Calling all LPNs?? What is and is not in your Scope of Practice compared to an RN? - page 2

Hello all LPNs, I am starting a new job at a hospital that uses the Team Nursing approach (RNs, LPNs, and CNAs). I have never worked with LPNs or CNAs before. At my last hospital, they used Techs... Read More

  1. by   TheCommuter
    Quote from kaydrian
    I think it all depends on your state and the place in which you work. I haven't had the opportunity to work as an lvn yet ( still waiting my results). As a student though, I was always told PO, IM, Sub Q, and Intradermal. An LVN can be IV certified but can't hang anything with Meds. Just fluids. Basic nursing skills.
    You must be in California, which is a very restrictive state regarding LVNs.
  2. by   swee2000
    Here are some of the things I can do at my hospital in WI:
    **enter an admission database or discharge instructions
    **perform ongoing patient assessments(although in the LPN world, it is
    called "data collection")...ALL assessments/data collection charting
    has to be co-signed by an RN
    **administer PO, SQ, SL, IM, ID, and hang IV fluids(with or w/o
    potassium) or IVPB meds...there are some exceptions to this,
    though
    **dressing changes
    **reinforce teaching/education already started by RN
    **start IVs with or without using lidocaine
    **be a witness for hanging blood &/or starting or changing dose on
    PCAs
    **Remove an NG or IV(only peripheral)
    **all the skills, tasks, and responsibilities of a CNA


    Now my advice about working with LPNs: Treat them for exactly what their title says they are......NURSES. Another words, DO NOT call or refer to them as aides, CNAs, "glorified CNAs", "low-paid nurses", techs, or nursing assistants. LPNs ARE NOT any of these and therefore should not be called, seen, referred to, or acknowledged as such. Rather, they have worked just as hard as any RN and earned their title, license, and the right to be called, viewed, and acknowledged as nurses. That's the whole point to nursing school and the NCLEX exam, right?

    So please give any LPN you work with an ounce of respect by recognizing that they're more than just a "low-paid nurse" or "glorified CNA". They are nurses, too. Thank you.
    Last edit by swee2000 on Nov 21, '07
  3. by   JaredCNA
    Quote from txspadequeen921
    there are several things that don't seem right here

    in the hospital the initial assessment has to be completed by the rn then after that the shift assessment must be co- signed by the rn. the care plan is usually initiated by the rn and i guess some places let the lvn update the care plan but my experience is the rn's handle the care plans..yeeeaaaah.
    lvn's do not work under surgeons licenses because they have their own.
    i can tell you 100% for sure lvn's cannot pronounce in texas
    i wasn't sure about whether or not they can pronounce. you are right on that.

    however, lvn's do initial assessments on every floor of the hospital that i have worked, including icu. an rn (usually our charge nurse) has to sign the assessment.

    in the or, lvns do work as scrub techs. i know for a fact that lvns can push in surgery if the surgeon is present because when the rn on call doesn't respond, a surg tech may scrub for the rn and surg techs can push meds if the surgeon tells them to.
  4. by   txspadequeenRN
    lvn's are not allowed to pronounce death in any way shape or form in texas. they are allowed to contact the doctor with the assessment information but that is it. they cannot take a doctors order and pronounce the patient dead. you still have to have a rn come and fill out the paper and assess the patient. dumb i know , ive been gripping about it for years.... here is the link to the texas bon
    www.bon.state.tx.us/practice/position.html



    Quote from thecommuter
    however, the lvn's initial assessment in the hospital setting is usually termed "data gathering," so that the facility does not get into trouble with the state. the texas board of nurse examiners mandates that lvns are not to complete the initial assessment in the hospital; rather, their role in the initial assessment is "data collection." i'm sure that lvns are doing initial assessments at your hospital, but they must be cosigned by an rn. there are certain sedating meds that lvns are not to push. again, this is a state rule, and not a facility rule.
    texas lvns are allowed to pronounce death only if they are doing so under a physician's order. if there's no physician's order to pronounce, then the lvn cannot pronounce death in texas. this is another rule mandated by the texas bne.
  5. by   txspadequeenRN
    i didn't say that they could not push iv drugs i said they did not need the doctor there to do so, just the order. you know the texas bon is so wishy washy when it comes to clarification of certain things and this is one of them. they have no rules regarding this subject other than the rn performs the comprehensive assessment and the lvn does a focused assessment. it does not say that a lvn cannot do a initial assessment and leaves that decision to the facility. no facility i have ever worked at or known has allowed the lvn to do the initial (admission ) assessment. i think you are talking about the shift assessment (daily assessment) in this case then yes of course the lvn can do it and have it co- signed by the rn.

    Quote from jaredcna
    i wasn't sure about whether or not they can pronounce. you are right on that.

    however, lvn's do initial assessments on every floor of the hospital that i have worked, including icu. an rn (usually our charge nurse) has to sign the assessment.

    in the or, lvns do work as scrub techs. i know for a fact that lvns can push in surgery if the surgeon is present because when the rn on call doesn't respond, a surg tech may scrub for the rn and surg techs can push meds if the surgeon tells them to.
  6. by   Xbox Live Addict
    In Oklahoma, LPNs have an extremely broad scope of practice. They can do everything short of hanging blood and IV push meds. They run LTC - the RN (usually the DON) needs only be there eight hours a day. They do almost all the assessments that RNs do in every setting where they are employed.
  7. by   NRSKarenRN
    read pa's rules and regulations for exact info on pa's scope of practice.

    each state is different so nurses need to read, understand and follow the state's practice act in state where you work, to keep out of legal hot water

    link to all states bon
    Last edit by NRSKarenRN on Nov 21, '07
  8. by   JaredCNA
    Quote from txspadequeen921
    you know the texas bon is so wishy washy when it comes to clarification of certain things and this is one of them.
    i agree.

