LPN's Role in the ICU? - page 9

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   tfunkrn
    Quote from tferdaise
    Regarding the disrhythmia course, I wish it could be that easy to just take one of those courses, but since I HAVE to take ACLS (its a job requirement) the disrhythmia course wont cut it. So please drop this stuff that a LPN shouldn't be taking these advance courses.. It must be very lonely in your ivory tower...
    I never said they should not take the courses, I said I did not know they offered it to LPNs. And.. I have plenty of company in my 'Ivory tower'.. Thanks for your concern.
  2. by   BinkieRN
    While I have no problems what-so-ever working with LPN's, I find them very capable and knowledgeable and they carry their own full workload I do not believe they should be able to challenge the NCLEX-RN no matter how long they've been a nurse or no matter how much experience they have.

    Anyone can study and pass a test. The requirement of having a minimum of an ASN should remain the requirement to be able to take the NCLEX-RN
  3. by   ddoosier
    Our med center does not hire LPN's. Kaiser is phasing them out and hopefully offering assistance to help them obtain their RN's. We need them!!
  4. by   HazelLPN
    In my state and hospital, LPNs have a broad scope of practice with few restrictions. The charge nurse, who takes no assignment, covers what is outside of the LPNs scope. I certainly keep my charge nurse informed about my patients, but honestly, there is little that she/he needs to do that I am unable to do myself. I do not take new admissions, I don't give IV chemo products, I must check several IVP meds and all blood products with an RN. I don't write care plans or serve as a patient's primary nurse. I don't take charge or train to be an ECMO tech. Everything else, I manage on my own. There are at most two LPNs per shift, and that is rare. Usually there is one or none. Most of the LPNs who work in the units have 25+ years of experience and are very competent nurses. There are not many left, and when they leave they are often replaced with RNs.
    The ICU came into being in the early 1960s and I signed on to work there several months after it opened. Before that, very sick patients were called "constant cares". That patient was 1:1 care with the nurse AND the doctor constantly at the bedside. Nobody can tell me I don't belong in the ICU, because I've been doing critical care since critical care was invented..and its been my life's work and passion ever since. My "instructors" if you will were some of the best specialists, doctors, nurses, and therapists of the past fifty years. My mentors were truly pioneers in critical care and I have been blessed to have worked with such talented people.
    That said, the LPN is the ICU is an exception to the rule, but exceptions exist and one size fits none. I've said it before, experience is the best teacher.
  5. by   SaraO'Hara
    Speaking as an LVN in California, and knowing my scope of practice, even though I am IV-certified (can hang blood, start IVs, hang PPN) - I think that in an ICU, the LVN would mostly function as a second pair of eyes/hands for the RN, assisting with the q 1 hour assessments, hanging fluids, administering tube feeds, etc. This could certainly be very helpful, but it would be strange and silly to have a nurse who cannot hang IV meds, do IV pushes, etc, be the primary on a patient with more than a couple of such things.
  6. by   ddoosier
    Quote from HazelLPN
    In my state and hospital, LPNs have a broad scope of practice with few restrictions. The charge nurse, who takes no assignment, covers what is outside of the LPNs scope. I certainly keep my charge nurse informed about my patients, but honestly, there is little that she/he needs to do that I am unable to do myself. I do not take new admissions, I don't give IV chemo products, I must check several IVP meds and all blood products with an RN. I don't write care plans or serve as a patient's primary nurse. I don't take charge or train to be an ECMO tech. Everything else, I manage on my own. There are at most two LPNs per shift, and that is rare. Usually there is one or none. Most of the LPNs who work in the units have 25+ years of experience and are very competent nurses. There are not many left, and when they leave they are often replaced with RNs.
    The ICU came into being in the early 1960s and I signed on to work there several months after it opened. Before that, very sick patients were called "constant cares". That patient was 1:1 care with the nurse AND the doctor constantly at the bedside. Nobody can tell me I don't belong in the ICU, because I've been doing critical care since critical care was invented..and its been my life's work and passion ever since. My "instructors" if you will were some of the best specialists, doctors, nurses, and therapists of the past fifty years. My mentors were truly pioneers in critical care and I have been blessed to have worked with such talented people.
    That said, the LPN is the ICU is an exception to the rule, but exceptions exist and one size fits none. I've said it before, experience is the best teacher.
    Are you assigned the stable patients or are you able to care for the really sick ones that are on drips, ventilated, dialysis, on CCO and have central lines. Can you draw off the central lines? Are you ACLS certified and able to push emergency meds? Are you able to push narcotics, benzos ect.? Are you able to travel with your patient? Just curious. I'm just being honest, but the limitations that you mentioned above is reason enough not to work in the ICU. If your scope does not include any of what I mentioned, then even more so. Your experience probably surpasses many RN's that you work with but your scope of practice is limited. No disrespect to you and all of your years of practice. But I stand by my belief that a LPN should not work on the unit and for more reasons other than what is mentioned on this post.
  7. by   HazelLPN
    Quote from ddoosier
    Are you assigned the stable patients or are you able to care for the really sick ones that are on drips, ventilated, dialysis, on CCO and have central lines. Can you draw off the central lines? Are you ACLS certified and able to push emergency meds? Are you able to push narcotics, benzos ect.? Are you able to travel with your patient? Just curious. I'm just being honest, but the limitations that you mentioned above is reason enough not to work in the ICU. If your scope does not include any of what I mentioned, then even more so. Your experience probably surpasses many RN's that you work with but your scope of practice is limited. No disrespect to you and all of your years of practice. But I stand by my belief that a LPN should not work on the unit and for more reasons other than what is mentioned on this post.
    I agree with you that somebody should not work in the units if they can not do most of these things. I certainly do titrate my own pressors and so on and so forth. LPN practice here is certainly is nothing like LPN practice in your state/hospital. I respectfully and politely stand by my belief that LPNs can work in the unts given a broad scope of practice with few restrictions. I've done it very well for a very long time. Thank you for being polite about your disagreement...we need to see more of that here. LPNs probably won't be in the units in the next 10 years at all. I've decided to fully retire at the end of the year and most of LPN colleages are not that far behind.

