LPN's Role in the ICU? - page 4

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   Kate28
    Quote from RN34TX
    I know it gets ugly in here, esp. for someone new and impressionable to nursing. Just a word of advice:
    ICU and ER jobs for LVN's are out there in TX but not all that plentiful and they generally will want someone experienced rather than a new grad.
    My advice to you upon graduation is to go straight to Telemetry.
    It's a great place to start for someone wanting to move eventually to ICU and there are plenty of telemetry units in TX who hire LVN's.
    hmm i didn't even think of that. thank you so much for your advice!
  2. by   lindarn
    The hospital where I used to work and one of the largest here in Washington, laid off ALL OF THIER LPNS TWO YEARS, AS HAVE OTHER HOSPITALS. California hardly uses them in the hospital. Here in Spokane, jobs for LPNs are pretty much just in Nuraing homes and Assisted Living Facilities.

    I have ony worked with LPNs/LVNs in NY. I have worked ICU for years, and I don;t know anyone who uses LPN/LVNs in ICU. LPNs and LVNs don't belong in ICU due to the knowledge base that is needed to work ther safely. I don;t care who says that they can "run rings around the RNs". The RNs are responsible for what you do or don't do, and there is too much in ICU, that you can't. I do not want to be responsible for someone elses work in the ICU. I am too busy with my own one or two patients, to want to be responsible for someone elses' one or two patients. If there are nurses who are stupid enough to take on that responsibility, what can I say. It is not my license.

    But wait, this is Texas, where workers have no unions and no rights. And the nurses will lose their jobs, if they refuse to work with LVNs in the ICU. And be reported to Group One, and blacklisted from every job that they apply for. JMHO, and my NY $0.02.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  3. by   RN34TX
    Quote from lindarn
    The hospital where I used to work and one of the largest here in Washington, laid off ALL OF THIER LPNS TWO YEARS, AS HAVE OTHER HOSPITALS. California hardly uses them in the hospital. Here in Spokane, jobs for LPNs are pretty much just in Nuraing homes and Assisted Living Facilities.

    I have ony worked with LPNs/LVNs in NY. I have worked ICU for years, and I don;t know anyone who uses LPN/LVNs in ICU. LPNs and LVNs don't belong in ICU due to the knowledge base that is needed to work ther safely. I don;t care who says that they can "run rings around the RNs". The RNs are responsible for what you do or don't do, and there is too much in ICU, that you can't. I do not want to be responsible for someone elses work in the ICU. I am too busy with my own one or two patients, to want to be responsible for someone elses' one or two patients. If there are nurses who are stupid enough to take on that responsibility, what can I say. It is not my license.

    But wait, this is Texas, where workers have no unions and no rights. And the nurses will lose their jobs, if they refuse to work with LVNs in the ICU. And be reported to Group One, and blacklisted from every job that they apply for. JMHO, and my NY $0.02.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
    I'd agree with some of your statements, however....
    This is also the same Texas that has the good sense to actually utilize LVN's to their fullest potential rather than employ them to be little more than glorified CNA's who can pass pills and insert foleys.
    Talk about a wasted resource for a hospital with a tight budget.

    I also think you're being a little dramatic in your painting a picture of TX RN's being forced to work with LVN's in the ICU or be blacklisted.
    The RN's I worked with back when I was an LVN were not resistant to the idea and were certainly not forced to work with me. They more than welcomed me.

    The recurring theme here is that the RN's in this discussion who are the most resisitant to the idea are the same ones who have little or no experience actually working with LVN's in the ICU.
    Many RN's who go to work in specialty areas where there is little or no LVN presence rely on old ideologies and outdated information about LVN practice that they recall from years ago in their RN programs.
  4. by   toadie
    the state i live in allows lpn's only to hang ivf and some antibiotics. no ivp meds. they are not allowed to take verbal orders from md or allowed to do assessments. they are not allowed to titrate drips either. they may not initiate an iv infusion but may hang a new bag of ivf if it is empty. i don't think they are allowed to access any type of central lines either. my hospital doesn't have lpn's in our icu. the truth is i think they would be very bored to be there.
    while in nursing school i worked on med-surg and found the lpn's to be more knowledgeable about many things than some of the rn's. i think it doesn't have so much to do with your degrees or certifications, rather your own states practice act and what things are within your scope of practice that determines where you can and should work. just my 2 cents.
  5. by   lady2
    I think this is a waste of time because, it is not going to change things, actually there should only be one entry level and we would not have to debate about who can work where! If the LPN's were RN's they could work where ever!
  6. by   HazelLPN
    Quote from lindarn
    The hospital where I used to work and one of the largest here in Washington, laid off ALL OF THIER LPNS TWO YEARS, AS HAVE OTHER HOSPITALS. California hardly uses them in the hospital. Here in Spokane, jobs for LPNs are pretty much just in Nuraing homes and Assisted Living Facilities.

