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

  1. 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
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  2. 38 Comments

  3. by   kat7ap
    This answer will differ from state to state and even from hospital to hospital. In my hospital LPNs have their own pt assignments and the RN is there to do intial transfer/admission assessments and legally must sign our charts that the care and assessment has been reviewed. My hospital allows LPN II (an LPN with one year of experience and who has completed a competency test) to push certain IV meds. We do not hang blood either. In my unit there is not much difference between RN and LPN, we both do the same job. Your best bet to find out exactly what the LPNs role at your workplace would be to contact your manager directly.
  4. by   OgopogoLPN
    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.
  5. by   Fiona59
    I work in Alberta, Canada which is the province next to BC.

    PNs work everywhere. We work active treatment, LTC, post partum and L&D, icu. With additional certifications, we work in the OR, Dialysis, and immunization programmes, certification is also availabe as Orthopedic techs. We are responsible for our own patient load and perform our own assessments. PNs and RNs answer to the Charge Niurse. Our scope of practice is constantantly expanding and restrictions placed on our pratice by our employers is disapearing. I was trained in how to insert an NG but our health authority deems it an RN skill.

    Basically, we do what is required of us.

    Nursing Assistants in my health authority can not perform vitals or administer any type of medication. Their role is to maintain patient hygiene and nutrition, make beds, and be a nurses extra pair of hands. A good NA can make your shift or break it. They are worth their weight in gold.

    We start and hang our own IVs but cannot "push" but then only ICU and ER RNs perform this at my hospital. We cannot puncture the TPN or blood bag. Hang it but not spike it.
  6. by   nurseinthefield
    Quote from 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
    same work except IV...
  7. by   TheCommuter
    I am in Texas, where we're not permitted to pronounce death, push a few specific IV meds such as vitamin K, or complete the initial assessment in the acute care setting. However, we're allowed to complete initial assessments in nursing homes and other LTCFs.
  8. by   JaredCNA
    Quote from TheCommuter
    I am in Texas, where we're not permitted to pronounce death, push a few specific IV meds such as vitamin K, or complete the initial assessment in the acute care setting. However, we're allowed to complete initial assessments in nursing homes and other LTCFs.
    At the hospital where I work in TX, LVNs can perform an initial assessment when a pt is admitted to the floor but this (and their shift assessment must be cosigned by an RN). All other documentation doesn't even have to be reviewed by an RN, such as care plan. LVN's can take telephone/verbal orders from the doc, discuss pt condition with the physician/family, and as LVN II's they can even push IV meds and do everything with PCA pumps except the loading dose.

    Another thing which is rare, is that we have a lot of LVN II's working in ICU and the ER. They are employed in surgery as scrub techs but can push meds down there under the surgeon's license. I want to even say that my facility allows LVN II's to pronounce...but I'm not sure.

    It seems my facility is pretty lax with LVNs compared to others.
  9. by   txspadequeenRN
    you are talking about a hospital setting. the commuter is talking about ltc. in ltc lvn's do all the initial assessments.



    Quote from jaredcna
    at the hospital where i work in tx, lvns can perform an initial assessment when a pt is admitted to the floor but this (and their shift assessment must be cosigned by an rn). all other documentation doesn't even have to be reviewed by an rn, such as care plan. lvn's can take telephone/verbal orders from the doc, discuss pt condition with the physician/family, and as lvn ii's they can even push iv meds and do everything with pca pumps except the loading dose.

    another thing which is rare, is that we have a lot of lvn ii's working in icu and the er. they are employed in surgery as scrub techs but can push meds down there under the surgeon's license. i want to even say that my facility allows lvn ii's to pronounce...but i'm not sure.

    it seems my facility is pretty lax with lvns compared to others.
  10. by   txspadequeenRN
    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


    Quote from jaredcna
    at the hospital where i work in tx, lvns can perform an initial assessment when a pt is admitted to the floor but this (and their shift assessment must be cosigned by an rn). all other documentation doesn't even have to be reviewed by an rn, such as care plan. lvn's can take telephone/verbal orders from the doc, discuss pt condition with the physician/family, and as lvn ii's they can even push iv meds and do everything with pca pumps except the loading dose.

    another thing which is rare, is that we have a lot of lvn ii's working in icu and the er. they are employed in surgery as scrub techs but can push meds down there under the surgeon's license. i want to even say that my facility allows lvn ii's to pronounce...but i'm not sure.

    it seems my facility is pretty lax with lvns compared to others.
  11. by   nitewarrior
    In VA I can do anything except hang blood and the first 15 min of the infusion, draw from a PAC/PICC, and hospital wise the admission assessment is to be done by a RN
  12. by   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.
  13. by   TheCommuter
    Quote from JaredCNA
    At the hospital where I work in TX, LVNs can perform an initial assessment when a pt is admitted to the floor but this (and their shift assessment must be cosigned by an RN).
    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.
    Quote from JaredCNA
    as LVN II's they can even push IV meds and do everything with PCA pumps except the loading dose.
    There are certain sedating meds that LVNs are not to push. Again, this is a state rule, and not a facility rule.
    Quote from JaredCNA
    I want to even say that my facility allows LVN II's to pronounce...but I'm not sure.
    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.
  14. by   Fiona59
    Basically, in my province, the PN has evolved into the diploma trained RN. We have roughly the same skill set as a hospital trained RN of the 1980s.

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