Why?

[Rexie68]

I've seen this a few times and don't understand it. Why aren't some of you allowed to give a PRN med without approval from an RN?? I mean, the MD/DO order is already there, and you can certainly tell if your patient needs it, so why in the world do you need permission to give it?? Gosh, I can't imagine being the pt and having to wait for my PRN pain med until the RN gets a chance to approve......then again, I work in a facility where there might only be one RN in the building. The LPN's are in charge of their units and only call the RN if they're unsure, need help, or something is outside their scope of practice (IV push, etc.)

[swee2000]

Well, I guess I'll be the oddball to say "I've heard of it" because I have to do it.

At the hospital I work at, whether I'm assigned with an RN but primarying my own patients or working under the charge RN, and regardless of there being an MD order, I still need an "ok" from them BEFORE I can give any PRN med. The reason for this is, even though I am able to get the med myself from the PYXIS machine & chart it under my name, the RN is still the one ultimately in charge and therefore has to approve what I give, how much, etc.

Besides, even if it wasn't facility policy, I can't see any of the RNs on my unit being ok with me(or any other LPN) administering PRN meds as I see fit & w/o asking them. Not because they don't trust me or my judgement. Rather, they wouldn't be able to rub in my face the attitude of "I'm boss and the one who calls the shots around here". Now before anyone yells back at or has a few choice words for me, let me reinforce that my last comment was not referencing or directed at all RNs...just some of the ones who work on my unit. Unfortunately, they really look down on LPNs and treat them like subservient people. Thank God I don't work night shift(although I have and that's how I know they act like this)!!!

[caliotter3]

Swee2000

So sorry that some of the RNs who work at your facility do not know how to treat LPNs with respect or how to even act like adult workers. Don't let bad attitudes of a few bring down your morale or job performance.

[caliotter3]

Pagandeva

I've worked flu clinics, some of them for the same employer as one of your's, and have never had to have an RN along to do the screening. I guess it is just a difference in the rules in different states. Seems rather backward. All I have to do is to go down the checklist with the patient, ask them the question, and give or refuse to give and refer to private MD based on their answers to the questions. We were also advised that when we had any doubts, do not administer the vaccination, but direct the client to their own doctor. If they had to have RNs along to do this chore, the flu clinics wouldn't get done. Most of the flu clinic nurses are LVNs. Oh well.

[pagandeva2000, LPN]

Pagandeva

I've worked flu clinics, some of them for the same employer as one of your's, and have never had to have an RN along to do the screening. I guess it is just a difference in the rules in different states. Seems rather backward. All I have to do is to go down the checklist with the patient, ask them the question, and give or refuse to give and refer to private MD based on their answers to the questions. We were also advised that when we had any doubts, do not administer the vaccination, but direct the client to their own doctor. If they had to have RNs along to do this chore, the flu clinics wouldn't get done. Most of the flu clinic nurses are LVNs. Oh well.

It is strange to me, because both, the agency as well as my main job are in the same state, but have different rules. The only way I can see it making sense at my clinic for an RN to assess before giving a flu shot is a walk in patient who did not come to see a doctor, but just to have his yearly flu vaccine. Otherwise, if there is a doctor's order, I see no restrictions. I swear, it is the ANA trying to have the foothole over LPNs by saying that the RN makes an assessment. Really, really silly. We do also work under the auspice of the doctor, PA, dentist, NP, etc. In that case, THEY are making the assessments.

I have turned people away from getting flu shots at the flu clinics. Outside of having epinepherine and doing CPR, there isn't much we can do for them in case of emergency.

[pagandeva2000, LPN]

In med-surg at my hospital, most times, PRNs are given freely, mainly because when an LPN tells an RN that a patient has pain, they are too busy to be bothered. They will check the MAR later, then say that it was administered and I am sure numbers and data is made up for their 'assessment'. Heck, that is the real world at my side of the earth.

[caliotter3]

They told us to call 911 or make sure a store clerk or somebody who knew the address was calling 911, before we even worried about giving the epi. I had one woman one evening who had brought her hubby along and really was giving good acting lessons. She was really putting on a show. I felt like telling her to go home and grow up some. You could tell that I had already had a long day that day. One of the drawbacks of doing these public clinics. I preferred the time when I had appointments to go to businesses and do clinics for the employees that wanted the shots. They acted a whole lot more mature. I guess because they didn't want to act like fools in front of their bosses.

Oh, and I've also seen contradictory actions/info given out by the same employer or between employers. Sometimes it is difficult just to keep up with who does what and why.