California LVN's Question about duties at work....

[pink2blue1]

Hello all, I am an LVN and work in Acute care on a Med-surg floor. We take care of post surgical patients after they have had surgery and are discharged from PACU. As an LVN I am IV certified. I know I am unable to perform initial assessment, push IV meds or hang piggy backs etc. I know all that. I can hang blood because I am IV certified.

For the past 2.5 years I have been doing my own re-assessments, acuities and taking care of patients who have had a duramorph or spinal anesthesia as a one time injection. Not continuous epidural. I have always worked on my own on the floor, having my own group of 5 patients, with the charge nurse covering my IV's etc. In the last week, someone pulled the policy regarding Spinal narcotic protocol, Scope is RN. It doesn't so much mention that LVN's cannot take care of patients who have had duramorph/spinal anesthesia as a one time injection, but more adresses the fact that the RN assesses the patient with a continuous epidural. So now they have deemed that LVN's are not allowed to take post-op patients who have had any type of duramorph etc. Also they have told me I am no longer allowed to do my own acuities on my patients. The interim manager has come to me asking if I wanted to consider doing "team" nursing with me teamed with an RN. I do not want to do this because as much as RN's dont' want to cover an LVN, there are many RN's on my floor that I would not want to be teamed with. I spoke to my manager about this yesterday and never got a response. Never. She said she would get back to me, but had not by the end of the shift.

What is it like where you work. Glad to hear anyones experience in any state.

[ColeySuniga]

I'm also an LVN on the Surgical floor at an acute care hospital in Northern California. I graduated last May, and have been working there since graduation. My hospital went to team nursing about 2 years ago. I had been a CNA on the same floor for 3 years before finishing school, so I saw the changes take place, and I have heard everyone's opinion on the subject during the whole transition. I'm not sure how great my opinion is, since I've only done team nursing since graduation (although my hospital's DCU and ICU don't do team nursing, and I float to DCU about once a month, have my own patients there...), but it hasn't been too bad, depending on the RN that I'm teamed up with. For the most part, it's been kind of nice. The RN's that I work with understand that I'm educated, not just a "work horse" and I still get to do everything that's in my scope. I'm still starting IV's and hanging fluids without meds in them, checking the Dermatomes for my post-op's, passing meds, doing Accuchecks, hanging blood, reinfusing and D/Cing Stryker's, etc. The main difference is that the RN and I team up and take 8 patients (we can technically take 10, but they try not to), the RN does the assessment and initial charting on our patients, while I make the RN an IV list and then take care of the rest of the meds. I can still chart my care, but it is frustrating to not be able to do assessments or chart. I've written to the LVN board and it IS in my scope to chart and assess, it's just my Med-Surg director who has decided to change our scope. Still feeling lucky, though, to have a job in an acute care hospital, which is hard to find as an LVN these days (the hospitals in my area don't hire LVN's anymore, I only got my job because I worked there for so long before graduation.) This was kind of rambly, if you have any more questions, feel free to ask!

NICOLE

[pink2blue1]

Hi Nicole, thanks for responding...

Our situations sound a lot the same. I also worked as a CNA for 4 years on this same floor before finally getting my LVN license. So I transitioned right into LVN. I am sure I would have not gotten hired in as an LVN had I not worked there before as a CNA.

Some of the RN's went to our union rep yesterday and they said that we, by law, cannot do team nursing unless it is 2 LVN's to 1 RN. Strange I know. I also have called the board to find out and see if they have a better written scope of prctice. I have been charting my own shift "RE-ASSESSMENTS" but I am no longer allowed to chart acuities, or do the careplan obviously. Seems strange seeing as I know my patients problems and goals.

We shall see how this turns out.

Thanks again,

Shannon

I'm also an LVN on the Surgical floor at an acute care hospital in Northern California. I graduated last May, and have been working there since graduation. My hospital went to team nursing about 2 years ago. I had been a CNA on the same floor for 3 years before finishing school, so I saw the changes take place, and I have heard everyone's opinion on the subject during the whole transition. I'm not sure how great my opinion is, since I've only done team nursing since graduation (although my hospital's DCU and ICU don't do team nursing, and I float to DCU about once a month, have my own patients there...), but it hasn't been too bad, depending on the RN that I'm teamed up with. For the most part, it's been kind of nice. The RN's that I work with understand that I'm educated, not just a "work horse" and I still get to do everything that's in my scope. I'm still starting IV's and hanging fluids without meds in them, checking the Dermatomes for my post-op's, passing meds, doing Accuchecks, hanging blood, reinfusing and D/Cing Stryker's, etc. The main difference is that the RN and I team up and take 8 patients (we can technically take 10, but they try not to), the RN does the assessment and initial charting on our patients, while I make the RN an IV list and then take care of the rest of the meds. I can still chart my care, but it is frustrating to not be able to do assessments or chart. I've written to the LVN board and it IS in my scope to chart and assess, it's just my Med-Surg director who has decided to change our scope. Still feeling lucky, though, to have a job in an acute care hospital, which is hard to find as an LVN these days (the hospitals in my area don't hire LVN's anymore, I only got my job because I worked there for so long before graduation.) This was kind of rambly, if you have any more questions, feel free to ask!

NICOLE