All Lpn's Please Read

  1. Hello,

    My 226 bed acute care hospital has formed a committee as we are going to re-introduce LPN's on the med-surg floors. The committee is looking at how we are going to utilize the LPN's.

    SO, would you please tell me--if you work in a hospital--what exactly your duties are and what you as an LPN are and aren't allowed to do. I realize that the LPN/LVN scope of practice varies by state, I am in Northeast Ohio.

    I am specifically interested in Nurse- patient ratio for the LPN in your facility and any other infor mation you can provide will be helpful.

    Personally, I am looking forward to working side by side with the LPN's and feel that it was a grave mistake that a lot of hospitals--especially in this area of the country-that they were phased out of the acute care setting.

    Thank you for your help!

    Kelly
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  2. 64 Comments

  3. by   joyflnoyz
    Preface: I hold a Michigan LPN liccense, currently living in Texas and working as a CNA <TX won't give me a license cuz I stayed home with my kids for too long..retook boards in May to reinstate my MI license, passed 1st try..anyway, I digress..>
    In the facility where I work, the LVNs do everything the RNs do, except for hanging blood and an RN has to do the initial assessment upon admission.
    That's it. they start IVs, take verbal.phone orders, meds (oral, injection, IV and IV push), post op/post cath care, drsg changes, foleys ..whatever is required. I think it may be texas state law that prohibits them from hanging blood, though they can monitor it while it's going in.
  4. by   ucavalpn
    In NC LPN's do not push iv meds , mix iv sol. for meds or draw blood from a central line ,no charge duties . Other wise we work pretty much the same as the RN's . Oh and we don't do the complete assement on new admit's . Nurse /pt. ratio is the same as for RN'S . Varies day to day depending on staff / #of pt's on unit { to many pt's , not enough staff } Typical staffing for a 30 bed unit would be .
    1 RN - charge
    2 RN or LPN - team leaders
    3 Staff for pt. care - can be Aid / RN / LPN - Once in a great while we get another person.
  5. by   mommanurse
    i work in labor and delivery but my coworkers on the med-surg floor do everything except sign the initial assessment and push meds.
  6. by   Genista
    Hello. I am an RN "visitor", just stopping by the LVN boards to see what's new. I can tell you a little about scope of practice for LVNs in N. California where I work... At my acute care floor, LVNs take 5 pts & are "resourced" by RNs. RNs usually take 4 pts a piece and cover 2-4 pts of LVN each. The LVNs cannot do: lead nurse (charge), central lines, IV push, IV piggybacks (they can hang primary IV though, go figure). LVNs cannot note orders (unique to my facility, not a state thing...too bad for us). LVNs cannot take orders for restraints or assess whether a pt should be in restraints. They can hang blood (with double check of blood & ID w/ RN), can start IVs, can do admit assessment, phlebotomy if certified (but no central line draws- RNs do only). We have some great LVNs working w/ us. Good luck w/ your new matrix.
  7. by   Dayannight
    I'm an LVN and work in a acute hospital in northern California. We take the same patient load as an RN which is usually 6 to 7 on nights for the med/surg floors. We take and note orders, do our own 24 hr chart checks, and perform an assessment for each patient assigned to us. We start IV's, hang blood and IV fluids, but no IV meds. No central line draws. If the patient has a PICC line it must be an RN who is also PICC certified to even change the dressing. Only an RN can be Charge on the acute floors and she is responsible for patient assignments and overseeing all patient care, as well as performing any procedure not within the LVN's scope of practice. We also have a SNF in our hospital, and and that is the only unit that is allowed to staff without having an RN in charge. If there is no RN scheduled to work SNF, an LVN will be charge. In which case, the float RN will be expected to perform any necessary procedures that are not within the LVN's scope of practice.
  8. by   Janice8551
    I am here in British Columbia. Vancouver/ Victoria area to be specific. I work in a community acute care hospital on a medical floor. I am also the LPN practice Leader there. We have LPN's working in all areas of the hospital except psych and OR/PAR. The hospital works on a team nursing approach- 1 Rn gives meds for 8 patients, gives direct care for 4 patients and the LPN gives care for 4 patients while her Rn does the meds for her patients. The only floor that takes a different approach, is the floor I work on- 3South. We use a paired caring model. One RN and one LPN work in a team- side by side. We care, together for 8 or 9 patients on dayshift and on nights, we take 13 or 14 patients. As the RN does the meds for the patients, the LPN will pick up other things, like all of the glucs. We both do vitals, and we both do treatments
    for the patients. The LPN scope of practice overlaps with the RN one by as much as 70% in some cases. Working in a paired caring model enables the patient to have some continutiy, just as it does for the pair of nurses caring for those patients. When we developed our floor, about 10 years ago, we posted job lines in pairs, one RN+LPN for each rotation. We signed up to work TOGETHER! I have been with my RN partner since day one. We know how each other works, and she will pick up what I miss just as I will pick up on what she's missed. The patients get excellent care and we are on top of our practice. I don't start IV's or draw blood, but I do glucometer testing. LPN's are trained to administer insulin, heparin and all meds except narcotics. As far as skill go, LPN's remove NG's and corpak feeding tubes. We maintain IV's and maintain and initiate enteral feeds. We remove IV's and saline locks. We prep patients for tests and surgical procedures. We also preceptor graduating LPN students. LPN's are an integral part of the nursing team in our hospital. I've been here for 13 years and have done it all- primary care nursing, team nursing, and paired caring nursing. The last, by far, is the best for everybody- nurses, patients and families, and then the system, in general. We roll with the punches so to speak. We are able to adapt to anything, and in fact we have! E-mail me if you'd like more info.
  9. by   LynniNurse
    As an LPN in Tennessee working on a medically complex floor, I work to the full extent of my licensure. I push IV meds, hang IV fluids and piggybacks, draw blood from PICCs and central lines, assess patients, assist the physcians in all bedside procedures such as inserting central lines, lumbar punctures, PEG placements, colonoscopes,etc. I take verbal orders, phone orders and note off any and all orders. I mix any IV drug that is ordered then administer it. For a while, I was the only ACLS provider in my unit so I run the codes -- administer all the ACLS drugs and defribillate when needed. I am the charge nurse when there is no staff RN available but there has to be at least an agency RN on the floor. An RN has to open the clamp to iniate a blood transfusion, but other than that, I do it all. I even precept RNs that are new to our floor, especially if the RN is a new graduate. LPNs take the same patient load as the RNs. We have a lot of vent dependant pts. so we take them as well. A good LPN can do anything an RN can do except demand the respect and collect the pay. Any facility that doesn't use LPNs to the fullest extent of the licensure law is wasting money!!! Management should love the LPNs just for the budget savings if nothing else!
  10. by   Lisa_Lynn
    Hello. I'm a 16 yr Missouri Lpn. I currently work in St Louis Mo @ St Louis University Hospital. Here @ home (in Poplar Bluff) Lpns as I previously read in one of the posts...do just about everything the RN does...and the same at SLUH. The differences are that @ home...we can call the doc's take T/O's, V/O's, write the orders on the physician order, no IVP's with the exception of the flushing of saline locks, and we can't touch the piccs etc. In StL we can do nothing with the orders. No taking them from the docs, no verbals,telephone no anything. However, we can flush and draw blood from the centrals and piccs (go figure) but can't change the dressings on them. The RN has to hang the blood but we take care of it after that and we can remove it once it's done. Talk about some getting used to! I've worked most of my career here at home doing darn near everything, and then go upstate 3 hrs and have to try and remember to leave the docs alone or drag them to an RN. Incredible.! I love being an Lpn and have never tired of it, however...and I think that it's very unfair...most of what I want to do you have to be an RN for. I want to do Trauma/Flight Nursing and called the 2 or 3 chopper transports in our area and of course...you have to be an RN. So hopefully if all goes well I will be going back to RN school at StLU in the spring or summer.
  11. by   antralan
    I also a LVN in california i agree with very thing DAYANNIGHT said but i floated to rehab i was the only nurse no RN total 20 pts
    Last edit by antralan on Dec 5, '01
  12. by   Future LPN Sheryl
    I am in Massachusettes and LPN's do the same work as RN's but can't start IV's (unless IV Certified) and can't hang blood. That's it!!
  13. by   JMP
    I work in ICU now, but when I was on the floor, LPN/RPN's did nothing........because they are not there- we did primary nursing and the hospital laid off ALL the lpn/rpn's .......they are all gone. When they where there, they did vitals, baths, personal care. I am curious, I see many posts refering to LPN's "pushing meds" In the hospital that I work in, only pts in ICU or a step down unit can push meds. Why? Because for many meds the pts need to be on monitors.

