...hum...they do say that those can't do, "teach"! Your pitfull attempt to state, that you weren't "trying" to be "rude" sickens me!!! Your response was RUDE...R U D E, I N S E N S I T I V E, inaccruate, a pathetic generalization in the highest form, and just plain ignorant! All that education didn't seem to help you become a more effective communicator did it?

    Noooooo NOT ALL nurses are the same...and THANK GOD for that miracle!!!

    Prescriptive abilities...LOL...
    I think they train monkeys to write also...LOL! OOOoohhhh...and they can use computer too...LOL...hmmmm ..I wonder...nawwwwww...couldn't be. Wait... they do have a hirearchy...maybeee..lol.

    Now that the "Masta has spoken"...don't anyone dare to disagree...lol...don't hold your breath! And as for the ANA...the same goes for me, ever wanting, or even trying to join them! I have NEVER even thought about joining them, but there is a organization for LPN/VN, called the National Federation of Licensed Practical Nurses. Unity in the nursing profession, that has "Regal Nimcompoops", disgused as "Another Common Needle Pusher" as their member, will NEVER become a reality! I have never, and will NEVER lower my S T A N D A R D S, to become a part of anything you would support! ACNP= Advanced Cricitzing Nasty Poster"


    It's those who expouse your kind of thinking, that makes this profession what it is today! Thankfully, I work with "Nurses", who don't look down their noses, and see me as less than them. "WE" work as a team, and they don't feel the need to belittle others, as a way of feeling better about themselves, or to cover up their own insecuities!

    I have worked with many RNs, who have given me high praise, and have help me secure a contract in THEIR ICU, not once, for FOUR back to back, because THEY felt I was an EXCELLENT NURSE! AND...let's not forget, the head of the OB dept, who offered me a position as HIS head nurse, when he had FOUR YEAR RNs, who couldn't preform any better than ME...LOL! It made me crack up, to see those, who just like you, thought their education made them better, get pissed as all get out...LOL...not because I took the position, but that HE offered it right in front of them!!! Too bad YOU weren't there to tell him, that I wasn't any better than a "highly trained monkey"!!! I guess that is why there are so many LPN/VNs who are now Doctors, NP, PAs, and RNs, huh? So if they can obtain the same level of education, that you supposedly have, now please tell me, how did they obtain it? Did they suddenly become critical thinkers, just because they achieved another year or two of education? What about the genisues, who never went to college? Where they also trained monkeys?? Too bad, and just too sad!
    Wasn't generalization covered in your many years of trying to become superior??


    Brownie, the highly trained, and but oooooh so highly paid trained monkey!!!


    [ May 07, 2001: Message edited by: Brownms46 ]

