Ever feel pressured to go out of your scope?

Nurses LPN/LVN

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Im a new LPN (5 months) and I work in a LTC/Rehab. I dread when a resident has an order for an IV med because I know I am going to either be made fun of, or be made to feel guilty for being overly cautious.

On one day I had a resident on Vancomycin and we don't even have pumps in my facility. Just those sets with the dial on them and even if I was IV certified (which I am not) I am not comfortable hanging such a powerful anti-biotic w/o a pump. Also there are 40 residents on my floor and I am the only nurse, I can't even really monitor the person so the whole deal just screams danger to me.

Anyway, the supervisor didn't give me a hard time but she ended up making a med error because the nurse who transcribed the order forgot to update it to reflect that the dose had been decreased. I felt a little bad about it but isn't it the supervisors responsibility to check the MD order before they administer a med? The nurse who didn't transcribe the order got a talking to from the supervisor and then she came to the floor angry with ME and ended by stating "I hang my own IVs" as she stormed off.

I retorted that she could do that if she wanted to but that I wasn't going to take the risk with my license.

Second situation the resident (a new admit) is getting Bactrim via a PICC line. Again, this situation makes me very uncomfortable and I get the feeling that this nursing home just takes any an everyone regardless of the ability to provide decent care. So I call the supervisor to flush the PICC line and she comes up and is agreeable enough but tells me she is going to teach me how to do it for the next time. I told her that I would observe because I am in school for my RN and like to learn but that I would be leaving the flushing up to her because I KNOW for a fact that the scope in my state says LPNs cannot flush PICC lines regardless of being IV certified.

The supervisor didn't give me a hard time but I got the standard eye roll.

Did I do something wrong? :banghead:

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Specializes in Mother-Baby, Rehab, Hospice, Memory Care.

It seems as though your supervisor should know what the LPN scope of practice is in your state. Obviously it creates a little more work for them but when it comes down to it, it's your license if something would go wrong and you were practicing outside your scope. Fortunately I haven't experienced that much at all in the 2 years I've been an LPN. However in states I've practiced in (Texas and Washington) are less restrictive for LPN scope of practice. I wouldn't want to give IV antibiotics without a pump either. Are you not able to have your facility's pharmacy provide you with one?

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Specializes in LTAC, Med/Surg..

Nope.

Frankly, I think you did EVERYTHING RIGHT!

Good for you for sticking to your guns. We have a clearly defined scope of practice, and the only person who will answer for it if you step beyond that is YOU, not your facility or your supervisor. She can roll her eyes all she likes when it's not HER license on the line.

I also have to wonder about a supervisor who ROLLS HER EYES at an employee following scope and protocol - don't you think the sup should be HAPPY that you're doing things by the book? I mean really - would she be happy with you bending OTHER rules, just because it would make life easier? I doubt she'd give you that lee-way if you bent any other rule that didn't directly enhance her ability to be LAZY. :) We get the same kind of eye-rolls from several staff nurses on our clinical floors when we tell them we don't touch IV pumps or push meds - but they sure are the first to scream at us if something else unrelated to their convenience isn't by the book.

Regardless of IV cert (which I will have when I graduate in September) LPN's can't hang the 1st bag of vanco in my state. Nor can we flush PICC's. EVER. Clear and in black and white. Be polite. Be Professional. BUt continue to be firm. I'm not risking MY license over an idiot supervisor. :)

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Specializes in Community Health, Med-Surg, Home Health.

I agree with everyone else. Your license is just as important to you as theirs is to them. And, they can get in trouble for even asking that you do this; remind them the next time they roll their eyes.

I am sorry to say, but, the RN knows that if something is out of the scope of practice for anyone, CNA, tech, or LPN, then, THEY are supposed to do it, or ensure that it is done by a qualified person. The role of the RN includes leadership and accurate delegation. Is there a union around? If so, I would ask for their intervention or ask for a meeting with the scope of practice and job description in my hand.

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Sigh, I think it's just the culture of this LTC to be lax in everything until the ______ hits the fan.

Today I got into a huge blow out with a resident because I wouldn't leave her meds at the bedside. She was really mad and kept insisting that I leave her meds even her Ambien and I was like no way and I'm not budging on that.

Then the night nurse got snotty with me cuz I waited for him to show and then I waited to count the narcotics with him. He goes "You didn't have to wait for the count" after he was done. I was so surprised I just stammered that it wasn't really that late and that I don't want any problems so I would rather wait and count.

Why do I feel like an a$$ for doing the right thing? I know I am doing what is right but as irrational as it is I feel like poo right now.

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Specializes in Community Health, Med-Surg, Home Health.
Sigh, I think it's just the culture of this LTC to be lax in everything until the ______ hits the fan.

Today I got into a huge blow out with a resident because I wouldn't leave her meds at the bedside. She was really mad and kept insisting that I leave her meds even her Ambien and I was like no way and I'm not budging on that.

Then the night nurse got snotty with me cuz I waited for him to show and then I waited to count the narcotics with him. He goes "You didn't have to wait for the count" after he was done. I was so surprised I just stammered that it wasn't really that late and that I don't want any problems so I would rather wait and count.

Why do I feel like an a$$ for doing the right thing? I know I am doing what is right but as irrational as it is I feel like poo right now.

Oh, year, I know what you mean. I do not leave medication at the bedside-EVER. I know nurses that do it, but it will not be me. I tell patients that I cannot control how other nurses practice, but I am not compromising on that one. If I have to document that the patient refused, or come back later, then, fine.

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

I have not yet felt pressured to practice outside my scope, probably due in part to the fact that I am licensed in Texas, which has a wide-open scope of LVN practice. I worked on a nursing home rehab unit where I regularly flushed and heparinized PICC lines and give IV ABTs such as Vancomycin, Tobramycin, Zosyn, etc. However, our board of nursing allows LVNs to engage in most aspects of IV therapy.

However, I wouldn't touch an IV without being certified in IV therapy.

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Then the night nurse got snotty with me cuz I waited for him to show and then I waited to count the narcotics with him. He goes "You didn't have to wait for the count" after he was done. I was so surprised I just stammered that it wasn't really that late and that I don't want any problems so I would rather wait and count.

Why do I feel like an a$$ for doing the right thing? I know I am doing what is right but as irrational as it is I feel like poo right now.

Heh. His insistence that you don't need to count with him would alert me to never, ever hand off to him s a count!

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Specializes in A little of this & a little of that.

It's sad but true that we are often asked to do things that are wrong/illegal like working out of our scope of practice. Stick to your guns. You're right. They are wrong. Remind them if they get too nasty that improper delegation is an action that can result in discipline of their licenses. I've been a nurse for a very long time and never had any disciplinary action. I plan to keep it that way. I don't work out of my scope. I always count narcotics. I don't leave meds at the bedside. I never have to worry that someone may be watching because I do it the way I was taught. People have been sarcastic, nasty, etc and I don't care. Also, remember that any adverse actions against your LPN license may affect your ability to get RN licensure. You are a good nurse. Keep doing the right thing.

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