    Tell me, the LPN's who are pushing meds.....what kind of meds are you pushing............ I am very curious. IF you are pushing lasix, what precautions do you take? If you are pushing cardiac meds, are all your pts on monitors????????????

    Let me know OK..........my curiousity has been peaked!
  14. by   LynniNurse
    Well JMP, yes, if I'm pushing cardiac meds during a code situation you can bet that the patients are on the monitor -- a lifepak at the bedside. All pts during a code are on a monitor. And in my medically complex unit, all of our pts are on telemetry at the very least, and most are on space lab monitors at the bedside. I use the same precautions as you should when pushing Lasix or any other med. I took Pharmacology in nursing school. I was IV certified during nursing school as were all the students at my school. The Canadians RNs I've worked with aren't allowed to start an IV, much less push meds thru them. Is this just a condition of their licensure in the states or typical of all RNs in Canada? Do I detect an attitude towards LPNs in your post? Do you not feel we are qualified to push meds? Do you consider yourself to be more qualified than my stateboard to determine whether or not I should push meds? Attitudes like the one I sense from you need to be trashed. We are all nurses and teamwork is so necessary. Get off your high horse and accept that LPNs are often more experienced, more knowledgeable and much more capable than so many RNs coming out of schools now. There may come the day that even YOU need an LPN to help, so watch how you talk to us!

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All Lpn's Please Read