All Lpn's Please Read

Nurses LPN/LVN

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Hello,

My 226 bed acute care hospital has formed a committee as we are going to re-introduce LPN's on the med-surg floors. The committee is looking at how we are going to utilize the LPN's.

SO, would you please tell me--if you work in a hospital--what exactly your duties are and what you as an LPN are and aren't allowed to do. I realize that the LPN/LVN scope of practice varies by state, I am in Northeast Ohio.

I am specifically interested in Nurse- patient ratio for the LPN in your facility and any other infor mation you can provide will be helpful.

Personally, I am looking forward to working side by side with the LPN's and feel that it was a grave mistake that a lot of hospitals--especially in this area of the country-that they were phased out of the acute care setting.

Thank you for your help!

Kelly:)

Well JMP, yes, if I'm pushing cardiac meds during a code situation you can bet that the patients are on the monitor -- a lifepak at the bedside. All pts during a code are on a monitor. And in my medically complex unit, all of our pts are on telemetry at the very least, and most are on space lab monitors at the bedside. I use the same precautions as you should when pushing Lasix or any other med. I took Pharmacology in nursing school. I was IV certified during nursing school as were all the students at my school. The Canadians RNs I've worked with aren't allowed to start an IV, much less push meds thru them. Is this just a condition of their licensure in the states or typical of all RNs in Canada? Do I detect an attitude towards LPNs in your post? Do you not feel we are qualified to push meds? Do you consider yourself to be more qualified than my stateboard to determine whether or not I should push meds? Attitudes like the one I sense from you need to be trashed. We are all nurses and teamwork is so necessary. Get off your high horse and accept that LPNs are often more experienced, more knowledgeable and much more capable than so many RNs coming out of schools now. There may come the day that even YOU need an LPN to help, so watch how you talk to us!

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I have started lots and lots of IV's - so what is the point of that comment.

I was a RPN before I became a RN- reason? here, RPN's have limited scope of practice. They have NO ROLE in most large teaching hospitals here.

Watch how you approach people who's background is unknown to you........ and always remember, dogs are trained......nurses are educated.

SKill sets can be taught to anyone....... but to understand the rational why you are doing something is key.

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oh, yes, only RN's in step down units or ICU can push lasix. It is an ottotoxic drug and pushing it can and does cause profound deafness. On the floor we hang it in a minibag to prevent this from happening. In the unit we push it over minutes.

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Lasix is commonly pushed on the floor ALL THE TIME. In fact, I've never seen it given by IV piggyback ( in a minibag as you say). Yes, ottotoxicity can occur and so can any number of other adverse side effects. Lasix is a potent non K sparing loop diuretic with many consequences along with many useful and often necessary properties. The main thing to watch with Lasix is the blood pressure, then of course lung sounds and the urinary output. Then it's necessary to monitor lab values, especially potassium levels. Personally, I push 10/mg per ml lasix over 15 seconds which works out to 40mg per minute or 80mg over 2 minutes. I've never seen any ottotoxic indications after using Lasix but I have seen severe nausea and vomiting and hypotension. As far as training versus education -- get off of it! Experience is the best teacher. And ability to get along with all the members of the healthcare team is necessary -- surely even in Canada. The nursing shortage here in the states has made the LPN just as desirable as an RN. We are licensed, educated, trained, capable and experienced. And so are some of the RNs I've worked with over the years:)

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Not nearly enough time- not worth it. I remember the RPN days only too well.

Been there, done that, have the t-shirt.

You live in your world, I'll live in mine. Hopefully the worlds never collide!

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JMP, WOW! I'm an LPN only a year, but I really thought I've heard every slam I could about the profession, until now. Why are you so bitter toward LPN's? Did you have a bad experience as a RPN? and what exactly is the difference between LPN and RPN?

Do you realize that it's attitudes like yours that are the reason we as nurses are having such a hard time getting the respect we deserve? as long as we have this animosity between RN's and LPN's managment is winning! Remember...divide and conquer? Think about that the next time you don't want to "cross worlds with an LPN" You have to be feeling the crunch of the nursing shortage, and some day you'll have to work side by side with one of us, and you'd better hope he/she hasn't seen your attitude!

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Hello,

I worked in a hospital acute care/med/surg/ortho before i went to agency nursing.my responsibilities varied maybe because the facility knew that i had strong clinical ecperience and went half way through rn school.iv push meds are supposed to be rn or supervised by and rn.my mentor questioned my critical thinking and let me do pushes on my own,if there were questions,there was a comfort level in asking.Drsg changes and patient care were also included,rn's did patient care too. i've worked in large teaching hosp where the techs have done drsg changes up to stage three i think,they've also done the catheter spec collections. this was on an ortho floor,when i worked in the other sectins of the hosp,nurses did all of those that i dtated that the tech's did!