    I have ony worked with LPNs/LVNs in NY. I have worked ICU for years, and I don;t know anyone who uses LPN/LVNs in ICU. LPNs and LVNs don't belong in ICU due to the knowledge base that is needed to work ther safely. I don;t care who says that they can "run rings around the RNs". The RNs are responsible for what you do or don't do, and there is too much in ICU, that you can't. I do not want to be responsible for someone elses work in the ICU. I am too busy with my own one or two patients, to want to be responsible for someone elses' one or two patients. If there are nurses who are stupid enough to take on that responsibility, what can I say. It is not my license.

    But wait, this is Texas, where workers have no unions and no rights. And the nurses will lose their jobs, if they refuse to work with LVNs in the ICU. And be reported to Group One, and blacklisted from every job that they apply for. JMHO, and my NY $0.02.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington

    My License can be lost just as easily as an RNs can.

    LPNs lack the knowledge base to work in critcal care? My LPN program was a 2 year long hospital based diploma program. RNs went 3 years. I'm not sure what kind of magic knowledge base that extra year would have brought me. My critical care knowledge came from doing, researching, and learning on my own. Experience is the best teacher.
  7. by   Geeg
    LVN/LPN have no place in an ICU.
  8. by   Princess74
    Wow, no wonder that there are so many nurses not in the profession anymore. Some of y'all need to get off of your high horse and settle down. With your bad attitudes toward your fellow nurses, I really wonder how you treat your patients. I would not want a nurse with a "GOD" Complex taking care of me or my loved ones. Some of you are acting like a Doctor with an I know it all and I'm better than you attitude. GROW UP!! (Not trying to put Doctors down but you all know what I am talking about. Every hospital has atleast one).

    Now, get off the RN vs LPN/LVN thing. None of us want to hear it!!
    Last edit by Princess74 on Mar 23, '06
  9. by   pedinurse05
    Quote from HazelLPN
    My License can be lost just as easily as an RNs can.

    LPNs lack the knowledge base to work in critcal care? My LPN program was a 2 year long hospital based diploma program. RNs went 3 years. I'm not sure what kind of magic knowledge base that extra year would have brought me. My critical care knowledge came from doing, researching, and learning on my own. Experience is the best teacher.
    Hazel--

    You are absolutely right...the very best teacher is experience. I am sure with your many years critical care experience that you are a capable as well as mentor!
  10. by   lindarn
    Quote from pedinurse05
    Hazel--

    You are absolutely right...the very best teacher is experience. I am sure with your many years critical care experience that you are a capable as well as mentor!
    LPN/LVNs in ICU? Not on my watch and my license. You are not as capable or educated as an RN, and you have no place in ICU. Period. There are more appropriate areas to for you to work in, that would better utilize your education and scope of practice.

    LIndarn, RN, BSN, CCRN
    Spokane, Washington
  11. by   speti4
    Quote from lindarn
    LPN/LVNs in ICU? Not on my watch and my license. You are not as capable or educated as an RN, and you have no place in ICU. Period. There are more appropriate areas to for you to work in, that would better utilize your education and scope of practice.

    LIndarn, RN, BSN, CCRN
    Spokane, Washington
    Wow Lindarn, You sound pretty sure of yourself.
  12. by   91CRN
    Quote from lindarn
    LPN/LVNs in ICU? Not on my watch and my license. You are not as capable or educated as an RN, and you have no place in ICU. Period. There are more appropriate areas to for you to work in, that would better utilize your education and scope of practice.

    LIndarn, RN, BSN, CCRN
    Spokane, Washington
    LINDARN--I've got to say, I think you are fabulous but I think you've been a little harsh on this one. I agree that LVNs should not be in the ICU but for different reasons--more political/business reasons. I started out my career as an ICU-LVN (military trained). Like the previous poster I was very proud of my abilities/expertise and QUICKLY found myself out-nursing MOST of the RNs around me. Having said that, I think there is a large variance in training; theory as well as clinical. The talents of people getting thru LVN and RN programs also varies markedly. Here is the point: we have to have a GENERAL MARKER for making sure that the people hired to perform in critical care are up to the challenge; I agree that should mean an RN license with the appropriate certifications, ACLS etc.. I truly value the work of some talented LVNs and I think there can be a place for them in clinics etc.. I think that because an RN is responsible for the overall care that otherwise licensed people are providing, it doesn't make sense to have them provide it. So, while I really feel for the talented LVNs out there who are outraged--channel your outrage into an RN license and get paid double for the work you are already doing! Get your training any way you can and see if the hospital will pay for it. I SAY THAT WITH GREAT LOVE AND RESPECT. ALSO BECAUSE I AM THE SAME PERSON I WAS WITH THE SAME BRAIN, AND WITH VERY LITTLE ADDED EDUCATION WAS EARNING OVER TWICE WHAT I MADE AS AN LVN DOING THE SAME JOB. DON'T GET MAD---GET PAID!!!!!!!!!!!!!!!!!!
  13. by   Beth's granddaughter
    Quote from CV_LVN
    Ok, I'm going to get on my soap box here.....

