LPN's Role in the ICU? - page 10

I am an RN in a 24-bed ICU. Currently, we have 1-2 LPN's scheduled per shift. Our policy is no more than 2 patients per RN unless you have an LPN working along with you, in which case you may have... Read More

  1. by   HazelLPN
    Quote from mommy.19
    How does this idealism evolve even further to LPN's who got their license through applying for equivalency after finishing the 1st year of an accredited RN program, would people feel that they are any "better"? I honestly had never heard such dissent "amongst the ranks" between the roles of LPN and RN, on the gen med floor we did clinicals on, the only way you could tell the difference between an LPN and RN was the tiny print on their name tag. I have learned much reading these posts, thanks to the OP for starting this thread.
    It would have no effect on what others in this forum feel, because training is not the main issue. The issue is scope of practice. Nurses such as lindarn and ddosier work in states and hospitals where LPNs scopes are very limited and this places additional work on the RN.They fear that their licenses are in jeopardy with the additional work load that would come from covering patients cared for by an LPN. This is a valid issue and argument.

    However, no poster can speak for all states and certainly are not able to speak for me. I work...well worked (I've been retired since this past July) in a state where the LPN scope is very broad. I took care of very sick patients and there was little that my RN charge nurse had to do who "covered" my patients. By "covering", she or he would be the one to check blood products with me and double check certain drug calcs with me before I gave them. That was never an issue. The only thing that was occasionally an issue is that LPNs don't take new admissions. We used to take them with an RN cosigning the admission assessment, but it was decided that it made no sence for an LPN to do an admit as LPNs do not serve as the patient's primary nurse who is responsible for the careplan and that writing the initial admission assessment is not in the scope of practice for the LPN. Fair enough. To some RNs, it was an aggrevation to change her assignment mid shift to take a new admission.

    Ironically, the last shift that I worked in July, I had to change assignments with an RN in her mid 20s so that she could take an admission....a 16 year old meningococcal meningitis direct admit from the pediatrician's office. She is a very sweet girl who isn't the strongest nurse yet....smart enough I think...but no self esteem and way too soft. She REALLY didn't want the admission so she asked the charge nurse "can Mrs. H do it with me?". So we did it together. He crashed in the pediatrician's office and was nearly dead by the time he arrived on the unit. I hadn't worked that hard in years...he was a handful...I thought he was going to die on us..coded twice....I gave the meds...the young RN did compressions (I'm definately too old for that on a 16 year old!)...but we got him through it and he left the hospital with no major complications when all was said and done. It was a nice way to end my career. I gave my patient and family the best care that anyone could give ...and the young RN learned a great deal about organization and problem solving...and a few things about technique and human relations.

    So thoes of you who still maintain that I should have worked up on the floor or in long term care because I'm "just an LPN"....we can agree to disagree. My colleagues and the patients and families that I took care of will disagree with you as well. And if you had a chance to work a shift alongside me I would imagine that you would change your mind. Good nursing comes with experience and a self motivation to learn...as well as inborn talent that can not be learned from any accredited nursing school.

    I think that nearly everything has been said that can be said about this post. Its a simple matter of scope of practice. Where LPNs have a full scope, LPNs can work in the units very well. Where their scope is limited, it dosen't work nearly as well.

    Best to you,
    Mrs. H
  2. by   xixp111
    wow seriously??? ive pretty much read through this entire thread... and i am astounded by some of you people, so let me begin by saying that in certain states where lpns are not allowed to hang bags titrate drips or do other essential jobs needed in an ICU then they should probably not be there ...not because RNs are magical or better educated ..cause guess what guys you really arent ( all a nursing license and school really is , is a license to learn your job.. which you do at work... nursing school is just the basics) but because as a lpn you really cant do the job due to scope or practice issues lpns in most states probably dont belong in an ICU , now having said that a little about me , i am an lpn student about to take my boards.. now before you go he knows nothing hes a student ..let me say i spent 8 years as a military medic and held a civilian emt-b ...crappy cert right... glorified first aid ...well heres the point of what im saying ...in the military you dont have to be licensed to perform medical task's just trained ... would it suprise you if i told you i have assisted and done things im sure most you RNs havent ...i taught IVs ... hell i gave one under fire in night vision.. id like to see any of you RNs pull that off ..i can suture, i spent time in the casting room , i have assisted (and by assisted i mean had a doctor stand over me and talk me through the majority of an amputation) my point is ...just because i held an emt License.. does that mean im dumber , or less educated than an RN ...not if i had the privilege of working with excellent trauma doctors and Special forces physicians assistants who had the time and patience to teach me on a daily basis ....listen the letters after your name are just that ...letters ...it only matters what you have absorbed , your personal capabilities, and the hands on you have received during your clinicals ..lets face it ... you cant learn most invasive tasks from a book , and unless im really daft , you arent learning the majority of your job from a textbook at least in trauma ,,the theory ..yes ill give you that, but the skills to do what you need to do quickly and safely... only through experience so im willing to bet if the restrictions of lpn tasks were lifted and an lpn of normal intelligence was privy to the same orientation an RN had at the ICU he could pull it off fine ..cause i damn sure worked the emergency room like a pro in the military with just an emt-b
  3. by   cpcnurse
    I noticed that no one has posted on this thread in some time, however I felt the need to make a statement.

