Can LPNs Flush P.I.C.C. lines in TN

mmutk, BSN, RN, EMT-I · Feb 26, 2007

You can check w/ your local state guidelines. Personally I don't know of any hospital that will back up LPNs doing anything w/ PICC Lines

DutchgirlRN, ASN, RN · Feb 27, 2007

Both in the hospital and now in HH, Yes, LPN's can flush PICC lines, change the dressing, only an RN can DC the PICC line or draw blood from it.

Haunted · Mar 12, 2007

Both in the hospital and now in HH, Yes, LPN's can flush PICC lines, change the dressing, only an RN can DC the PICC line or draw blood from it.

That's scary!!!! I hope I never have to be hospitalized here in Tennessee....eeeeek

Southernurse · Mar 13, 2007

that's scary!!!! i hope i never have to be hospitalized here in tennessee....eeeeek

why is that scary? if one is trained correctly, it can be done safely and with as much skill as an rn. (real nurse). it's okay, i understand, a lot of people are ignorant through no fault of their own to what a nurse, particularly an lpn, is capable of. i am licensed in florida and had to be iv certified for that licensure. having dual licensure is a great way to expand the education, as we all are learning more everyday, every shift. in a facility worth jcaho approval even if one is a nurse for many years, any respectable facility will train a "new" nurse to what is acceptable or not. if the nurse does not demonstrate capabilities as witnessed by the sign off nurse on the skill checklist received upon employment, the nurse is not allowed to perform those activities until a reasonable level of skill is achieved. (and no they do not use patients as guinea pigs!) there are also skill "spot checks" to assure the nurse is competent. any nurse who is unsure of how to do something should not be ashamed to ask their charge nurse or closest supervisor before touching a patient. it is the prudent thing to do if one does not want to harm a patient or lose their livelihood. this attitude is why lpn's feel ashamed of what should be an achievement. this is why people who would otherwise be wonderful nurses don't even try. this is why people mistrust nurses and are under the impression they eat their young or cannibalize other nurses. please don't disrespect lpn's for what we do. or don't do. :icon_roll

Haunted · Mar 13, 2007

why is that scary? if one is trained correctly, it can be done safely and with as much skill as an rn. (real nurse). it's okay, i understand, a lot of people are ignorant through no fault of their own to what a nurse, particularly an lpn, is capable of. i am licensed in florida and had to be iv certified for that licensure. having dual licensure is a great way to expand the education, as we all are learning more everyday, every shift. in a facility worth jcaho approval even if one is a nurse for many years, any respectable facility will train a "new" nurse to what is acceptable or not. if the nurse does not demonstrate capabilities as witnessed by the sign off nurse on the skill checklist received upon employment, the nurse is not allowed to perform those activities until a reasonable level of skill is achieved. (and no they do not use patients as guinea pigs!) there are also skill "spot checks" to assure the nurse is competent. any nurse who is unsure of how to do something should not be ashamed to ask their charge nurse or closest supervisor before touching a patient. it is the prudent thing to do if one does not want to harm a patient or lose their livelihood. this attitude is why lpn's feel ashamed of what should be an achievement. this is why people who would otherwise be wonderful nurses don't even try. this is why people mistrust nurses and are under the impression they eat their young or cannibalize other nurses. please don't disrespect lpn's for what we do. or don't do. :icon_roll

ouch! i have worked with many wonderful lvn's/ lpn's in my time whom i would never hesitate to trust with my care or that of my family and friends. i am extremely concerned with the lack of monitoring in regards to medications, technical skills and assessment that lvn's routinely perform here.

i am not painting every rn or lvn with the same brush here. i have worked with advanced practice rn's who have very limited clinical experience and you send in an lvn and the job is done and we all move on. the standards of practice for rn's are different, as well as the level of responsibility that falls upon us. i am not comfortable having an lvn perform iv pushes, flushes, hanging piggies or performing tasks that are legally my responsibility. call me "anal" but if it's my license on the line, if i didn't do the procedure i should not have to fall into the fray if it was done wrong.

lvn's training is very different. and very important to the dynamic of nursing. the position is more clinical and geared to a team nursing aspect. i also admit i am spoiled by the ratios and rules of nursing coming from california. i mean no disrespect, i worked as an lvn myself. there are a lot of things i am learning here.

withasmilelpn · Mar 13, 2007

An LPN that is IV certified is operating under her scope of practice and would be responsible for any mistake they made, not you. We can lose our license, which is why I make sure I'm aware of what I can or can't do, and never overstep my role.

withasmilelpn · Mar 13, 2007

By the way, hospitals often have policies that completely differ concerning what LPNs can or can't do, that do not conform to the state's practice act. They are more likely to limit what LPNs can do due to their policies and not the law or what we have been trained to do. The funniest thing though is not being allowed to assess patients (which is part of my state law). We did head to toe assessments in school. I don't even know how you can be a nurse and not know at least basic assessments. You need to know if your patient might be in trouble so you can notify your supervisor don't you? When someone might require a chest xray or a breathing treatment or have injured themselves when they fell. Most of the time my supervisors completely trust the decisions and assessment I've made because they know I know what I am doing. I find it frustrating that LPNs can be so limited in some areas but others like home care and LTC/rehab are not. Also that we are denied membership to our state Nurses associations and ANA because we are not RNs.

