Can an LPN in FL legally have a Cardizem Gtt?

[Gurhlygirl]

I am an LPN, (EKG test passed as of this past Weds). I am trying to figure out if it is beyond my scope of practice to have a Pt on a Cardizem gtt. I have had these Pt's on TELE, Charge nurse handling all doings with the med, was on ICU yesterday, first time in months, refused a Pt coming from ER with orders for Cardizem...I just don't feel comfortable...not to sherk my responsibility, just not sure. I am looking at NPA for FL and no definite answer. Can anyone help?

[NRSKarenRN, BSN, RN]

fl bon regs:

[color=#883388]64b9-12administration of intravenous therapy by licensed practical nurses

64b9-12.004 authority for the lpn to administer limited forms of intravenous therapy.

(1) with the exception of those aspects of intravenous therapy deemed outside the scope of practice of the licensed practical nurse by rule 64b9-12.003, f.a.c., above, and subject to the approval of the institution at which the licensed practical nurse is employed, any licensed practical nurse who meets the competency knowledge requirements of rule 64b9-12.005, f.a.c., below, is authorized to administer intravenous therapy under the direction of a registered professional nurse.

(2) individuals who have completed a board approved prelicensure practical nursing education program, professional nursing students who qualify as graduate practical nurses, or licensed practical nurses who have not completed the specified course under rule 64b9-12.005, f.a.c., may engage in a limited scope of intravenous therapy under the direction of a registered nurse, physician or dentist. this scope includes:

(a) perform calculation and adjust flow rate;

(b) observe and report subjective and objective signs of adverse reactions to iv administration;

© inspect insertion site, change dressing, and remove intravenous needle or catheter from peripheral veins.

(d) hanging bags or bottles of hydrating fluid.

64b9-12.003 aspects of intravenous therapy outside the scope of practice of the lpn.

(1) aspects of intravenous therapy which are outside the scope of practice of the licensed practical nurse unless under the direct supervision of the registered professional nurse or physician and which shall not be performed or initiated by licensed practical nurses without direct supervision include the following:

(a) initiation of blood and blood products;

(b) initiation or administration of cancer chemotherapy;

© initiation of plasma expanders;

(d) initiation or administration of investigational drugs;

(e) mixing iv solution;

(f) iv pushes, except heparin flushes and saline flushes.

(2) although this rule limits the scope of licensed practical nurse practice, it is appropriate for licensed practical nurses to care for patients receiving such therapy.

specific authority 456.013(2), 490.004(4) fs. law implemented 456.013(2) fs. history-new 1-16-91, formerly 21o-21.003, 61f7-12.003, 59s-12.003, amended 4-9-98.

(2) central lines. the board recognizes that through appropriate education and training, a licensed practical nurse is capable of performing intravenous therapy via central lines under the direction of a registered professional nurse as defined in subsection 64b9-12.002(2), f.a.c. appropriate education and training requires a minimum of four (4) hours of instruction. the requisite four (4) hours of instruction may be included as part of the thirty (30) hours required for intravenous therapy education specified in subsection (4) of this rule. the education and training required in this subsection shall include, at a minimum, didactic and clinical practicum instruction in the following areas:

(a) central venous anatomy and physiology;

(b) cvl site assessment;

© cvl dressing and cap changes;

(d) cvl flushing;

(e) cvl medication and fluid administration;

(f) cvl blood drawing; and

(g) cvl complications and remedial measures.

upon completion of the intravenous therapy training via central lines, the licensed practical nurse shall be assessed on both theoretical knowledge and practice, as well as clinical practice and competence. the clinical practice assessment must be witnesses by a registered nurse who shall file a proficiency statement regarding the licensed practical nurse's ability to perform intravenous

above regs indicate that lpn can be responsible for patients with cardizem drips under direction of rn. in addition to state practice acts, what does your hospital policy state about the lpn's + iv therapy??

as a new nurse to telemetry, you need to seek additional training so you can confidently care for these clients if institution permits you to titrate iv cardiac meds.

[wibobr]

I don't know about Florida, but here at home, if it's identified as a critical care drug and titrated no, an LPN is NOT allowed!

[Gurhlygirl]

Thanks to you both...also, any words of wisdom on how to deal with difficult people? Thanks!

[classicdame, MSN, EdD]

depends on your state BON. Might be worth a phone call.

[classicdame, MSN, EdD]

as for difficult people - I pretend they are all psych patients and treat them accordingly. Somehow that helps me detach emotionally from what they are saying and doing. It also helps to remind yourself that your encounter with them is brief but they have to be with themself all the time!

[Agedeon]

Thank you so much NRSKarenRN for you reply to this post. That make the situation very clear and added clarification to even myself about the scope of practice. Thanks again.

[guest2210]

Just let them know it's not within the scope of practice for you and you are not going to jeopardize your license.

[Sherriblu]

I would say no. As an LPN i have been floated and if I dont feel qualified I just tell them. You always have to stay in your scope of practice, u cant get in trouble fot that but u can get in trouble if you did that and something went wrong. Always protect your license and pt by doing the right thing.

[GM2RN]

If an LPN's scope of practice is so limited as to not be able to care for certain patients then they should not be floated to that floor or unit. Refusing a patient from the ED forces the ED to have to care for a critical patient in addition to 2-4 other patients, depending on the ratio where you work, and those other patients could also be critical. The ED nurse would now be forced into a position where HER license is in jeopardy but has no choice in the matter, not to mention that the critical patient is also at risk because he will not receive the care that he should be getting.

[ShannonRN2010, BSN, RN]

Wow...when I was an LPN, I floated to cardiac a lot and had pts on titrated drips, usually my charge nurse would do the actual titrating for me though.

[nursestacey62]

When I worked in PCU, sometimes we had med-surg RN's float to our floor and they were not allowed to take a patient with a drip like Cardizem so I don't know how an LPN would be allowed to either.:redbeathe