LPN in charge in the ED?

  1. Question for all you legal experts out there. One of the for-profit hospitals in the Phx area now has an LPN in charge of the ED. This is when there are RN's actually working. What the ED director has done is change the wording of the charge nurse and says it is a "flow control" nurse. Well, in my opinion this person is assessing, triaging to appropriate rooms, etc, i.e monitored vs unmonitored bed, deciding what rooms ambo pts go into, deciding which pt needs to come to the back first, I believe it to be out of the scope of practice of the LPN, and I do know about this as I worked there as an actual charge nurse recently and left there due to the poor quality of care and the fact that profit was all they were looking at and did not care about employees or patients for that matter. In fact, I think a for profit hospital should be illegal !

    thanks,
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  2. 23 Comments

  3. by   lindarn
    LPN/LVNs have no business being in charge of anything. I cringe when I hear that nursing homes pushed to change the wording that allowed LPN/LVNs to be the only licensed person present in facilities. I would not allow anyone in my family to be admitted to a facility that allowed LPN/LVN to be the sole person avalilable and/or be in charge. LPN/LVNs do not have enough education to take that responsiblity. One year of post HS education, and allowed to take that responsibility? How much do people pay to be in nursing homes and hospitals? Do schools allow individuals to teach even kindergarten with a one years "teachers assistant certificate" ? I don't think so. JMHO.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  4. by   Little Panda RN
    Quote from lindarn
    LPN/LVNs have no business being in charge of anything. I cringe when I hear that nursing homes pushed to change the wording that allowed LPN/LVNs to be the only licensed person present in facilities. I would not allow anyone in my family to be admitted to a facility that allowed LPN/LVN to be the sole person avalilable and/or be in charge. LPN/LVNs do not have enough education to take that responsiblity. One year of post HS education, and allowed to take that responsibility? How much do people pay to be in nursing homes and hospitals? Do schools allow individuals to teach even kindergarten with a one years "teachers assistant certificate" ? I don't think so. JMHO.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington

    "WoW" pretty harsh statement! Actually I have to disagree with you, some LPN's have associate degrees. Which means they have to years post HS education. That is as much as some RN programs. LPN's in this part of the country take the same classes as the RN. But when you do get into the RN program they stretch your knowledge on what you already know what I mean by this is that you may already know about electrolytes, acidosis and alkalosis (as an example) but now we will expand your knowledge a bit more and go more indepth about these subjects. With that said I do believe that and LPN can not supervise an RN. And shame on the LPN who is practicing out of his/her scope of practice.

    Please dont let this thread turn into a debate about who is better. We all have our own little place in the world.
  5. by   Janlynn
    Quote from lindarn
    LPN/LVNs have no business being in charge of anything. I cringe when I hear that nursing homes pushed to change the wording that allowed LPN/LVNs to be the only licensed person present in facilities. I would not allow anyone in my family to be admitted to a facility that allowed LPN/LVN to be the sole person avalilable and/or be in charge. LPN/LVNs do not have enough education to take that responsiblity. One year of post HS education, and allowed to take that responsibility? How much do people pay to be in nursing homes and hospitals? Do schools allow individuals to teach even kindergarten with a one years "teachers assistant certificate" ? I don't think so. JMHO.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington

    As an LPN I find your post to be very demeaning. With that I wouldn't at this point being a new grad feel comfortable being in charge of anything or anyone except the pt's I'm taking care of. But I can see 20 years down the road where I may feel comfortable with such a task--I guess it just depends on the LPN's experience and comfort level--it doesn't matter how much schooling you have, most of your learning and experience comes from doing things on a day-to-day basis.

    I work in a very busy level 1 Trauma Center and I can tell you that most of my pt's can't tell the difference as to whether I'm an LPN or an RN--just last night I had a pt look at my name tag and was amazed that I wasn't an RN she then went on to tell me that I was the best nurse she's ever had (I'm sure the dilaudid I had just given her may have had something to do with it. )

    I however would never want to do anything out of my scope of practice, this is why I will be going back to school in April.

