Are LPNs Second Class Citizens?

joyflnoyz, LPN · Oct 28, 2003

Three words come to mind :"Hostile work Environment"

Perhaps y'all should use that phrase when speaking to

the hugher ups BEFORE the November 15th meeting.

SmilingBluEyes · Oct 28, 2003

Originally posted by cotjockey
Is this the norm in other places? Are RNs everywhere being assigned lighter loads? Here, the responsibilities are really no different except the patients who are assigned to RNs do not have to be assessed by the charge nurse. We have a med nurse who give all meds including IV (except PRNs). Does anyone know any logic behind giving the RNs such light assignments compared to the LPNs?

Venting more than anything here. A lousy few weeks. I'm leaving the unit in a couple weeks...can't wait to get back to the ER.

you have every right to vent. but no, this is not the "norm" everywhere. not where i work.........

i wish you well. hope this gets changed. take care.

ktwlpn, LPN · Oct 28, 2003

Originally posted by cotjockey
Lately, the RNs I work with have been treating the LPNs and CNAs like dirt. I'm not the only one with this complaint and a lot of us are getting very frustrated. Classic example...today we had 14 patients...LPN had 7, CNA had 2, one RN had 3, the other RN had 2. All 14 were 2 points on the acuity scale they use, so no, the LPN didn't have 7 easy patients and the RNs to difficuly patients. The charge nurses have also been denying the LPNs and CNAs breaks or paging them 10 minutes into their breaks and telling them to come back to the floor. Also, one of them has been making really rude comments, like "Stupid CNA" and "Worthless LPN" when talking about other staff.

Management is aware and is going to "have a talk" with the RNs at the next RN meeting...on Nobember 15th. Also they're going to have the charge nurses justify a difference in more than 3 acuity points when making patient assignements. So...until November 15th, I guess we have to put up with it.

Is this the norm in other places? Are RNs everywhere being assigned lighter loads? Here, the responsibilities are really no different except the patients who are assigned to RNs do not have to be assessed by the charge nurse. We have a med nurse who give all meds including IV (except PRNs). Does anyone know any logic behind giving the RNs such light assignments compared to the LPNs?

Venting more than anything here. A lousy few weeks. I'm leaving the unit in a couple weeks...can't wait to get back to the ER.

I have worked in the team nursing and primary nursing model in acute care.When I did primary I often had a district of up to 8 patients.the RN's had from 4 to 6 and each covered 2 of mine...Team nursing at my last acute care postion was 1 RN and 1 LPN with up to 16 patients and 2 aides being shared by the whole unit.LPN's scope of practice seems to be more limited in my area and the RN's were kept busy.An RN has to assess every patient once in a 24 hour period-takes verbal orders-hangs blood-does IV pushes-takes off orders....I have only once in the past 15 yrs been dis-respected to my face by an RN and Iconfronted her at that time....Don't sit back and take those comments.You are all adults and if a co-worker says something that offends you take him or her aside and let them know it...You are all entitled to your breaks UNDER THE LAW-if you are reporting off to a co-worker who is covering for you then there is no reason to have to come back to the floor-and if you don't "hear" the page you can'T RESPOND TO IT...

**SKM-NURSIEPOOH, BSN, RN** · Oct 28, 2003

i'm afraid the the charge nurse (rns in hospitals & either lpns or rns in ltc facilities) do have the need to take less patients...if any patients at all. the point is that they're in charge...they're responsible for all the patients on the unit...not just their patient load.

generally, in the hospital setting, rns do all of the admissions which on the average can take anywhere from 30 minutes up to an hour per patient. they have to not only do the assessment, but they also have to interview & document everything on that admission. most cases...the charge will have everywhere from one to four admissions per shift...not to mention all of the discharges on the floor that have to be supervised/monitored. usually lpns can do discharges...but the rns are the ones who usually do the discharge teaching, collaboration with other inter-disciplines such as setting up home health therapy/aides/ etc via the social worker. the charge also have to make sure the floor is running smoothly...they have to be the *problem solvers*...the buffer so to speak between the nm & the staff...they're it often times whenever the nm isn't available. the charge has to be able to delegate & make shift assignments according to standard....they have to be able to jump-in & pick-up whenever a patient is crashing. how on earth are they able to do this if they themselves are tied-up with a more even patient assignment.

now granted...i don't understand this thing about having co-charge nurses....that i've never heard of. but it's true that the rns are ultimately responsible for their two/three patients as well as your seven. so in reality...your charge nurse is ultimately responsible for 18 patients (2 that the cnas have, the 14 that the 2 lpns have, & their 2/3 patients). that's is where the level of safety should be questioned. employers should never expect any one nurse to be legally responsible for sooo many patients! i know that lpns have their own licenses at stake...however...the rn charge also have to be able to know what's going on with each & everyone of the lpns' patients as well. if they don't...then they're liable & risk disciplinary action against their license.