    [ May 07, 2001: Message edited by: Brownms46 ]
  10. by   Chellyse66
    Oh boy let me take a deep breath and jump in...While stating that Tim was trying to make a point which is valid the post got a wee bit emotional and personal at the end.
    All nurses are not the same, all doctors are not the same...There has to be standards, part of the problem when we start talking about standards it leads into the elitist stance and defensive mode (stealth mode for some Good Lord)
    I think the ANA should represent LPN's as I said in a different post and if the time comes, maybe it is now, why not allow LPN's that have x experience to challenge the boards? This is not a fast track equation, the military does this all the time.For those that choose not to that is fine too.
    The standards could be raised for a BSN, since ADN and BSN take the same boards, add some questions that pertain to the mandated curriculum why not...seperate us out more or level the field.These arguments are old began with eltism and were meant to be divise.Standards were different 50 years ago then they are now.In the last 5 years we have gone from taking the Boards for a two day written session to an online computer version (and yes this has changed the format,check the debates and articles at the NCLEX site) There are so many options available in Healthcare today that a revamping of the entire nursing process is a possibility really. To better prepare speciality nurses focus the curriculum and criteria there.
    I know I am stepping into hot water just by posting on this thread. I work with many LPN's because I work in geriatrics,I can tell you that some are perfectly content with thier practice and some choose advancing to ADN or BSN but all that I have talked to,tell me that there is a difference in the knowledge base requirements between an RN and LPN. I did not say one was better than the other, and I did not say that working as a nurse in LTC in particular has any basis in clinical skills needed, just that there is a difference. The difference becomes apparent when you sit for the boards.
    I mean I might be so competent as to know how to take care of the needs of a particular client better than the physician assigned to the case but that does not negate the fact that the physician has more education than me, because he does. We have the opportunity to make our opinions known with a tremendous nursing shortage hovering atop this profession.Now is the time to make changes, we need to decide what those changes need to be. The ADN nurse was brought in and designed for a nursing shortage and today makes up 70% of the workforce. The word "professional" is the target or was, the class system was set up long ago but it does not mean it can not be changed. I enjoy working with LPN's,treat everyone with respect and you will get respect in return.This argument did not need to happen if this was observed,but the fact remains it is a real issue and the only way to find solutions is to dialogue about it, because it keeps coming up over and over again.I hope we can dialogue again
  11. by   Brownms46
    Originally posted by Chellyse66:
    <STRONG>Oh boy let me take a deep breath and jump in...While stating that Tim was trying to make a point which is valid the post got a wee bit emotional and personal at the end.
    All nurses are not the same, all doctors are not the same...There has to be standards, part of the problem when we start talking about standards it leads into the elitist stance and defensive mode (stealth mode for some Good Lord)
    I think the ANA should represent LPN's as I said in a different post and if the time comes, maybe it is now, why not allow LPN's that have x experience to challenge the boards? This is not a fast track equation, the military does this all the time.For those that choose not to that is fine too.
    The standards could be raised for a BSN, since ADN and BSN take the same boards, add some questions that pertain to the mandated curriculum why not...seperate us out more or level the field.These arguments are old began with eltism and were meant to be divise.Standards were different 50 years ago then they are now.In the last 5 years we have gone from taking the Boards for a two day written session to an online computer version (and yes this has changed the format,check the debates and articles at the NCLEX site) There are so many options available in Healthcare today that a revamping of the entire nursing process is a possibility really. To better prepare speciality nurses focus the curriculum and criteria there.
    I know I am stepping into hot water just by posting on this thread. I work with many LPN's because I work in geriatrics,I can tell you that some are perfectly content with thier practice and some choose advancing to ADN or BSN but all that I have talked to,tell me that there is a difference in the knowledge base requirements between an RN and LPN. I did not say one was better than the other, and I did not say that working as a nurse in LTC in particular has any basis in clinical skills needed, just that there is a difference. The difference becomes apparent when you sit for the boards.
    I mean I might be so competent as to know how to take care of the needs of a particular client better than the physician assigned to the case but that does not negate the fact that the physician has more education than me, because he does. We have the opportunity to make our opinions known with a tremendous nursing shortage hovering atop this profession.Now is the time to make changes, we need to decide what those changes need to be. The ADN nurse was brought in and designed for a nursing shortage and today makes up 70% of the workforce. The word "professional" is the target or was, the class system was set up long ago but it does not mean it can not be changed. I enjoy working with LPN's,treat everyone with respect and you will get respect in return.This argument did not need to happen if this was observed,but the fact remains it is a real issue and the only way to find solutions is to dialogue about it, because it keeps coming up over and over again.I hope we can dialogue again </STRONG>
    I agree in part with your post, and feel that you communicated it in an intelligent, and thoughtful manner.

    However, I feel that the previous poster's, point was made mote, when he decide to include inaccruate statements, and sunk to making generalizations, and elitist boasts!

    As far as the ANA goes...they can keep going, and should never be forced to represent LPNs, in my opinion!

    I wouldn't want to be represented by any organization, that has to be pushed into allowing me into their group, or who has members who feel, I, and other LPN/VNs are beneath them!


  12. by   Brownms46
    ACNP Ouch.. I get the feeling it is that bad in many places. My best friend who works in Portland, OR told me that a local agency is paying $95/hr for critical care nurses.
    I'll tell you three brief stories.

    Four years ago, a seasoned RN in the hospital in which I worked “accidentally” infused 1500 mg of Demerol within a 20-minute period. Now clearly she is at fault, because it does take only a second to TRIPLE check the drug being given. She thought it was an experimental anti-biotic, which the pharmacy tech who brought it to her said it was. She was so stressed from caring for 15 patients on days, she just hung it quickly and moved on. She’s gone now.

