LPN"s and telephone triage

  1. I am the nurse manager for an outpatient pediaric department. I hve 4 RN's that are strictly triage nurses. I have two LPN's that I utilize as back up. I am uncomfortable with LPN's triaging. These are good, well seasoned LPN's but I feel they are working out of their scope of practice. Upper management doesn't get it. Cost is the bottom line. Cheaper to pay an LPN than RN. Anyone else in this situation? How are you handeling this?
    Thanks in advance.
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  2. 22 Comments

  3. by   Fiona59
    Initially I would check if telephone triage is within their scope of pratice before approaching managemnt.

    If it is within their scope, why are you uncomfortable with an LPN working within her scope.

    If it is NOT in their scope go for it.

    Nothing I hate more than risking my license and working at my LPN wages to save managment money.
  4. by   sirI
    Quote from 4kidsrn
    I am the nurse manager for an outpatient pediaric department. I hve 4 RN's that are strictly triage nurses. I have two LPN's that I utilize as back up. I am uncomfortable with LPN's triaging. These are good, well seasoned LPN's but I feel they are working out of their scope of practice. Upper management doesn't get it. Cost is the bottom line. Cheaper to pay an LPN than RN. Anyone else in this situation? How are you handeling this?
    Thanks in advance.
    Hello, 4kidsrn,

    Telephone Triage nursing scope of practice varies from state to state dealing with the RN and LPN. In NH it is within the scope of practice for the LPN to assume this position of responsibility.

    Here is a link to the NH BON answering that question:

    http://www.state.nh.us/nursing/faqtelehealth.html
  5. by   wincha
    Quote from 4kidsrn
    I am the nurse manager for an outpatient pediaric department. I hve 4 RN's that are strictly triage nurses. I have two LPN's that I utilize as back up. I am uncomfortable with LPN's triaging. These are good, well seasoned LPN's but I feel they are working out of their scope of practice. Upper management doesn't get it. Cost is the bottom line. Cheaper to pay an LPN than RN. Anyone else in this situation? How are you handeling this?
    Thanks in advance.
    our entire dept is all rn's. we have many nurses who are also going to school to be pnp's while working for us. i agree with you. also what about possible lawsuits if the lpn makes a mistake?
  6. by   4kidsrn
    Thank you for your reply. I do worry about a lawsuit. I also worry about documentation. About a year ago we had a sudden death of one of our teenage patients. Parents swear they called and spoke to "a nurse" No documentation was ever found. Thankfully it never went any further. Administration keeps telling me that as long as the RN is available for further assesment not to worry. How can I not?
  7. by   sirI
    Quote from 4kidsrn
    Thank you for your reply. I do worry about a lawsuit. I also worry about documentation. About a year ago we had a sudden death of one of our teenage patients. Parents swear they called and spoke to "a nurse" No documentation was ever found. Thankfully it never went any further. Administration keeps telling me that as long as the RN is available for further assesment not to worry. How can I not?
    Lack of documentation can be an error of omission on the part of the LPN and/or the RN in any case. So, if this is an issue with your organization, you have reason to be concerned.

    As for worrying about litigation, the RN can be liable just as much as the LPN can. If your organization has in place the proper rules/regulations/protocols/policies/procedures outlining the responsibilities of the LPN and you have LPNs who are qualified and adhering to these responsibilities, then your organization is practicing safely per the scope of practice outlined within your state BON.

    Anyone can sue anyone for anything at anytime, be it RN or LPN.

    Also, and, I do not want to frighten you, I might add the statute of limitations has not run out on the teen death you just described. You might still hear from that.
  8. by   4kidsrn
    siri,
    Thank you for your wise words.
  9. by   Fonenurse
    Do you use computer software in your daily triage with built-in protocols? How do you train your staff? As well as the great info Siri has given you, induction training is all-important. I work for a UK telephone triage service - would be happy to discuss this with you offline if you want. Send me a PM if you want to discuss this further...
  10. by   txspadequeenRN
    I am a LVN and wouldnt do it!!!
  11. by   frankslb
    What about the RN's that make mistakes? Is it okay for them to make mistakes just because their title is RN? I know many RN's that are terrible nurses (many that are good too) and really shouldn't be in the field!
  12. by   sirI
    frankslb]What about the RN's that make mistakes? Is it okay for them to make mistakes just because their title is RN?
    Everyone makes mistakes. RN and LPN. Is it ever o.k. to ignore them? No.
    Last edit by sirI on Jan 15, '06
  13. by   ojoson
    In Washington state, LPN's cannot assess pt's only gather data and educate. Once you pick up the phone and hear the complaint and respond to it you are assessing. LPN's are not taught critical thinking. I was one for 10 years before becoming an RN many many years ago
  14. by   tutusandfrogs
    I don't really have much to add...but wanted to say, I am taking the lpn course in Canada, and there definitely is training for critical thinking. It is the main focus of the whole "nursing arts"

    ETA: I am not taking the course yet... oops the last quote sounded as if I am!

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