Haunted · Mar 14, 2007

I have read the TN nurse practice act cover to cover and am more confused than ever! The laws and scope of my liability were so specific in California (where you pay 350.00 fines for jaywalking, your tax dollars at work duh!) that I never wondered walking into a facility what they expected of me.

I am also amazed at the way the nursing staff defers to the MD here. I accompanied a friend to the hospital and actually saw a nurse ( I assume since she wore no ID ) give up her chair at the nurses station when an MD came in to write orders. She had to close the chart she was working on and go prop it up on a counter so this Doogie Howser could prop his feet up and play with his blackberry!!!! I wanted to smack him right off the chair!

I am also astonished to see facilities BRAGGING that they offer a 1:22 nurse to patient ratio!!!! What the........ Anyway, thank the cannolies I am anonymous here so far and not working because from the looks of things I am gonna have to do a Norma Rae on administration around here. No ratios, very little support for the nurses, really low wages and no job security. I'm like y'all, I deliver my trays, do my own I and O's, linen changes and bed baths.

When I give shift report I want to be sure I know what I am talking about. I had to work harder, smile wider, accept the extra hours being agency and it paid off for me where I came from. I could be counted on. I'm going to work really hard to be that same person here because I respect the work that we all do. I can't wait to work with you guys.

Southernurse · Mar 14, 2007

yeah, miss haunted, i must say i was taken aback by the way the docs treat the nurses. where i come from in florida, the nurses were expected to be in the room when with them. we also had a great report with the docs. they never usurped and took seats from a lady (no kidding-this is the mentality). it's a different world. where i work now, the charge nurses and administration make sure we aren't treated badly by the md's. there is an open door policy, and they actually take any complaint seriously and look into everything. yes it is a small facility-good! by the way, the 1:22 ratio is for a ltc. not that that is great by any means-it stinks and puts residents at risk. not all facilities are horrible. unfortunately there is some trial and error. you will find a place to work that fits you.

Living4HIM · Apr 1, 2007

why is that scary? if one is trained correctly, it can be done safely and with as much skill as an rn. (real nurse). it's okay, i understand, a lot of people are ignorant through no fault of their own to what a nurse, particularly an lpn, is capable of. i am licensed in florida and had to be iv certified for that licensure. having dual licensure is a great way to expand the education, as we all are learning more everyday, every shift. in a facility worth jcaho approval even if one is a nurse for many years, any respectable facility will train a "new" nurse to what is acceptable or not. if the nurse does not demonstrate capabilities as witnessed by the sign off nurse on the skill checklist received upon employment, the nurse is not allowed to perform those activities until a reasonable level of skill is achieved. (and no they do not use patients as guinea pigs!) there are also skill "spot checks" to assure the nurse is competent. any nurse who is unsure of how to do something should not be ashamed to ask their charge nurse or closest supervisor before touching a patient. it is the prudent thing to do if one does not want to harm a patient or lose their livelihood. this attitude is why lpn's feel ashamed of what should be an achievement. this is why people who would otherwise be wonderful nurses don't even try. this is why people mistrust nurses and are under the impression they eat their young or cannibalize other nurses. please don't disrespect lpn's for what we do. or don't do. :icon_roll

i agree. i'm an lpn in nc about to graduate adn next month. i have just accepted a job in tn and cannot believe the limits lpn's here have. i worked at mission hospitals in asheville, we did everything an rn did except the initial assessment and our discharge teaching had to be reviewed by an rn prior to dc. we had an iv team, but we flushed central lines, iv pushed central lines, administered blood and drew blood from central lines. we were iv certified at this facility and mistakes that we made would fall back on us. we have our own license and we work off of it and we are responsible. the rn was only responsible if they delegated to us something which was out of our scope, then we were responsible too. an extra note to the training, my training was better for lpn school than for rn and the lpn program was much more difficult at the same school, the rn program at least in nc is primarily the lpn program plus 2 semesters and a boatload of busy work. all lpn's should be proud of their accomplishments and their license because they sure worked for it and they deserve it. don't let someone put you down just because you are a "low paid nurse." i also worked in ltc and would have been happy to have 22 patients, there were nights that i came to work and had 72!! according to nc state law there is no limit on the amount of patients one nurse had in ltc and by the way it was night shift. 2 lpn's and 7 cna's, that's it. no rn on the premises. we all work very hard for our licenses and all should be proud. i am excited to get my rn and to be able to do all the same work that i was doing before, but to get paid more. actually, in east tn that's not true either. the pay is higher in wnc for lpn than in east tn for rn. we all do what we can and try to be the best nurse we can because eventually we all may be patients some day and we have to support eachother. good luck to you all and god bless!!