    I have been a LPN for 1 year (and am currently working on my RN) and work in my hospital's Emergency Department and Intermediate Cardiac Care Unit. I cannot work, per say, in Intensive Care, however our ED and ICC is very high acuity. My skills have never been questioned by my managers and most of my peers prefer me to work on a shift with them than most our RNs.

    LPNs in my facility are allowed to push most IV meds, manage a patient on a gtt (as long as the RN titrates), take orders and complete a shift assessment (as long as an RN performs initial/triage assessment). I have never had an issue with any of the RNs that I work with signing off charting or managing my medications that I was unable to give per policy.

    A LPN's ability, just as much as any RN, is based upon the person's work ethic and dedication for their patients rather than the letters behind their name. My primary concentration is with chest pain and acute coronary syndromes. I have ran STEMIs by myself, managed patient's on NTG, diltiazem, amiodarone, heparin, Integrilin, dopamine, and dobutamine gtts without difficulty and without danger to my patients. My patients have ALWAYS appreciated the care that I provide and have NEVER felt that I was unqualified to care for them.

    I have trained, and still educate, many RNs on policy and procedures that are implemented in our facility. Most RNs seek me out with cardiac and medication-related questions based upon my experience. I attended a school that taught, and held their LPN students, on higher levels than was in the same school's RN program. I would never trade my clinical experience I received in LPN school for anything.

    I feel that I will be a better RN because of my experience as an LPN.
  4. by   fran313
    smiles at all of the comments.............I am an ICU Rn, here in Florida Lpn cannot assess, push iv meds, titrate gtts, etc.............and although I know several long time Lpn's that probably have forgotten more than many Rn's will every know..........it is because of thier yearssss of experience and learning and seeing it all on the job, kinda likethe old way nurses were trained, on the job, not college degrees. Yes it does depend onthe individual and how interested they truely are, but Lpn do not have the same education here in Florida as Rn, Lpn is a technical trade, not a college degree, they dont have anatomy, physiology, pharmacy, chem, micro, etc .................we should all strive to the highest level we can, that we enjoy are comfortable with, it takes all kinds of nurses to get the job done....
  5. by   NCRNMDM
    I live in NC, and LPNs are rarely hired at hospitals around here anymore, and they certainly aren't hired in the critical care setting. I'm a nursing student with 11 months left until I graduate, and I want to be an ICU nurse after graduation. I understand the rationales behind not hiring LPNs in the critical care setting (such as not being able to administer blood, not being able to titrate drips, etc), but I don't think that RNs should disparage the skills and knowledge of LPNs simply because they, the RNs, hold a higher degree. If I get a critical care residency as a new grad, I don't care what my preceptor's qualifications are as long as they are a good, compassionate nurse who is enthusiastic about teaching a young nurse the ins and outs of ICU nursing.

    In the end, LPN and RN are both letters behind someone's name. LPN doesn't make you a lesser nurse, and RN doesn't make you a more superior nurse. I've always heard nurses say, "I would take an older, experienced LPN over a young, inexperienced new grad any day." I can see why this would hold true, and I think that some RNs need to remember that. Just because you have your RN doesn't mean that you are suddenly more skilled, or better at nursing.
  6. by   lindarn
    I beg to differ with you. "LPN and RN:are just letters after someone's name". Those, "letters", indicate and educational difference and legal title. The education of an LPN is similar, but lacking in the education that increases the scope of practice between them.

    RNs are educationally more prepared for the larger scope of practice. Are, "just letters after someones name", the same mentality between a PA and an MD? Are PAs and MDs the same, just differences in the letters after someones name?

    I have all the respect for LPNs but they are just not educationally prepared to work in ICU, ER, etc.

    A long time ago, I worked with an RN who was an LPN, who went back to school to be an RN. She had this dream of working in ICU.

