LPN scope of practice

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    Can anyone give me an exact link that tells me ALL the specifics for the scope of practice for an LPN is? I found a link on the state board of nursing that tells me all about the IV med things (and of course that is out of my scope of practice) but I need even more specifics on ALL things I am running into on the soon to be all rehab floor I am working.

    I am VERY upset right now. Last night the overnight LPN told me that I need to refuse to do a strictly saline flush of a nephrostomy tube because that is out of my scope of practice. Only an RN is aloud to do this!

    What's worse is I ALREADY did it. Not just once either. I was in training and an RN super took me to my first nephrostomy tube showed me what was to be done and ever since they have been having me not only do this but teach other nurse's how to do it?! I do the dressing changes around these tubes every evening also?

    I am REALLY questioning everything I am told to do and not do at this facility. So if I cannot do saline flushes on nephrostomy tubes does that also mean I should not be doing saline flushes on PICC lines? They also taught me to do those too and have me doing them all the time too?! (Mind you I must get an RN to do the dressing changes on these. They do NOT have me do those?)

    I do not ever start or hang IV fluids or meds but they DO have me do the saline flush to the line after meds are completed? The RN comes, hangs the meds then tells me what time to expect them to be completed and I am to go saline flush and disconnect them.

    I never touch anything to do with TPN. The RN does all that and no one tries to make me do that.

    I am do confused and upset right now. I can't even remember what I was taught at school I am so upset!
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  3. 13 Comments so far...

  4. 0
    There is no such document as scope of practice varies from state to state. Have you tried calling your board of nursing?

    Since you said you are in PA, I've found these documents:
    http://www.pacode.com/secure/data/04...1/s21.145.html

    21.414. Interpretations regarding the functions of Licensed Practical Nurses (LPN)—statement of policy.

    (a) Collection of venous blood samples fall within the scope of Licensed Practical Nurse (LPN) practice under 21.145(a) (relating to functions of the LPN).
    (b) The following nursing practices fall within the scope of LPN practice under 21.145(b):
    (1) Changing cystostomy tubes after the stoma heals.
    (2) Changing gastrostomy tube when stoma is healed.
    (c) The following nursing practices fall within the scope of LPN practice under 21.145(a) and (b):
    (1) Insertion of nasogastric tubes.
    (2) Changing outer tracheostomy tube after stoma is healed.
    (3) Addition of medications to peritoneal dialysate in the care of those patients with chronic renal disease.
    (4) Removal of sutures of a simple and uncomplicated nature.

    from: http://www.pacode.com/secure/data/04...bchapDtoc.html

    The specifics regarding LPNs and IVs are due to come out in the upcoming weeks as per a notice on the BoN website, http://www.portal.state.pa.us/portal...egulations_pdf (this seems to include expectation regarding LPNs and central lines)
    Last edit by JustBeachyNurse on Jul 28, '12
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    No I did not call anyone yet. I only was told this last night at midnight. I also became to AFRAID to call anyone until I even had time to figure this out. As I said I have already been doing these things on multiple patients for the past 8 months!

    I was already over my limit for "crap" before she told me this due to having TWO septic admissions, neither on IV antibiotics thrown at me as soon as I walked in the door, one WAY to unstable that should never have been sent to me in the first place. I was fighting all night to get the RN and or a Dr to help me with this poor septic soul.It was a nightmare just trying to keep this febrile fellows stats above the 83% he was at when he rolled in the door! The RN was to busy trying to get this lady that came in 20 minutes before him above 90%. She also was unstable and behavioral to boot! This guy had blood pouring out of his nephrostomy tube and catheter, they left a guide wire in place taped fast to his foley. BP dropping as we go. They said it was because they attempted to put a stent in due to a kidney stone being stuck and it failed so they were going to try again later? it of course escalated from the get go.

    I am still in shock that these people are being sent me in the conditions they are. It makes me very nervous that my facility not only accepts them but throws them at an LPN with 20 some other patients already and with only one year experience as a nurse, period. Not one year experience rehab with piles of other years as a nurse otherwise. No... new nurse PERIOD. (Although Indeed I have RAPIDLY gained a WHOLE LOT more experience than the other nurse's that are on strictly LTC halls, it has been one scary "ride". The LTC only nurse's don't want to come anywhere near my hall and they have been here way longer than me) These people need an RN and I half the time think my facility forgets that only the DAYTIME nurse in this hall is an RN! Me and the overnight regular are only LPN's and out of the two of us only SHE is IV certified! They have yet to send me for that like they told me I was going for.SO I am STILL not certified for even that!

    At 7 pm shift change for the RN supers is when I finally got an RN that could help me that fought with Dr's to get this guy sent back to the ER. (They must of thought I was just being a "big baby" and not wanting to care for my new patient or something! They wouldn't send him back for me) He was only in the building six hours and he was back out to ER.

    I walked in the door after all these ordeals to find one of my beloved cats with a swollen foot unable to walk on it and so all my energy and focus was on him and how to help him until I could get him to the vet this morning.

