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

[Nrs_angie]

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 which were like CNAs but they could also draw blood, and a few other things. Can any of you remind me, what an LPN can and can not do? also what a CNA can and cannot do? Also, if you have any advice on how to work with the LPN's and CNAs as a new employee. All the other RNs on this unit have been there for years. So I dont want to step on anyone's toes.

Thanks so much,

Angie

[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.

[OgopogoLPN, LPN, RN]

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. :)

[johnp127]

From what I gather.... Texas is the only place where you would really be able to totally care for your pt... everywhere else LVN/LPN hands are tied. RN complain about the work load but the Nursing board with what LVN/LPN scope of pratice for us keeps the rope tight. It is an eye opener, and a motivationg factor that sends a nurse back to school. In texas you are a "NURSE". Not "I am a RN" or "I am a LPN"... "I am a nurse". never have I experienced the discrimination until I moved away from home.

[Fiona59]

Dear John: (I've always wanted to type that, sorry)

Our practice is very much restricted by our employers. My health authority is suffereing a severe staff shortage and aging population. Guess what, my scope has just been expanded to starting and hanging IVs and their meds. Still no starting TPN, or spiking the blood bag. No extra money.

Nursing shortages demonstrate our skills. Hopefully we demonstrate our negotating skills on the next contract renewal.

[purenholy]

Where I worked the LPN have their own assignment as the RN. We were responsible for admissions and discharges, I start IVs and hang IV antibiotics and fluids, monitor blood, insert ng tubes, supra pubics, foley catheters,draw blood...ekgs ect...no iv push meds

[TheCommuter, BSN, RN]

From what I gather.... Texas is the only place where you would really be able to totally care for your pt... everywhere else LVN/LPN hands are tied.

In general, the Southern States tend to have the widest LPN/LVN scopes of practice in the nation, which means that we can do more and function maximally in these places.

[NursePeace]

Welp in Ohio LPNs basically steer clear of IVs. No piggybacks, no blood, no pushing anything. Not even care on a picc. You may start and hang NS on someone over the age of 18 I believe it is. You must be IV certified. Which Im not. I work in a LTC setting and we have NOTHING to do with the IVs. I think most places just use the RNs anyway because theres sooooo many restrictions.

[lpn1972]

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'm not sure your instructor knows what she is talking about. I am an LPN in BC working on Acute Surgical floor. I have my own pt load, do full head to toe assessments, give out medications ( IM/PO/SC/NEB) everything but IV meds, do care plans. We cant take Dr.s orders, but we can on the Medical floor. We also do most of the catheterizations on the floor, do I&O's. We basically work to full scope. I am guessing by your name that we are in the same Health Authority, and they want LPN's working to their full scope.

[Fiona59]

Nursing in BC varies from health authority to health authority and then within the facilities in that system.

Campbell River, Comox, Nanaimo all had/have different ideas about how to utilize their PNs and they are all part of VIHA.

[LPN2RN1975]

in ok, lpn scope of practice is quite broad but does vary from facility to facility and even floor to floor. the hopsital floor where i work is, at least for now, quite liberal in regards to lpn scope of practice. i do all my own assessments - admission and regular q shift assessments. i take my patients' initial set of vitals (the techs get the rest) and other vitals as needed. i pass all of my own meds - iv and otherwise. i take verbal and telephone orders from mds.

i do not do care plans. my admission assessment must be co-signed by an rn. i do not spike blood, and must verify it with an rn and have an rn present for the first 5 minutes of transfusion. i will not be assigned as a charge nurse.

so basically, i function as an rn but get paid a little more than half what an rn is paid.

any situation i am uncomfortable with, i seek out the help of my charge nurse. like the first time i pushed digoxin or cardizem i had someone with me. like when i know a patient has had a significant change in condition.

ours is an initial-driven profession. too much emphasis is placed on lpn vs rn vs bsn and not enough on ability. i have worked with both rns and lpns who are fantastic and well-matched to their jobs, and with some who are just plain scary. it bothers me to this day when i come across someone who is more concerned with initials than with experience, aptitude and heart. there is nothing that shows one's inexperience more than a nurse (or doctor) who only pays attention to what's after your last name than to what's between your ears!

so find out your facility's policy, and state regulations, to be safe.

[OgopogoLPN, LPN, RN]

I'm not sure your instructor knows what she is talking about. I am an LPN in BC working on Acute Surgical floor. I have my own pt load, do full head to toe assessments, give out medications ( IM/PO/SC/NEB) everything but IV meds, do care plans. We cant take Dr.s orders, but we can on the Medical floor. We also do most of the catheterizations on the floor, do I&O's. We basically work to full scope. I am guessing by your name that we are in the same Health Authority, and they want LPN's working to their full scope.

Ooops, I just reread my original post. It should have been "ICU", not acute care. I know we can work in acute care which is where I hope to work when I'm done. Do you know specifically about L + D in our health authority? :)

[lpn1972]

Ooops, I just reread my original post. It should have been "ICU", not acute care. I know we can work in acute care which is where I hope to work when I'm done. Do you know specifically about L + D in our health authority? :)

That I'm not too sure about! I used to work in Maternity all the time when I first graduated(2001) and then our nurse manager decided that LPN's shouldn't work there anymore (no reason given, just a control thing!) I still do occasionally work there but only when they are desperate! I know that in other hospitals in the region, LPN's do work in Mat. We don't do L&D although I have assisted with a few deliveries, mainly just a runner person. We can work post-partum though.