    She washed out of one ICU training program, and decided to work at the hospital I was working at, in the Stepdown unit, which had monitored patients, limited drips, etc. After a year or two, she applied for and got accepted for a position in the ICU.

    She struggled in orientation, but was eventually passed. She struggled just as much when she was on her own, but no one noticed it, and she did not ask for help.

    Her lack of critical thinking skills eventually was instrumental in killing a patient. She just did not understand that it was her responsibility to question a doctor's order, to critically re- assess the order that had been written, realize that if, "ABC was not happening" ,that you call the doctor and inform him/her, to request a change in the order.

    The doctorordered a large dose of IV lasix, she gave it, the doctor, or course, expecting the patient to diurese, patient did not diurese. But she continued to administer potassium boluses over one hour x 4, not noticing/having it compute, that if the patient was not diurese, after one or two doses, stop giving them and call the doctor. The patient became severely hyperkalemic, coded, adn died. She was finally fired after that incident.

    There were other incidents that had happened previously, that should have made the nurs manager question her ability to continue to work in ICU. That, of couse was not her fault, but she did not want to admit that she was not cut out to work in ICU.

    I have has other incidents with LPNs that affirm my belief that LPNs have no business working in ICU. That is not prejudice, it is a fact that their education is not cut out for ICU, ER, etc.

    JMHO and my NY $0.02
    Lindarn, RN ,BSN,CCRN
    Somewhere in the PACNW
  7. by   HazelLPN
    Quote from lindarn
    I beg to differ with you. "LPN and RN:are just letters after someone's name". Those, "letters", indicate and educational difference and legal title. The education of an LPN is similar, but lacking in the education that increases the scope of practice between them.

    RNs are educationally more prepared for the larger scope of practice. Are, "just letters after someones name", the same mentality between a PA and an MD? Are PAs and MDs the same, just differences in the letters after someones name?

    I have all the respect for LPNs but they are just not educationally prepared to work in ICU, ER, etc.

    A long time ago, I worked with an RN who was an LPN, who went back to school to be an RN. She had this dream of working in ICU.

    She washed out of one ICU training program, and decided to work at the hospital I was working at, in the Stepdown unit, which had monitored patients, limited drips, etc. After a year or two, she applied for and got accepted for a position in the ICU.

    She struggled in orientation, but was eventually passed. She struggled just as much when she was on her own, but no one noticed it, and she did not ask for help.

    Her lack of critical thinking skills eventually was instrumental in killing a patient. She just did not understand that it was her responsibility to question a doctor's order, to critically re- assess the order that had been written, realize that if, "ABC was not happening" ,that you call the doctor and inform him/her, to request a change in the order.

    The doctorordered a large dose of IV lasix, she gave it, the doctor, or course, expecting the patient to diurese, patient did not diurese. But she continued to administer potassium boluses over one hour x 4, not noticing/having it compute, that if the patient was not diurese, after one or two doses, stop giving them and call the doctor. The patient became severely hyperkalemic, coded, adn died. She was finally fired after that incident.

    There were other incidents that had happened previously, that should have made the nurs manager question her ability to continue to work in ICU. That, of couse was not her fault, but she did not want to admit that she was not cut out to work in ICU.

    I have has other incidents with LPNs that affirm my belief that LPNs have no business working in ICU. That is not prejudice, it is a fact that their education is not cut out for ICU, ER, etc.

    JMHO and my NY $0.02
    Lindarn, RN ,BSN,CCRN
    Somewhere in the PACNW
    Lindarn, old girl, I think that much of what you said is correct, HOWEVER, as a retired critical care LPN, I must also add my midwestern two cents.

    There are still some LPNs around who have been doing critical care nursing for many years who live in states where the LPN has a broad scope of practice who do have the critical reasoning skills. There are also plenty of RNs that I have worked with who lack the critical reasoning skills to be ICU nurses...and I too have watched these girls fail miserably and cause substantial harm to their patients because they didn't have the natural talent to do the job. If I may be so bold, I've saved the license of more than one inexperienced BSN who simply lacked the experience and/or talent to truly understand what she was doing and why.

    At the time of my retirement from critical care nursing (three years ago after fifty four years on the job), we had only a few LPNs left in the units. They were replaced by an RN when they retired. All but one were veteran nurses with 15+ years of experience in critical care and the youngest LPN was simply an exceptionally intelligent young woman with a thirst for knowledge and an inborn talent for nursing. She had worked as a unit clerk in the PICU and was hired as long after the hospital stopped hired LPNs in critical care. I would happily let any of these LPNs care for my great grandchildren if God forbid they ever needed it.