    Now I am back to being nervous about all this flushing of every tube problem.
  6. 1
    In PA Nephrostomy tubes are not addressed in either LPN or RN scope of practice -If you consult the nursing board admits that there is no way to cover all that a nurse may encounter - so the nurse must demonstrate competence and follow her facility protocol in these instances. Basically make sure you always follow best practice when it's an area not addressed.
    loriangel14 likes this.
  7. 0
    There is no document that covers every single procedure and scopes vary from state to state and from facility from facility.you need to read up on the Policies and Procedures for where you work.
  8. 1
    Flushing a nephrostomy tube is within the LPN scope. Maybe what that nurse meant was that at your facility it's a RN only task. Many facilities place their own limitations on what their LPNs can do that have nothing to do with any actual BON scope of practice rules. A friend of mine is a LPN at a facility where they can't even flush a PICC line. Totally within our state's scope, but that facility decided to place that arbitrary restriction.
    AngelicDarkness likes this.
  9. 0
    I'm with you!!!! I'm in Tx and I work in facility that keeps pushing me to do things outside my scope--because others do,and it's a real drag. This last time I refused to do venipuncture and am worried they will fire me. I can't eat or sleep with the worry. I have gone over and over the board site and it is really hard to decifer WOW! This has gone on for several years and even with my HR Director backing me it is a constant hassle. I put an inquiry into the "webmaster" at board but haven't heard anything yet but advocate at board told me 3 yrs ago cannot do iv/venipuncture without cert so just keep pushing. Hope your situation gets better!!
  10. 0
    Quote from Country fried
    I'm with you!!!! I'm in Tx and I work in facility that keeps pushing me to do things outside my scope--because others do,and it's a real drag. This last time I refused to do venipuncture and am worried they will fire me. I can't eat or sleep with the worry. I have gone over and over the board site and it is really hard to decifer WOW! This has gone on for several years and even with my HR Director backing me it is a constant hassle. I put an inquiry into the "webmaster" at board but haven't heard anything yet but advocate at board told me 3 yrs ago cannot do iv/venipuncture without cert so just keep pushing. Hope your situation gets better!!
    I thought Texas had the widest scope of practice for LVNs? If its not in your scope they legally can't fire you. Did you learn venipuncture in nursing school? If not chances are its not in your scope.

    I'm from Aust, sorry if my post sounds silly
  11. 0
    Nope don't sound silly. No we did not cover in LVN school and it is very specific in our position statements that Lvn's cannot do iv or venipuncture without certification. I've been a nurse for more than 15 yrs and have never seen anyplace like the one I work in. We are in the country and jobs are limited and many Lvn's either don't know their scope or don't care. I repeatedly refuse but each year a few more give in to the demands of superiors. This year they gave an hour long in service from two guys that have no knowledge of board requirements and hav never taught before and wanted us to consider that as"certified". I asked multiple times about this and was brushed off every time. We even have Lvn's that push meds iv which is also outside our scope. I've heard people say "who will know, we are in the middle of nowhere." to be honest they scare the heck out of me but with one in college and another almost there I grind my teeth and continue to go.
  12. 0
    Well thankfully no one there has tried to get me to do any veni punctures or start/ hang any IV's. (of course those are blatantly obvious no no's)
    I worry about a lot going on where I work for so many reasons. One of the things that spooks me is the fact that two of the three main RN supervisors for my shift are ALSO newer nurse's. Of those two neither worked as an LPN before hand. Both just went to school for their RN's and came straight to work as my supervisor. That is scary to me. They are both smart and all but what happened Friday night is a perfect example of why I am so afraid.

    The RN super that was on the first half of the shift was one of the new RN's. She was struggling herself to be able to handle ONE crisis. I had to help her with that patient, deal with the even worse guy by myself, still get med pass out, deal with my trouble makers (they think they are the only one's there and the world must stop when they want something even if someone else is literally dying)

    Number one trouble maker had reported another nurse for "not immediately giving her pain meds when she requested them" EVEN THOUGH the aid told her "the nurse will be with you as fast as she can she is in the middle of a crisis with another patient". The man was being sent out to the ER! He passed away the following morning. He was critical and she didn't care! She was sitting up talking to trouble maker number two laughing and carrying on when she "requested" them no less.

    She sees the new people rolling in down the hall and she starts to literally whine! "Who is going to do my leg treatment now?!" Umm it doesn't get done until after second med pass any other night but because new people are getting more attention than her she demands treatment be done immediately. I have to scramble to get her treatment squeezed in through all this mayhem to avoid bigger issues later.

    This woman had deliberately thrown herself on the floor for attention when a different admission was getting more attention than her! The aid actually caught her deliberately sliding herself off her chair with the call bell in hand (accidentally pushed to button to soon alerting aid to come in room "to soon") laying herself on her side then begin yelling "HELP SOMEONE HELP I fell off my chair!
    Trouble maker number two reported me for "not doing my dining room duties" because I was dealing with this new septic guy that was crashing on me! She had to actually ASK someone down there to bring her her yogurt! If I had done my dining room duties it would have been waiting for her on the table when she rolled in. Ugh really? Yeah and this on top of her going to activities stuffing her face full of cake and ice cream then coming back to the hall to say "I was "bad" I ate stuff off my diet. My sugar is going to be high" Yeah you aren't kidding! The glucometer couldn't even get a number! I had to give her standing order of insulin wait 15 minutes to even get a number of 493 to call the Dr with!

    I really have my hands full on any given day as it is. Admissions coming in are overwhelming. Having an inexperienced RN in the middle of all these crisis is VERY scary. Particularly when they give you the "death look" for telling them a second crisis is in progress! As if I was the fool that sent two unstable patients at once. She did not come right out and say "That's your problem you deal with it" like the other new RN does when she is ""in a mood" but the results were still the same. She never came to assess and I was left to deal with it all by myself till the more experienced RN came in.What if this guy would have passed away while still in my hall? Full code.

    It is my supervisors inexperience that makes me most nervous that I am being told to do things I am not really aloud to do either out of their own ignorance of the rules or simply not wanting to have to do it for themselves. I know everyone has to start somewhere and has to gain experience somehow but when their are to many of us at once it makes for a very scary situation.


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