Worried About I.v.'s - page 2
here in CA, there is a push for LVN's to be able to hang i.v. meds. i'm not worried about my job, i'm worried that i will be asked to supervise any number of LVN's while they hang i.v. meds, most... Read More
Apr 27, '03Hi there,
I'm new here and I don't want to step on anyones toes, but I have been on both sides of this debate. I was an LPN for seven years and have been an RN for two years. All I can say is what some have already said. There are many LPN/LVN's with far more knowledge than I will ever hope to posess. Though I am there now to "supervise" them, they are often the ones helping me out of a bind. To tell you the truth, when I was an LPN, I used to see a lot of RN's and think "If so and so can be an RN, then I certainly can too." Unfortunately, licensure exams do not measure common sense. In my opinion, some RN's find it hard to give up control. In our hospital, LPN's can hang IVPB's, but cannot push meds and cannot hang blood/chemo etc. There is alot of talk about having them push meds. I say "Halleluiah". Less for me to do, and less for me to worry about.
Does anybody really think LPN's can work in nursing and not have any assessment skills? It's crazy.
Apr 27, '03I am in LPN school right now, I will graduate in December of this year. I have to take IV therapy and all the things you listed that you are worried about we (in Louisiana) have to learn. I can understand your concern. I am pretty sure LPN's that are not IV certified will need to be before they can hang meds. This should also take some work off of RN's that are constantly having to hang meds for the LPN's on the floor.
Apr 27, '03look out!!!! ca will become just like texas, oklahoma, fla, and other states that over-extend the role of practical/vocational nurses then want to hire one rn to " sign-off" and/or be "supervising" them. i've been fortunate while here in south texas to work with lvn's willing to do anything to prove themselves, but i've also tried to enlighten them that they are not being paid for the responsibilitie some advanced skills carry with them. i'm from new york which i here is similar to california in delegation issues so i understand your concern. good luck
Apr 27, '03As an LPN in my state, we hang IVPB's, hang blood and give IV push meds such as Lasix and Lopressor to name 2. One thing I feel about ANY procedure no matter the licensure; If you don't know how to do the task, then find someone that does. If there is ever anything I am unsure about or uncomfortable with, I will find someone with more experience and knowledge on it and have them to show me and explain it to me. I would never go in a room and just do something because it is ordered or I was told to do it without getting the ins and outs on how and why first. I am not ashamed to say "Teach me, show me". I want to be able to do the procedure correctly and never ever endanger my patient.
Apr 27, '03Originally posted by amk1964
look out!!!! ca will become just like texas, oklahoma, fla, and other states that over-extend the role of practical/vocational nurses then want to hire one rn to " sign-off" and/or be "supervising" them. i've been fortunate while here in south texas to work with lvn's willing to do anything to prove themselves, but i've also tried to enlighten them that they are not being paid for the responsibilitie some advanced skills carry with them. i'm from new york which i here is similar to california in delegation issues so i understand your concern. good luck
Do you realize that in the past that most of the work of RNs was done by MDs? That the role of RNs and LPNs have not been over extended but extended to accomodate the larger population as people are living longer. There have also been many many advancements in medicine (thus, longer life spans) and not only the MDs cant keep up with the pace of this but RNs and LPNs as well. Everyones role and scope MUST be extended. In some facilities CNAs are trained and educated in drawing blood. Their role must also be extended. Mind you I did not say over extended.
An example: Some time ago RNs were never allowed to insert central lines. This was the job of the MD. But with people living longer (more advanced medicine) There are many many more people needing central lines. Thus the RNs role was extended to do this procedure. Notice I did not say overextended.
I look forward to your responseLast edit by nurse2002 on Apr 28, '03
Apr 28, '03touche...it all comes down to common-sense . i have worked with rn's as well as lvn's who were excellent and others dangerous. i don't want to hurt anyones feelings. i was an lpn 5 yrs before becoming an rn[ by attending college, not the internet], and was well trained and proficient, but i didn't always understand the limitations of my training and licensure as an lpn. it wasn't until i started rn training and got my ass kicked [so to speak] that i humbled myself, opened my ears, and shut my mouth and learned new perspectives and ways of getting the job done. bye for now. anne
Apr 28, '03dear amk, thank you for hearing my real concern and understanding what i was talking about. if one reads back to my first post, the original post, one will see that my concern is about my having to oversee more lvn's. if CA goes to a 1:4 ratio, then the way that i see the hospitals as achieving this is to hire mostly lvn's, and have one rn to oversee them. now, if i wind up having 26 pt., where does my responsibility end. as it is now i am checking mar's against kardex, checking charts, new orders, labs, progress notes, assessing,,,,,doing the care plan, teaching, and last but not least i.v. meds. there are not enough hours in a shift to do this for 26 pt. i'm probably worried about nothing. i can just move into a specialty area.....