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Just a reminder from one who has worn both the LPN and RN caps. The biggest problem I see is RNs who do not know the LPN's scope of practice. and LPN's who don't know their owns scope of practice because the LPN comes for another state. Know the scope inside and out. Then listen to you LPN's. They will be your best source in learning what they can and can not handle.

I question the practice of setting nurse patient ratios. I truly believe assignments need to be made based on patient need and nurse's abilities. I have had 2 patients that took all my time and then some, and 7 patients that that took no more. Look at acuity and the skills needed and the skills the nurse has. Keep in mind that no two LPS will have the same background. LPN's are capable of handling as many patients as you but some patients need the knowledge of an RN because of their acuity. As an LPN I have cared for some very sick cookies but I had an RN there to back me up or even take over when necessary.

I work with some very good LPNs in critical care. I have a great deal of respect for them. But some times I forget that they do not have an RN's education even though they have more years on me. This can be a problem at times because there are sometime things I assume they know and of course they never were taught. This is not so much in the area of skills but more in the realm of indebth scientific knowledge, that is often assumed by RNs and physicians and the LPN never needed to learn.

So remember the very complex patient probably should not be assigned to and LPN unless they are stable or unless an RN is assigned with her/him.

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Anyone that judges a nurse's ability only on the initials behind the name is an IDIOT! LPN or RN, diploma, AD, BSN, MSN, or even nurse practioner doesn't mean a damn thing concerning a nurse's ability or even knowledge. I have a non-nursing BS as well as my LPN. I have ten years of solid experience in ER, ICU, CICU and the medically complex unit. I've worked with RNs that didn't know a PEG tube went to the stomach, another that didn't know that cardiac compressions pumped blood thru the body in the absence of a heartbeat, another that didn't understand that monitoring lung sounds is necessary with CHF, another that didn't relate unresponsiveness as a sign of hypoglycemia, another that couldn't get a handle on dialysis doing the work for nonfunctioning kidneys.

On the other hand, I've had CNAs point out DVTs, bladder spasms from incorrectly placed foley catheters, swallow difficulties that turned out to be an extension of a stroke, subtle changes in LOC, an abdominal aortic anuerysmn just from feeling an abdomen and and a partial bowel obstruction just from the shape of a bowel movement.

So my suggestion is to get over what initials are on a name badge and watch ANY nurse for sound nursing practice and judgement. And for the RNs that are so full of themselves, I just pray that you don't need my help -- I'll take care of your patient, I'll make up for what you can't do and I'll watch you drown when you're yanked up for license review and LMAO!

But hey, I'm just an LPN. I don't have to take the responsibility for your actions. I only have to answer for my own and that, my dear, is why I remain an LPN!!!

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Lynninurse.. You, my dear, sound a little bitter? I agree with you that it doesn't matter what initials are behind a person's name, as long as they look out for their own practice. But, as "Nurses" we look out for each other. We care for patients TOGETHER! I am an LPN who works in partnership with an RN. We care for patients together. If she misses something, I pick up on it. There is no blame for errors unless the error made falls outside my scope. I know some RN's who could learn a thing or two from us more seasoned LPN's, but we all had to start somewhere, an d I for one am extremely glad to have the kind of nursing colleagues I do. I love nursing as a career. I wouldn't trade it for the world, and I wouldn't trade where I work either.:)

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LynniNurse.....what the heck is your problem and I'm sorry, I just don't buy 'your duties'.....you stated that you, "draw from PICC's, IV push Lasix, mix any drug & administer it, were the only ACLS provider, ran the codes including administering ACLS drugs...." who are you kidding? I'm too an LPN, IV Cert. but know for a FACT that as an LPN, IV Certified or not, you CANNOT legally do most of what you stated you do. If 'your' facility lets you, shame on them and God help the patients!

Your also ragging on JMP for an attitude????? Get with the program sister. I didn't sense any 'attitude' from JMP that warrented you jumping down throats.

Take a chill pill, trim the ego and calm down. I, too, agree that the difference between an RN and LPN is mainly cost.....of the degree and pay. I work beside some really dumb RN's who make me wonder HOW they got their license. I do the exact same job, work just as hard but get paid less. I wish, and hope that someday, we LPN's can get the chance to 'test out' with RN boards. Heck, if some of these RN's I work with can pass, I know for a fact that I could ace it!

It takes all of us, working together, making a difference. Nurses are nurses and worth our weight in gold......forget the initials because in the long run, they don't mean a thing, the heart does!;)

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Well Grey, you need to realize that different states have different laws concerning the scope of practice for nurses. In this state, it is legal for an LPN to push drugs in accordance with the policy of the facility.

Then you need to get off of your judgemental horse and quit making assumptions! I don't lie about what I do. I'm a competent and well trained professional and I and my team have saved many lives. And if you want, you too can move to this state and do all the same things I do.

And in my most professional voice:) you my dear, can BITE ME!

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