    Your post just struck me the wrong way--just because I'm an LPN doesn't mean that I don't understand or am not smart enough to handle certain things. Just because we only have 1 year of schooling (a very intense 1 year of schooling) doesn't mean that I don't know what's going on or am incapable of making the right decisions.
  6. by   unknown99
    Quote from lindarn
    LPN/LVNs have no business being in charge of anything. I cringe when I hear that nursing homes pushed to change the wording that allowed LPN/LVNs to be the only licensed person present in facilities. I would not allow anyone in my family to be admitted to a facility that allowed LPN/LVN to be the sole person avalilable and/or be in charge. LPN/LVNs do not have enough education to take that responsiblity. One year of post HS education, and allowed to take that responsibility? How much do people pay to be in nursing homes and hospitals? Do schools allow individuals to teach even kindergarten with a one years "teachers assistant certificate" ? I don't think so. JMHO.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
    I am an RN now, but was an LPN for 20 years before that. I, too, take offense at what you have said. Have you ever been an LPN? How do you actually know what an LPN is or is not capable of??
    I was manager and supervisor of a 50 bed skilled nursing facility for 6 years. I got higher accreditation scores during the 6 years I was there than any other manager before that. I went 6 years with a deficiency - free rating. I went 6 years without any state compliants. The percentage of pressure ulcers originated from our facility during those 6 years was only 2%. Foley catheters were in only when medically necessary. Falls were almost nil. Restraints were not used. Low ratio of nurse to patients. And low percent of staff turnover.
    So, as the only LPN to ever have that position at the facility; this LPN must have done something right!!!
    When I first left and went to the hospital, I was still an LPN. I had more doctors comment that my assessment skills and patient care was outstanding.
    Gee, imagine that from a meagerly LPN!!!
  7. by   suzanne4
    Being the flow control nurse does not require an RN, tehcnically it doesn't even require an RN license, if you think about it. I am sure that the LPN that has been put into that role has had quuite a bit of experience behind her, otherwise management would not have decided to use her for this roll. The flow control nurse is not the one doing the assessing and the triaging, are they?

    I am sure that they are not doing the assessment or even doing the triage, the triage nurse is still doing their part, and seeing all of the patients first. Flow control is concerned with where patients are located, who is in CT scan, or x-ray, who is waiting for a bed, etc. Who is going to need a GYN room for a pelvvic exam, etc.

    Making a decision as to where to put the patient still requires that the triage nurse is seeing the patient first.

    BON rulings state that an RN must do the triaging, as well as do the assessment in Arizona, as well as most other states.
  8. by   suzanne4
    please play nice. there is no reason to verbally attack anyone here.
  9. by   txspadequeenRN
    Here we go again!!! I do agree that in a hospital setting a RN should be in charge. I have no problem with that at all. I would do my job and head to the house. However, saying that now you have turned your focus to nursing homes and long term care facilities. I have some news for you.. so get yourself ready. In the nursing homes it is the LVN that is primarily in charge of the units. There is always a RN employed and within an arms reach at my facility. LVN's have been charge nurses for years in this capacity so if you feel that your family member is in danger because he/she is being taken care of by a LVN, you better keep them at home. I want to add something else here ... I am a nursing suprvisor for the weekends at a large nursing facility. Everything that happens good and bad comes through me first. I am very respected at my job and work hard to make sure everything gets done right. Once again I take great offense to your post and thoughts towards LVN's especially since I know you have never worked with one according to your previous post.