Apr 28, '03yes cokie i did understand the original concerns you raised and no one can understand this until they are the rn " in charge". sometimes staff members aren't aware of what is said and directed behind closed doors with managers and administrators. i have found that quietly observing others work habits can speak loads without saying a word; identify your staff and go from there.
Apr 29, '03[QUOTE]Originally posted by cokie
[B] supervise any number of LVN's while they hang i.v. meds, most without the knowledge base to know proper doses, proper uses (micro),. infiltration, phelbitis, drugs that need to be diluted (K), drugs very hard on the veins....
Ummm, I dont think you get it. Lpns are educated on all the above before actually being able to give IV therapy. The Board of Nursing makes sure of this. If not in the nurses IV therapy class the facility the lpn works for is responsible for this education. As a supervisor you are also responsible for RNs hanging IV meds. They are also educated in all the above. If not in school, the facilty is responsible for this.
Do you honestly think the faciity is going to let ANY nurse give drugs if they are not aware of it's use, side effects, doses. (all the above.) Oh, you forgot compatability.
On the floor, the first time a RN or LPN gives an IV med or does any procedure they have never actually done they must be supervised. This is protocol at every facility I have had the pleasure of working with. Then ya have the good ole drug book, this is actually read by LPNs. I dont know a single nurse who knows off the top of her/his head all the meds they are going to give. We are taught that if you dont know, look it up. We read too!
As I stated in my last post the LPNs education is being extended due to their scopes of practice HAVING to be extended. Notice I did not say overextended. Just as in the last decades the RNs education has had to be exdended due to their scope of practice having to be extended. As I said earlier this is due to longer life spans, the growing population and advancement in medicine.
Do you think when they started teaching RNs to hang blood, insert central lines and do initial assessments on patients the MD said "OMG, they wont know what they are doing." (Years ago the MDs job included all this.) No, they didnt say this. They knew that the RN would be well prepared and educated appropriately.
Just a vivid thought.
Peace and openmindedness to you my fellow nurse
May 3, '03Originally posted by amk1964
we all have to just cover our own asses. no more co-signing for me.
May 4, '03I have worked where there were 2 RNs and LPN and 1 aide on the night shift for 47 pts....14 of those beds were telley. there were nights when i was the only tellycert. RN on the floor and assigned to work the back half of the unit with the LPN. It all comes down to knowing who is competent and who is not and believe me, I have, shameful to say, worked with RNs that I prayed desperately that I never had to work with them again and would have give my left eye to have one of my LPNs with me. That was back when we were allowed to mix our own KCL into IVs....the LPNs would always ask me to mix up the KCL and if they were not comfy with hanging the bag, they told me and I had no trouble doing it (after all I am the RN and ultimately responsible). I mixed all our meds and the LPN hung the meds on "her half" of the pts and I did my half...then I just went around and checked on all the LPNs pt to make sure everything was kosher, which the LPN never had grief with or felt like I was second guessing......95% of the LPNs I have worked with had better assessment skills than some RNs and I tip my hat to a group of professionals that get treated like glorified CNAs (not knockin ya folks cause we could not do our job with out you aids) rather than having a brain in their head and allowed to use the professional skills that they were trained to use. It is unfortunate that all the legalities have taken the job away from the licensed folks and put it in the hands of the UNlicensed assistive personnel (not counting all the fantastic CNAs I have worked with)
Now....putting the critical job in the hads of those with out a state license of any kind always baffled me
May 4, '03PS: And the RN had to open and document the assessment in the LPNs charts too...which was the new policy and an insult to the LPN on shift......I prefered to read what they wrote, ask my questions, eye ball the patient if necessary and co-sign the chart (when I felt comfortable) And there were some that I did everything myself because I was not confident in their skills.....