    A few months later, I was working ICU when a code was called overhead. The time was at 6:00 a.m. The patient, who was mottled, was lying in a coagulated pool of blood. Early during the night, he apparently pulled out the Swan-Ganz introducer port by accident (possibly confused or while sleeping). Anyway, he was taking Coumadin, and his INR must have been way out. We stared in amazement while the RN pleaded for help. We told her, “Rigor mortis has already set in. There’s not a thing we can do”. He clearly died soon after the shift began. The nurse was so busy, she had not a chance to go into his room until preparing for shift change.

    A year later, I was a traveler in Memphis when I was pulled to a general ICU. I received the two sickest patients there. I picked up one of the patients from an RN who had made a lateral shift from the pysch ward. He had never worked ICU in his life, but was in “training”. The patient, who had chronic renal insufficiency, had been on a dopamine gtt at a renal dose of 2mcg/kg/minute. The patient had been dropping her pressure, and thus he called the physician. The physician said, “Okay, titrate the gtt as needed”. The nurse (I swear I’m not kidding) increased the Dopamine from 2mcg/kg/min to 22 mcg/kg/min (2 mcg above the maximum recommended dose) in one shot. Her pressure shot up of course, and I imagine her SVR was through the roof. When the nurse told me what he had done, I thought he was kidding. Then he had a puzzled look on his face and said, “She hasn’t had a drop of urine in her foley since soon after I increased the Dopamine”. At the same time, I was picking up a patient (ventilated) who was in extreme mixed acidosis with hypoxemia. ABGs were 7.26/65/55/19 at the beginning of the shift. I called the pulmonologist who was already irritated with the previous nurse. He gave explicit orders to extubate the patient immediately (in a pissed off tone). I simply made vent changes instead and was going to draw immediate lab, with subsequent ABGs. Yet, the resp tx. took it upon herself to extubate. Needless to say, I had two codes on my hands at the exact same time. While I was attempting to conduct both codes, I had someone call the physician for each patient. Within three minutes, five physicians were on the phone wanting to talk to me at the same time. End result? One patient died (the ARF), and the other lived (after being reintubated and NaHCO3 pushed).

    These are a few… sorry they weren’t so brief.
    Jason-ACNP You aren't being a pain in the ass. I noticed that after I submitted the post, I needed to clarify a few things. I was waiting for someone to catch the confusion. You are very astute.
    The patient WAS NOT in an ICU. I failed to mention that. I was working in the ICU on the 6th floor when this incident happened. The patient was also on the sixth floor, (on a med-surgical floor)

    You are absolutely correct to assume that the patient should be monitored continuously if a Swan-Ganz catheter was in place. In addition to my failing to mention that he was on a med-surgical floor, I failed to mention that the actual catheter was already removed. The floors don’t have SVO2 monitors or monitors to read the PA pressures. Thus, the catheter ALWAYS came out before we sent them to the floor. HOWEVER, the physicians always chose to LEAVE the introducer port intact, because it had a single-lumen IV access. (The introducer port we use is a very large bore and is inserted at least 5” into the IJ vein.) Thus, the nurses on the floor could obtain blood samples for lab without having to stick the patient every morning. (I realize that may not be the policy in some, or even most hospitals, but it was there).

    The patient’s heparin had been discontinued the day before. PTTs were discontinued immediately upon discontinuation of the heparin, because heparin has a fairly short half-life. It was said that the patient was placed on Coumadin at that point. I have absolutely no idea what his loading dose was, or if they had even checked a PT/INR that a.m. (Some docs give a loading dose and then titrate based on that (the next day), whereas other docs start low for a couple of days (2-3) and then draw a PTT, which I don’t like. I want to know the INR the next morning).

    I only suspected that his INR was way out because of the massive amount of blood (pouring from a major vein of course). The other explanation was that the patient, (who was very large) tore the internal jugular vein (even slightly). He was huge. I’ll be honest. I have no idea if he was confused. I was grasping at straws. The dressings that the hospital uses are EXTREMELY irritating to the skin, causing significant itching. Some patients cannot wait to get rid of the dressing. It drives them crazy. I thought that maybe (unwittingly) pulled at the Swan-Ganz in a light sleep (like shooing away a fly or something irritating), and pulled hard enough to tear the IJ vein when the catheter came loose. The only thing is that you have to pull VERY HARD because the adhesive on the transparent dressing is like glue.