i must say though...there's no excuse for the bad attitudes toward lpns & cnas by your charge rns...that behavior would make one (lpn/cna) think the rn charge(s) are purposefully being condensing, not respecting the lpns' knowledge & worth, as well as making unfair assigments...when in reality...these charges are making the appropriate assignments...they just have to work on people skills, management skills, & sensitivity. some folks think that just because they're in charge...they don't have to *answer* or explain their reasoning for how they make assignments. this isn't true...a sign of a good charge would definitely want their co-workers to know or at least understand...if not like...why the assignment are made the way they are. they're not there to make friends...but they should at least want a harmonious work environment!

and before i'm flammed...i just would like to point-out that i'm a lpn working in a hospital setting along side of rns & we work without the benefit of cnas! how i wish we had the extra expertise & hands...but alas...we don't.

may i ask you one question...are you at a ltc facility or a hospital? there does seem to be less autonomy for lpns in hospitals than in ltc facilities.

cheers!

moe

**SKM-NURSIEPOOH, BSN, RN** · Oct 28, 2003

i forgot to address the break thing! that's a facility problem...especially if you're not being paid for your lunch/dinner break! you have the right to get coverage & leave the unit/floor/ & if you wish, clock-out & leave the building! they're not paying you to be *on call* during your designated break-time...now *that* a bunch of crap :mad: !

cheers!

moe

Tweety, BSN, RN · Oct 28, 2003

Originally posted by cotjockey
Yes, the CNAs were doing primary care...it's allowed on a swingbed patient. The swingbeds patients get an RN assessment and the med nurse gives all meds to all patients (the primary nurses give PRNs, but the med nurse does PRNs for CNA's patients).

I went in for a meeting today and I looked at the assignment board...pretty similar to yesterday. Two LPNs have 7 patients each, a CNA is doing vital signs, glucometers, and helping with baths, two RNs are splitting charge and one RN is floating between the other two RNs. Sigh... no med nurse today. One of the LPNs was suppsed to be the med nurse, but the charge nurse gave her patients so she could split charge with the other RN.

LPNs can do pretty much everything the RNs can do. LPNs cannot hang blood - the charge nurse does that and the LPN monitors the patient. LOL...doesn't make a lot of sense to me. Also, sometimes the RNs will make rounds on their patients, but other than that, they don't do much that is different.

If this is indeed the situation, sounds like you have twice the load the RNs do and that is unfair. Hope you get some resolution.

So what's a "swingbed" patient.

flashpoint · Oct 30, 2003

Well...there is a charge nurse in addition to the RN with 3 patients, RN with 2 patients, CNA with 2 patients, and LPN with 7 patients. That is what has me frustrated. I know the charge nurse is also held responsible if the LPN messes up, but a lot of history in this area has shown that attorneys etc will go after the person responsible to an incident much more than they will the person who was simply in charge. I certainly see the point of RNs having a somewhat smaller load, but two patients to seven seems a little unfair. Our charge nurses NEVER, EVER take patients of their own...never have, never will!

fab4fan · Oct 30, 2003

It doesn't matter what lawyers "historically" do...ultimately, the RN is responsible. Some floors are so busy that if you're charge, it's almost impossible to take a pt assignment. It's a little hard to fully understand unless you've actually been charge on a busy hosp. floor.

Disrespect should not be tolerated.

Vsummer1 · Oct 30, 2003

LPN's are not 2nd class citizens, they are a needed component of a well run unit. BUT they work UNDER the RN's licence. So, whatever an LPN does, the RN is responsible for. So if the RN only has 3, in reality, they have your patients as well. What the heck is a CNA doing with ANY patients, much less 2??!!

If you want to be the top dog, and not the 2nd class citizen, get your RN and be responsible for every patient the LPN and teh CNA is doing for.

Sounds to me like there is a management problem, A BIG ONE.

flashpoint · Oct 30, 2003

So is every RN responsible for what the LPNs do, or just the charge nurse? Is an RN who was assigned to 2 patients while the LPN had 7 going to go down with everyone else even though they were not the charge nurse and did not assess the patient or have any contact with the patient at all? Our charge nurses do not take patients at all ever...they are not expected to and should not be expected to.

I never said I wanted to be "top dog." I just wanted to vent and wondered if it was common practice to assigned LPNs to twice as many patients as RNs (RNs who are not charge and have no contact at all with the LPNs patients).

Forgive me for even bringing this up...it's obvious to me that many RNs out there do look down on LPNs.

itsme · Oct 30, 2003

Your question was "are LPN's second class citizens" The answer is NO.

mattsmom81 · Oct 30, 2003

Cotjockey, sounds like you're very upset because you feel the RN's are getting off easy. Well, truth is some places ARE dysfunctional and the favorites get the easier assignments. But before you decide this is the case, why not ask your supervisor what else the RN's do. Most facilities I've worked at have extra duties for the RN. (mostly paperwork, QA, reports, etc)

If the RN's do NOT have extra duties, then you will have your answer, this is a dysfunctional place, and you can then decide if its time to move on. No point in staying angry and not doing anything about it, IMO.

Hope you get this resolved.