    I am an LVN, and have worked in ICU/CCU...taking my OWN patient load and doing my own IV pushes, IV meds, drips, calling docs, everything. I had no RN working with my patient's and sure never had an RN display an attitude towards me. It is VERY stereotypical to be making these comments about LVN's. Excuse me, but I know how to assess my patient's and was responsible for a full head to toe shift assessment on each patient. FYI - I'll run circles around some RN's and leave them spinning, and I'm guessing me and some other LVN's could do the same for some of you with your attitudes. Get over your BSn (b*llsh*t nurse) if you're going to have an attitude like that. RN's are technically considered Professional Nurses, but in your cases, I would have to beg to differ. Now, don't get me wrong, there are some LVN's who lack critical care skills, but HELLO - there are RN's that lack critical care skills also!

    You're nursing degree does not testify to what type of a nurse you are, how good you are, how crisp your assessment skills are or anything, it just states how long you went to school. I know everyone can attest that nursing school does not define a person as what type of nurse they will be. That's my 2 cents, some of your attitudes just FLOOR me!
    Dear LVN, I am sorry to hear you sounding so unhappy about the RN/LVN issue. It truly is not a question of how good you are as a nurse (and I am sure you are very good at what you do), rather, it is a question of what your state law allows you to do and how your state defines registered nursing and vocational (or practical) nursing.

    I have attached below an except from your Texas State Nurse Practice Act, which, in my mind, clearly defines the role of the RN and the role of the LVN. It does not go so far as to say who can work in an ICU, but it establishes the fact that legally, there is a difference in what an RN can do versus what an LVN can do. Individual hospitals might interpret the NPA in slightly different ways, but on the same note, they might not be aware of the legal consequences of using an LPN/LVN outside their scope of practice. I cannot account for the fact that you "had no RN working with [your] patients." And I will agree with you that some LPN's can "run circles around an RN" - but that is not the issue here. The issue is scope of practice. Your Board of Nurses are usually the official interpreters of your Nurse Practice Act. (I searched the net for "Texas Nurse Practice Act" to find this.)

    (Oops - I didn't copy the initial sentence which says, in essence, that a registered nurse practices professional nursing... my mistake, sorry. I added the italics.)

    2) "Professional nursing" means the performance for compensation of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or prescription of therapeutic or corrective measures. Professional nursing involves:

    (A) the observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes; (B) the maintenance of health or prevention of illness; (C)the administration of a medication or treatment as ordered by a physician, podiatrist, or dentist; (D) the supervision or teaching of nursing; (E) the administration, supervision, and evaluation of nursing practices, policies, and procedures; (F) the requesting, receiving, signing for, and distribution of prescription drug samples to patients at sites in which a registered nurse is authorized to sign prescription drug orders as provided by Subchapter B, Chapter 157; and
    (G)the performance of an act delegated by a physician under Section 157.052, 157.053, 157.054, 157.0541, 157.0542, 157.058, or 157.059.
    5) "Vocational nursing" means nursing, other than professional nursing, that generally requires experience and education in biological, physical, and social sciences sufficient to qualify as a licensed vocational nurse.

    My own state NPA (Utah) says the RN assesses, evaluates, plans, implements nursing diagnoses, and implements nursing treatments while an LPN "participates" in assessment, evaluation, treatment, and planning.

    In my experience, LPNs in Utah do not do IV pushes, access central lines, change sterile dressings, hang blood, titrate drugs, call physicians or take physician orders, note charts or orders, admit patients, assess immediate post-ops, or implement care plans. Because of these "do nots" it would be very inappropriate to have an LPN in a fast-paced critical area like ICU. LPN's are great, however, at ongoing bedside nursing. They can easily be a part of the team caring for stable med/surg and post-partum patients, as well as long term care patients. As a former Med Surg charge nurse, I enjoyed working with LPN's as team members, but honestly, and I don't say this in a mean way, if I carried a patient load, and the LPN carried a patient load, legally, both of the loads were my ultimate responsibility. I NEVER left the floor at the end of the shift before my LPN's did, because I had to countersign all their charting (in the hospitals where I have worked, every patient's chart needed an RN signature every shift to prove that "professional" nursing care was given), note all their orders, call the doc for them when their patient needed something, do all their 24 hour chart checks, assess any admission before I turned it over to them, and all this in addition to my own patient cares and documentation. That's not true team nursing, but then again, that is not the LPN's fault, it is management's fault for not understanding the legal scope of practice of an RN and an LPN, and for hiring an LPN to do what an RN is legally bound to do.

    Take a careful look at your nurse practice act. Aim your dissatisfaction toward the law, not toward the people who understand the law and its consequences, and who abide by the law. If you still disagree with how you are allowed to practice nursing, call your Board of Nursing and voice your opinion. See what they have to say about the way you feel you are being treated. If you feel so strongly about being a good nurse, then become active in your state nurses' association and in the political process that creates the laws that govern nursing. I wish you the best and a long and successful career in nursing!

    Out of curiosity - are there any other Texas nurses out there who have comments on this? Is it a normal practice in Texas to have LVN's pushing IV meds, titrating drips, calling docs, etc?
    Last edit by Beth's granddaughter on Mar 24, '06

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