    As far as the coagulation question goes, let me explain the scene. There was a MASSIVE amount of blood that, via gravity, pooled to the center of the bed. The HOB was elevated 45, and the end of the bed was slightly elevated. The massive pool of blood had a gelatin consistency (vs. being a hard, crusty consistency). While I was in nursing school, I worked with the coroner in homicides, suicides, automobile accidents, etc. Anytime the there was massive blood loss that formed a pool, the coroner (an M.D.) referred to it as coagulated, which made sense to me (due to its gelatin consistency) However, I may have used the word (coagulated) out of context.

    One more thing, and this are huge. Vital signs are to be taken on that floor every four hours. The CNAs in that hospital are not very efficient, and many are lazy. (That is not an attack on CNAs in general.. I’ve worked with some of the best that have greatly eased my life in the critical care units). The CNA falsified vitals. The nurse was supposedly busy that night with confused patients, dressings, bed baths, etc. She did have 15 patients that night. The CNA admitted to falsifying vitals (so I was told) once the time of death was actually determined.

    As a result, (or soon after), head honchos said that vital signs on the floors would be done every four hours by the nurses. Furthermore, they now wear these damn tags that monitor where they are at all times, and how many times they enter a particular patient’s room that shift, and how long much time they spent each time. YES! NOW THAT’S A SOLUTION!!!! I wonder how many hundreds of thousands of dollars the hospital spent on their new toy….it took effect over the entire hospital (except ICUs).

    I left the hospital soon after that incident to go traveling. It wasn’t worth the $11.88/hr they were paying me.

    I hope that answers your question, but feel free to tell me if anything needs clarification.

    By the way, 2.5 to 3 years later, I heard that this case was still in litigation. HUGE LAWSUIT! HUGE! I have no idea if the nurse was suspended. Like I said, I was quick to leave (to go traveling).

    I have posted the above, as posted by Jason, as to how critically ALL RNs who are such a distintive difference from LPNs, in the words of the same person who equated LPNs with "highly trained monkeys"!

    I have worked ICU/CCU, and have NEVER had an incident...THANK GOD! I also would have never walked into a unit, without, and had the nerve to care for patients out of my realm of expertise! Is it possible, that these "nurses", failed to critically think???
    Heaven forbid! Nooooo...tell this isn't so!

    Also please note, the disparaging remark about CNAs, as being lazy, ( so he was told...another example of stating information, that maybe or may not be accurate) when the RN in charge of these pts., was just overwhelmed!
    How did this nurse chart her assessment on these pts, if she didn't see them??? Did she also falsify her charts??? She had 15 pts., that nite, and how many did the CNAs have?? Oooh no...they were just sitting on their butts watching this hard working RN bust her behind! yeah right!

    Thank God, I'm just a "highly trained monkey", that couldn't critically think to save my life, but at least I haven't injured anyone else's...:-)!

    Brownie
  13. by   canoehead
    I think that whether a job is considered professional or not is more a legal definition than anything. It has to do with whether the group performing the job is self regulating. To take this self regulation thing a little further to the individual level is more what everyone is debating in this thread. That type of professonalism has to do with critical thinking, and accountability for one's own practice. So you are "self regulating" on an individual level. In my experience there are housekeepers that are accountable for their own actions, and there are docs that never think twice about a decision or read an article to advance themselves. So in the debate on whether RN's or LPN's are professionals, if you look at who is considered a professional legally there is no opportunity or reason for debate. If you look at who holds themselves accountable, and who uses critical thinking there are some real professionals, and some real unprofessionals practicing in both capacities. So no one will win this debate.

    Maybe we could start a new thread about what a person has to do to be considered to be praticing professionally. What situations have you been in where you saw real accountability, and responsibility for one's own actions- as opposed to someone saying "well, the doctor ordered it"

    Look for my new thread.

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