Misusing the low paid nurse

[Saraz23]

I would like to know if any nurse here has ever been asked (as an LPN) to hang IV antibiotics (to a Central line or PIC) or has been required to flush either of these as part of your regular duties?

I currently work in WA state but have also worked in CA where this was a major no no. This was an experience I had while working PRN at a SNF one night shift/week after I explicitly told them in the hiring interview that I have zero experience with IVs or anything in that realm...

They gave me 4 training shifts and two out of the four nurses I trained with had been fired by the end of the month... Awesome.

I ended up with 120 patients, mostly step down, some dementia, some long term... Myself and one other LPN (fresh out of school)... and 4 CNAs in the building overnight with an RN "on-call" at home in bed asleep... Is this legal??? I've never (in 16 yrs) seen this type of care... I couldn't handle the ethical issues I had with this situation and I was terrified I was going to kill someone... so I quit.

It just doesn't seem right. My experience is in QM, Infection Control, Employee Health, Triage clinics, oncology, long term care, adolescent behavioral health & forensic nursing.

Any thoughts??? Thanks! :)

[Rose_Queen, BSN, MSN, RN]

It is wise to know the nurse practice acts for each state you work in, especially as they will vary from state to state. It is indeed possible that one state prohibits hanging of IV antibiotics while another allows it. Facility policies may also be more restrictive than state scope of practice laws. As for whether the RN on call at home is legal, again, you will need to find out the law in your state. Perfectly legal where I live- as long as an RN is available, it meets the regulations. An RN on call is expected to be available (and will face repercussions if not).

[LadyFree28, BSN, LPN, RN]

It is wise to know the nurse practice acts for each state you work in, especially as they will vary from state to state. It is indeed possible that one state prohibits hanging of IV antibiotics while another allows it. Facility policies may also be more restrictive than state scope of practice laws. As for whether the RN on call at home is legal, again, you will need to find out the law in your state. Perfectly legal where I live- as long as an RN is available, it meets the regulations. An RN on call is expected to be available (and will face repercussions if not).

It will also vary from facility; if the facility has given you education and deemed you competent, then one would be satisfying that part in the nurse practice act to practice in a safe manner.

In my experience I was IV competent to access central lines and ports at a job as a LPN.

[CrunchRN, ADN, RN]

It is wise to quit when you are in over your head.

[nursel56]

I think quitting was a wise choice as well. I will add that your specific question regarding whether an RN who is home sleeping but available by phone (theoretically) can be considered as supervising is not an unheard of situation based on what I've read here over the years. Like you, my first concern is for my own license, not to analyze the risks the facility is apparently willing to take.

I've also noticed a definite trend toward accepting more complex patients (ie trachs, vents, IV meds) into longterm care without corresponding increase in staffing or salary.

Best wishes in finding a job where management cares about ethics and safety as much as you do.

[TheCommuter, BSN, RN]

I would like to know if any nurse here has ever been asked (as an LPN) to hang IV antibiotics (to a Central line or PIC) or has been required to flush either of these as part of your regular duties?

To answer this question, yes. Although I trained as an LVN in California, I spent my entire LVN career in Texas, which has a wide scope of practice. Hence, LVNs are permitted to hang IV medications and manage PICCs/central lines here, and these were part of my regular duties.

[Adele_Michal7, ASN, RN]

If I am understanding correctly, that would mean each licensed nurse had 60 patients and each CNA had 60 patients? If so that is wildly unsafe for everyone involved. And if the acuity of the building is that IV patients are accepted, that's really troubling.

[quiltynurse56, LPN, LVN]

I found this regarding LPNs and IVs: http://www.doh.wa.gov/portals/1/Documents/6000/IVTherapybyLPN.pdf

In my state, LPNs can take a course and become certified for IV therapy. The LTC facilities I have worked at are not certified by the state for IVs because they may have shifts where there is no RN on duty. In my state, an RN has to be on duty 8 hours a day and one available when one is not on duty. Our DON and ADON are both RNs and they alternate weekends for call and you can call either during the week.

[Moriah01, ADN, LPN, RN]

I'm Michigan so our scoop of practice is vague. I've hung IV antibiotics as well as flushed them. The only thing we can't do is insert a PICC line, pull a PICC line or change the dressing.

[NOADLS]

I ended up with 120 patients, mostly step down, some dementia, some long term... Myself and one other LPN (fresh out of school)... and 4 CNAs in the building overnight with an RN "on-call" at home in bed asleep... Is this legal???

Perfectly legal and super standard. If you are a competent LPN, this should not be a problem for you.