    Best to you,
    Mrs H.
  8. by   Indy
    It does make me sad to know that with the retiring nurses, whether they be LPN or RN, there goes experience that won't be regained easily. There goes possible mentoring, teaching, etc. Good mentors don't grow on trees, neither do good students unfortunately. Where I work there do exist a few nurses -of varying licensure- who are just not teachable. The rest are a joy both to teach and to learn from. One of our RN's has started teaching LPN students lately at the local tech school, and she's one of the more dense people on this planet. It's too bad they don't allow LPN's to be the clinical instructors because I know about 20 people personally who could really make a difference in that area.
  9. by   HazelLPN
    Quote from Indy
    It does make me sad to know that with the retiring nurses, whether they be LPN or RN, there goes experience that won't be regained easily. There goes possible mentoring, teaching, etc. Good mentors don't grow on trees, neither do good students unfortunately. Where I work there do exist a few nurses -of varying licensure- who are just not teachable. The rest are a joy both to teach and to learn from. One of our RN's has started teaching LPN students lately at the local tech school, and she's one of the more dense people on this planet. It's too bad they don't allow LPN's to be the clinical instructors because I know about 20 people personally who could really make a difference in that area.
    It was a real pleasure to read this post. You only have 2 years of experience, but you write as if you have been a nurse for 25 years. You're right, there are some nurses who simply don't have it. One of the WORST nurses I have known has her BSN with a CCRN who is very proud of her initials. I often wonder how they she made it through the rigor of her academic program and how she ever managed to pass the CCRN test. I hate to follow because she leaves such a terrible mess and it takes me a the first hour to clean up after her. Sloppy nursing is something that I will not tolerate. A good nurse on paper isn't always the best nurse. So many times young nures with few years of experience want to tell me "LPNs don't have critical reasoning skills" or "LPNs should only take care of stable patients with predictable outcomes"or "You know so much, why aren't you an RN?" I can tell these gals are repeating what their instructors are telling them and they have very little life experience to make such judgement calls. They have obviously never worked in an ICU with a competant LPN who has a full scope of practice. All older nureses have a responsibility to mentor the younger ones. Maybe LPNs can't be clinical instructors, but they can certainly be informal mentors in the unit. In this "Indian Summer" of my career, the mentoring of younger nurses has been one of the most fulfilling parts of the job.

