Quote from gutcheck
here is how I think of it.
LPNs cannot reassess. with blood products lpns cannot even check the blood product. that requires 2 RNs. and you have to stay with the pt. for 15mins. to reassess, evaluate how the are responding to the transfusion. same with tpn, that is an RN responsibility. the LPN can do some sterile produres. like dressing changes, trach care. but these should be simple procedures, which won't require the RNs assessment (that is the key, does it require reassessment). anytime you have a pt. with a sign or symptom, like restlessness, confusion, pain, headache. it requires the RNs assessment. the RN needs to assess the level of pain, are they confused/restless because they are short of breath. this requires the RNs asssessment skills. The RN is also responsible for admission and discharge. admission requires you to assess the pt. and discharge requires teaching in some ways. both of these only the RN can do. as long as the situaiton requires you to assess, reassess, plan care, evaluate, admit, discharge, teach, it will be the RN responsibility. so you have to think about are they needing something requiring me to reassess. before you give pain med. you have to assess there pain. after you give the med you have to reassess. so if it is a prn med or a med that requires reassessment. then that is the RNs patient.
It really depends on the state you live in, the scope of practice of the LPNs and policy/procedure of the facility. It is true, that an LPN is not to assess. However, in my state, if trained, we can initiate blood products, but the bloods have to be signed with an RN, not an LPN. Some states say that the LPN cannot do an initial assessment, but can do follow-ups (on the same situation if they are stable), and if there is a new situation, then, this is where consultation with the RN takes place.
Again, I am speaking of my state only, but we can do teaching for common place situations that are already established, such as diabetes, hypertension, etc...(no new and exotic diseases). Some nursing homes will have an LPN create an initial care plan, but it has to be countersigned by an RN; so, it can change based on the RN's judgement. Some states have a broader scope of practice for their LPNs, some are more limited.
I keep hearing about some places were their LPNs are not allowed to medicate their patients at all...that astounds me. What on earth can they be learning for 9 months to a year only not to be allowed to adminster basic medications is beyond me, but I guess it happens.