    i like that the bon leaves a lot open to the facility, though. i always wanted to go lvn first, then challenge what i could for rn...but i didn't want to do that because i was always under the assumption that lvns had sooo many things they weren't allowed to do.

    now i'm going for my lvn because i believe this will be less stressful and i think it will make my rn clinicals go a lot smoother. i will definitely work where i am now as an lvn because, like i said, they can do so much at my facility.
  9. by   rgroyer1RNBSN
    Andreas is right Oaklahoma LPN's can do everything short of hanging blood and IV-pushes, my mom is one of them. Now up here in Missouri where I work there pretty lax to as long as your Iv certified, they pretty much do everything up here to short of Hanging blood and pushing some meds. Now my sister and her friends are RN's up in Indiana and from what Ive heard from them which I dont know is true or not they can do everything in Indiana except the initial assesment.

    RR
  10. by   Rexie68
    Hi there!

    I'm a Pennsylvania LPN (and RN student, finally!) and there are some things we aren't allowed to do by state law, plus whatever your facility allows. We cannot legally PUSH IV meds, but can start IV's, draw blook, hang piggybacks, etc. We cannot hang blood or titrate IV meds by parameters. We can pass all other meds, take MD orders, sign off charts, do dressings, treatments, take an assignment, charting, etc, etc, etc. A good LPN knows when to call an RN for help. He/she can be an incredible help to the charge RN and make a great team member, leaving the RN to supervise the unit and/or care for the critically ill patient. Hope this helps. :spin:
  11. by   MaraG.
    Quote from Ogopogo
    I'm an LPN student in BC, Canada.

    I know that we cannot push IV meds, start IV's, hang blood.

    As far as I know an LPN cannot work in acute care or L + D. Although my instructor told us if we were ever floated to those wards, it would be much more in a "care aid" capasity. Very basic patient care with very little assessments or interventions.

    There is an additional course LPN's in my province can now take to work in the OR. I'm not sure how long it is.
    I am an LPN in BC. I have been working more or less full time since I graduated over a year ago. In BC an LPN can work in acute care. I work in on an acute care floor where the work is fast and busy. Occasionaly we use the team nursing apporach, but for the most part the RN and LPN's have their own assignment. I suppose it depends on who you are working with and the workload at the time. Pt load of 4-5 on days and 4-6 on nights.
    As an LPN I can do almost everything an RN can do. IM/SQ injections, narc's, assesements of almost everything including PICC lines. I can not hang blood but I can do all the pre- checks (ID pt, ID blood etc) I can also monitor the pt once the blood is hung. I can also hang some IV solutions. I can't hang IV meds but can monitor while the infuse. An LPN pt assignment has to be stable or have a predictable outcome.
    Hope that info helps.
  12. by   Fiona59
    I worked in BC a few years back and my practice was very restricted. It really depends on which health authority you are employed and even then it depends on the hospital.

    I went from a hospital that had a very good utilization of LPNs on nearly every unit (except ICU, NICU, and antepartum) to being an overpaid NA who wasn't allowed to administer meds on a general surgical unit. During the seven months I worked there, I was "allowed" to d/c an IV ONCE because they "trusted" me. I was told I would NEVER be allowed near a pregnant or postpartum woman in BC because that was an "RN" role. Another LPnurse from the neurotrama unit of my old hospital couldn't believe how we were treated. Basically, I think it was due to a very high unemployement rate in the area and the "old girls" network amongst RNs.

    A new Director of Nursing was hired and she came from the province I had trained in and kept telling us to hang in there as she was working on having LPNs brought up to speed but eventually we both left. Never did find out if she had brought in her changes.

    So, you are one of the lucky ones. My experience in BC was in the last 3 years.
    Last edit by Fiona59 on Nov 26, '07
  13. by   OgopogoLPN
    Quote from MaraG.
    I am an LPN in BC. I have been working more or less full time since I graduated over a year ago. In BC an LPN can work in acute care. I work in on an acute care floor where the work is fast and busy. Occasionaly we use the team nursing apporach, but for the most part the RN and LPN's have their own assignment. I suppose it depends on who you are working with and the workload at the time. Pt load of 4-5 on days and 4-6 on nights.
    As an LPN I can do almost everything an RN can do. IM/SQ injections, narc's, assesements of almost everything including PICC lines. I can not hang blood but I can do all the pre- checks (ID pt, ID blood etc) I can also monitor the pt once the blood is hung. I can also hang some IV solutions. I can't hang IV meds but can monitor while the infuse. An LPN pt assignment has to be stable or have a predictable outcome.
    Hope that info helps.

    Thanks for the updated info!!! I'm in Kelowna and will likley be hired by INterior Health when I'm done. Actually, a classmate and I were discussing today whether or not LPN's can work in L+D, actively helping during labor and delivery. I didn't think we could, but she did. I actually want to do that more than anything, but figured I would try to work on the post partum ward and then maybe one day bridge to the RN prgram, just to be able to do L+D. Do you know if LPN's can work there?

    Thanks!!

    Oh, we are on practicum right now and working at a LTC facility. I was talking to an LPN there who said she liked it there much mroe than the hospital. She said at the hospital, LPN's are regulated to "a lot of VS" and that their full scope is not utilized. Which sounds very opposite of what you described above. She likes LTC because she gets to do the nursing aspect, wheras at the hospital, the RN's do the "real nursing" stuff. (However, the entire 7 hours I was there, she was giving out meds. She said she does get to do the "good stuff" when it comes up, but other than that, she gave out meds all day.)

    What's your experience with LPN's in your hospital? And if you don't mind, what health authority do you work for? Please PM if you don't feel comfortable answering here. I'd love some more insight from a BC LPN.

close