    Best to you,
    Mrs H.
  10. by   Judeevee
    WOW!!!!! Very disturbing attitudes here! I've been a Licenced Practical NURSE for more than 27 years. Longer than many of the Registered Nurses I work with have been breathing. Most of my career has been in critical care, ER & cardiology. I'm also a paramedic outside the hospital doors. To say, or even imply, that to work with me would be dangerous, is a very ridiculous and degrading comment to make. I work with several RN's who would rather have me with them in a critical moment than a RN without experience. No, I can't push the meds, but I know them as well as anyone. I can start the needed 2nd or third IV in a flash, hand the right meds to my team mate before she asks, charge the defib, jot down med times and events, run and post rhythm strips, and even figure out med doses and drip rates in my head before the i-med can be programmed. I can program the i-med with her watching at the other side of the bed and she just needs to push the start button. We work as a team. This way I act as her extra hands. I stay within my scope of practice and she can focus on her level of duties. Believe it or not, there is more to taking care of a patient than pushing meds and transcribing orders. Nursing is an ART. More than the technical stuff, a nurse needs to reach the soul and heart of her patient, their families and their coworkers. There is never a good reason to put someone down whether it be due to their race, color, creed or title. It's rather interesting that the nurses who are remembered and loved by their patients and coworkers are not the ones who were able to titrate the IV meds, but the ones who took the time to be with and reach out to the patient and their family. Your title won't matter so much, but your professionalism, teamwork, and compassion will.
  11. by   RN34TX
    Quote from HazelLPN
    "You know so much, why aren't you an RN?" Mrs H.
    As a former LPN, whenever I heard that type of remark I always considered that to be a back-handed compliment if you know what I mean by that. Well-meaning yes, but to me it always inferred that the best and brightest of the nursing profession was exclusively reserved for RN's.
    It's assuming that LPN's "don't know as much" and for the few that do know more, well they need to go back to school.

    We are obviously not teaching our RN students enough about the value and function of LPN's.
  12. by   RN34TX
    Quote from Judeevee
    WOW!!!!! Very disturbing attitudes here! I've been a Licenced Practical NURSE for more than 27 years. Longer than many of the Registered Nurses I work with have been breathing. Most of my career has been in critical care, ER & cardiology. I'm also a paramedic outside the hospital doors. To say, or even imply, that to work with me would be dangerous, is a very ridiculous and degrading comment to make. I work with several RN's who would rather have me with them in a critical moment than a RN without experience. No, I can't push the meds, but I know them as well as anyone. I can start the needed 2nd or third IV in a flash, hand the right meds to my team mate before she asks, charge the defib, jot down med times and events, run and post rhythm strips, and even figure out med doses and drip rates in my head before the i-med can be programmed. I can program the i-med with her watching at the other side of the bed and she just needs to push the start button. We work as a team. This way I act as her extra hands. I stay within my scope of practice and she can focus on her level of duties. Believe it or not, there is more to taking care of a patient than pushing meds and transcribing orders. Nursing is an ART. More than the technical stuff, a nurse needs to reach the soul and heart of her patient, their families and their coworkers. There is never a good reason to put someone down whether it be due to their race, color, creed or title. It's rather interesting that the nurses who are remembered and loved by their patients and coworkers are not the ones who were able to titrate the IV meds, but the ones who took the time to be with and reach out to the patient and their family. Your title won't matter so much, but your professionalism, teamwork, and compassion will.
    Forgive the comment I'm about to make (see my post above) because I don't want to be one of those RN's who say "Well you're so smart and experienced, why aren't you an RN?" but.....why aren't you?

    We need more RN's who used to be LPN's and paramedics for that matter to change the culture and attitude.

    Although we have no LPN's on my unit or entire hospital for that matter, my unit consists of a large number of RN's who used to be LPN's and I truely believe that it makes a big difference.

    Case in point: A co-worker recently stated "I took my kid to the doctor and this person who was not even a nurse, she was just an LPN and she......."
    Another co-worker busted in "What do you mean she was not even a nurse? Didn't you just say that she was an LPN? They are licensed nurses just like us."
  13. by   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.

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