    Quote from lindarn
    LPN/LVNs have no business being in charge of anything. I cringe when I hear that nursing homes pushed to change the wording that allowed LPN/LVNs to be the only licensed person present in facilities. I would not allow anyone in my family to be admitted to a facility that allowed LPN/LVN to be the sole person avalilable and/or be in charge. LPN/LVNs do not have enough education to take that responsiblity. One year of post HS education, and allowed to take that responsibility? How much do people pay to be in nursing homes and hospitals? Do schools allow individuals to teach even kindergarten with a one years "teachers assistant certificate" ? I don't think so. JMHO.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington
  10. by   Dalzac
    At first I didn't think it would make any difference to try and change some folks opinions but then I got to thinking about the education of LPN's and RN's. I am an LPN I went to school for 18 months and graduated in 1979. I was a monitor tech the whole time I was going to school and was offered a job in the CCU I worked. The education of nurses is NOT what they just learned in school> I have 24 yrs of CEU's I have to have somany hours of CEU's a year in order to work. I have worked in ICU/CCU/ED for all of those years. There are some new nurses in ED where I work that think I am an RN and are tottally surprised I am an LPN. Just recently I was sought out to work in a new medical decision unit. The manager came to me and ask if I would work in this unit because she knew me when I worked with her 5 yrs ago. So remember this not all LPN's or even Rn's should be lumped into a stereotypical groups.
  11. by   TheCommuter
    Quote from lindarn
    LPN/LVNs have no business being in charge of anything.
    Additionally, many RNs have no business being in charge of anything. I'd rather be cared for by an LPN/LVN with years of experience over a new-hire RN any day of the week. Education is not the only thing that determines competence. Always remember that fact before spewing your offensive propaganda.
    Quote from lindarn
    I cringe when I hear that nursing homes pushed to change the wording that allowed LPN/LVNs to be the only licensed person present in facilities. I would not allow anyone in my family to be admitted to a facility that allowed LPN/LVN to be the sole person avalilable and/or be in charge. LPN/LVNs do not have enough education to take that responsiblity.
    Keep your loved ones at home. I wouldn't want to care for any patient that has unappreciative, picky family members anyway. If you do not appreciate LPNs/LVNs for who they are and what they do, then please refrain from the insults.

    After all, it is better to keep quiet if you have nothing nice to add.
    Quote from lindarn
    One year of post HS education, and allowed to take that responsibility? How much do people pay to be in nursing homes and hospitals?
    Many LPNs/LVNs possess a 2-year associate of applied science degree in vocational nursing. You post was truly offensive.
    Quote from lindarn
    Do schools allow individuals to teach even kindergarten with a one years "teachers assistant certificate" ? I don't think so. JMHO.
    You cannot compare the fields of education and healthcare accurately. Virtually nobody respects teachers, even though they possess a lot of education.

    I personally think your ulterior motive is to offend people. Otherwise, you'd express your honest opinions in a different manner. I've always been told that the delivery of one's message is more important that the actual message.
  12. by   carribeanbound
    Hello again,

    sorry, didn't mean to start any strife here. There is one really awesome LPN in this same ER, who refused to do this charge thing. The triage nurse does not see the ambulance pts who are brought in, that duty is the control Nurse, just thought I would clear things up. I guess the one of the problems here is probably financially motivated--- paying LPN wages vs RN wages.
  13. by   Nurse Ratched
    PAT PAT PAT PAT PAT

    Whew! Let's put those flames out folks~

    PLEASE, this should not be an RN vs. LPN thread - only what is legally permissible within the individual scopes of practice. Thank you!
  14. by   FocusRN
    Quote from lindarn
    LPN/LVNs have no business being in charge of anything. I cringe when I hear that nursing homes pushed to change the wording that allowed LPN/LVNs to be the only licensed person present in facilities. I would not allow anyone in my family to be admitted to a facility that allowed LPN/LVN to be the sole person avalilable and/or be in charge. LPN/LVNs do not have enough education to take that responsiblity. One year of post HS education, and allowed to take that responsibility? How much do people pay to be in nursing homes and hospitals? Do schools allow individuals to teach even kindergarten with a one years "teachers assistant certificate" ? I don't think so. JMHO.

    Lindarn, RN, BSN, CCRN
    Spokane, Washington

    I'd suggest that you get off your high horse, and stop using beat around the bush words to demean an entire profession. It seems to me that you are trying to over compensate for something. The fact that you would not "ALLOW" anyone in your familty to be admitted to a facility an LPN/LVN to be the sole person avalilable and/or be in charge, is fine, that's on you. But I doubt everyone in your family is stupid enough to let any one person, no matter how many letters are behind her name, to take away their right to choose. An to spoof off of something that someone else touched base on, have you ever been an LPN? I don't think so. Have you ever gone into an indepth review of LPN education? I don't think so. Because if you did you would know, that most if not all LPN programs, require basically the same as any RN program whether, it be a ASN or BSN program. The only thing that they do not include is something that I like to call filler courses. enough credits to fill up a transcript, to qualify for a degree. That is not saying that those courses mean nothing. But they are not absolutely essential to nursing practice. Education is very imortant, where you get that education from whether it be on the floor or in school, isn't that high on the list. I am not a nurse at all, and I was offended by your statement. I would suggest an apology to all LPNs/LVNs.

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