    I can't say the same for all of the RNs that I worked with.

    As you know, I'm with you that the BSN should be the standard entry into nursing practice. However, lets respect nurses from an earlier generation who don't have the formal education but who compensate for this by years of experience, natural talent, and a drive to learn new things. An LPNs formal education does not prepare her/him for critical care. I will add that most RNs formal education does not either. One must go above and beyond their formal education. One must read and research and question and seek to understand why and how on a much higher level of learning. This is informal education and informal education can be a very powerful thing indeed. It was due to my informal education and years of experience that made me a good critical care nurse...not my long obsolete practical nursing diploma from 1955....


    That's my own two cents. I enjoy and admire your passion for nursing and your comittment to improving the profession from your other posts. I think if you would have had a chance to work with me in the unit, you would have been happy to have this old LPN work the shift with you. Not just because I was a good nurse, but because I am also a very skilled home bartender and home cook (informal education again) and was known to help friends from work after work unwind with my legendary ability to titrate ETOH and chocolate desserts with my friends' stress levels.

    Cheers (clink!)

    Hazel H.
    Last edit by HazelLPN on Apr 20, '12
  8. by   rgroyer1RNBSN
    Lindarn lay off the Lpns, I was an Lpn before getting my bulls**t bsn, but now that I have worked as a nursing sup. and nm in both er and sicu, I have a few lpns that work for me and believe me when I say that a properly trained lpn can give wonderful care to a critical care pt. under an Rn, and that I would prefer one of them taking care of me then a new grad or some very incompetent Rns I know.Go LPNs! Rod RN, Bsn
  9. by   rgroyer1RNBSN
    Another thing Lindarn have u ever worked er, because if u have u would know that we have a heck of alot of things an lpn can do in er, as in I mean we do alot of wound care, splints, im inj, hanging fluids etc. I will admit I have had a great vetran lpns that have saved my butt before, so yes I will go to bat for them anyday, and not to be offensive or mean but save the superiorty complex attitude for someone else or the best thing would be to lose it, let me tell you I have had high and mighty Bsns who have killed someone, I had a chf pt who the bsn on duty before me turned her fluids on the pump to 999ml, and the poor women had to be tubed and have laxis out the wazoo. So I will always take one down a notch when they are feeling high and mighty because I have learned that is generally when they make their big mistakes. Rod Rn, Bsn
  10. by   HazelLPN
    Quote from rgroyer1RNBSN
    Another thing Lindarn have u ever worked er, because if u have u would know that we have a heck of alot of things an lpn can do in er, as in I mean we do alot of wound care, splints, im inj, hanging fluids etc. I will admit I have had a great vetran lpns that have saved my butt before, so yes I will go to bat for them anyday, and not to be offensive or mean but save the superiorty complex attitude for someone else or the best thing would be to lose it, let me tell you I have had high and mighty Bsns who have killed someone, I had a chf pt who the bsn on duty before me turned her fluids on the pump to 999ml, and the poor women had to be tubed and have laxis out the wazoo. So I will always take one down a notch when they are feeling high and mighty because I have learned that is generally when they make their big mistakes. Rod Rn, Bsn
    Thank you for your support of veteran LPNs Rod, but I have a lot of respect for Lindarn. She is a strong advocate for nursing as a profession. Where she lives, LPNs have a limited scope of practice and it would place additional work on the RNs who would have to cover what is outside of the scope of the LPNs. She's also had a negative experience with a very untalented individual who used to be an LPN. She's allowed to feel the way she does because these are her experiences. If she worked with me, her experiences would be much different.

    In states where LPNs are allowed a broad scope of practice, LPNs work well in critical care. They do so based on their experiences, natural talent and work ethic, not their formal education. I would add that no RN can simply go to work in an ICU either based solely on her/his formal education. One must take the initiative to learn far beyond what one was taught in school in order to be a successful critical care nurse.....RN or LPN.

    Best to you,
    Mrs H.
  11. by   rgroyer1RNBSN
    I had bad experiences as well, Mrs.H, and I feel for lindarn and have respect for her, but all I am trying to say is why dont we all just get along respect each other for who we are not just the letters behind our names be it lpn or bsn, and believe me here in missouri lpns are pretty limited but I would still take a veteran Lpn over a new grad bsn in my sicu, and er anyday.Rod Rn, Bsn, Cen, Cfrn, Ccrn.
    Last edit by rgroyer1RNBSN on Apr 21, '12 : Reason: grammar

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