LPN's in CCU, a vent - page 2
I've looked around and didn't see a thread discussing this problem so I started my own. Excuse me if it's been done to death. I just need to vent. :stone My anger is directed at the hospital not... Read More
Mar 28, '05I was an LVN and I went to RN school to be able to work in ICU.
I have seen some great LVNs in ICU. But the fact is I invested 5000 hours of my personal time to meet the state requirement to be able to take care of the critically ill. And they should too. Our new Texas NPA specifically states LVNs can only take care of "stable patients with a predictable outcome" and that pretty much precludes the vast majority of ICU patients I have seen in my 7 years of LVN experience. They are still there but I think that will end once a team of attorneys explains it to Mgt on behalf of a dead or disabled person because an LVN was involved in the care. And no doubt the RN charge who assigned said LVN will be working at Walmart.
I went to RN school because I got tired of being beat up for being just an LVN.
and to be clear I respect the LVN. they are valuable in many areas
I still have my LVN license
But the ICU should be an RN only area...because thats what the law says and for no other reason.
Mar 28, '05[QUOTE=bcjams. Our new Texas NPA specifically states LVNs can only take care of "stable patients with a predictable outcome" and that pretty much precludes the vast majority of ICU patients I have seen in my 7 years of LVN experience. They are still there but I think that will end once a team of attorneys explains it to Mgt on behalf of a dead or disabled person because an LVN was involved in the care. And no doubt the RN charge who assigned said LVN will be working at Walmart.
Wow I just moved out of Texas and did not know the BNE had ruled on this. Thanks for the update. The last ICU I worked utilized LVN's heavily...but I suspect that will change with the new rulings. But most of those LVN's were in RN school so they may have remedied their own problem already.
I hope this will not result in higher nurse patient ratios with hospitals further crying 'nurse shortage'.
Mar 29, '05Here is the file from the Texas BNE...
The is RN vs. LVN Chart is about half way down the page.
it all really comes down to three words. "Unpredictable Health Status".
We had some long discussions on this in my school....ie. if you know some is going to die anyway can you assign an ICU lvn to their care..yes...but if they might live then it has to be an RN.
I can tell you now there are definitely some LVNs I would prefer over some Rns if my life was in the balance.... but I think its pretty clear that the ICU LVn days are numbered if not already done....its just one big lawsuit away.
Mar 29, '05I am probably going to get flamed from some LPN's for this statement. I am an LPN and love it. There are places that LPN should not practice and I have to say critical care areas are places that LPN do not need to be. I know there are some LPN who have been practicing for years and are very knowledgable but they are not RN and do not have the assessment skills that most Rn have. If LPN wants to work in these areas they should go back to school for RN. I do believe there are places for LPN in nursing. We are still nurses, we just do not belong in every field of nursing. One problem I see is that LPN wants to be recognized as a nurse and sometimes feel that they are not preceived as nurses and are not always treated professionally by RN. We all need to learn to accept our limitations with the type of nursing that we have chosen. Someday I might go back to school for RN but for now I am happy with where I am in life. I hope that someone has a fire extinguisher when the flaming starts. :flamesonb
Mar 29, '05I am an LVN as well and I agree that LVNs/LPNs should not be in certain areas of nursing because of our "scope of practice". However, we are allowed to work in some areas and maybe (instead of always getting angry because we can't take a certain patient or do certain things) the RNs can just work together with the LVNs and do the things that isn't within their scope of practice and delegate them to do things for you that is with in their scope of practice. It's called teamwork... and it makes for a more nicer work day/night. The RNs I work with seem to like it.
Mar 29, '05Let the burning begin!
I have ER and Critical care exeperience. Many RNs I work with are of lesser skills then some of our LPNs. RN doesn't mean better care or better assessment skills, just means register nurse. of course, the law recognizes a difference and with that difference it can mean additional responsibilities, but I think it should be, if there going get paid more.
Most situations can be handled by more teamwork and maybe someone changing there mindset.
Nursing profession has many whiners and complainers, not saying no real concerns exist but often it's exagerated, IMO. :kissLast edit by RobLPN on Mar 29, '05
Mar 30, '05I also agree that LPNs do not need to be in critical areas.
I'm NOT an RN and I KNOW that. I do NOT have all the training, knowledge, skills that they have, and so therefore I do NOT want to be put in a position that could be dangerous for me or the patient.
My license doesn't permit me to do the things an RN can, plus I don't get paid to do what they do.
However, it doesn't mean I don't want to learn or be a team player.
I will assist my RN in any way that I can.
Mar 30, '05The P&V for practical/vocational mean just that...care of the patient with common conditions that have a stable, predictable outcome. Patients in ICU and other critical care areas are beyond the LPN scope of practice. I was an LPN for many years and always understood and respected this. I was never once insulted that I did not hold the skill and educational level to practice in these areas. LPN's are great and valuable! I learned so much as an LPN--it really helped me make the transition. We all have our place in nursing and we all need to stay within our legal scope of practice.
Mar 30, '05Quote from GN1974I understand what ya'll are saying and I was a LVN myself first. I just know quite a few sharp LVN's who learned ICU OJT and do very well well there; as well as I did. I myself, as a very old RN, never took a critical care course perse...I also learned ICU 'OJT'. But the times they are a changin'.The P&V for practical/vocational mean just that...care of the patient with common conditions that have a stable, predictable outcome. Patients in ICU and other critical care areas are beyond the LPN scope of practice. I was an LPN for many years and always understood and respected this. I was never once insulted that I did not hold the skill and educational level to practice in these areas. LPN's are great and valuable! I learned so much as an LPN--it really helped me make the transition. We all have our place in nursing and we all need to stay within our legal scope of practice.
The law is the law; and Texas and other states are making it law LPN's cannot go into these areas where instability is likely (and that's why they're in ICU).
Now we shall see what transpires. Hopefully it will not be even higher nurse patient ratios and addition of UAP's to specialty areas. If there is such a 'nursing shortage' out there I fear this will occur. I hope I am wrong.
Does it not seem strange: all the 'nursing shortage' hoopla yet BNE's make laws causing further staffing problems in areas currently utilizing experienced, competent LVN's who will now be reassigned to areas they are quite overqualified for. Will these LVN's resign? I might...after working ICU for 15 yrs I may have no desire to move to medsurg.Last edit by mattsmom81 on Mar 30, '05
Mar 30, '05Quote from sagarcia210Not so true. I work ICU and CCU from time to time, and our LPNs are very valuable members to both areas. An LPN can give meds--PO, IM, SQ, rectal, via tubes, and IV ATBs if IV cert.. An LPN can do an assessment on a patient, as long as one has been done by an RN Q12H. An LPN can do the baths, vitals,TLC, etc.... Our LPNs do not take a team, per se; they do help out tremendously to all teams. I know it might not be like this everywhere, but I just want to let the readers know that there are some places that LPNs can help tremendously. I do think however that the original poster's situation should be looked into. That does sound unsafe and unorganized.
Maybe you work in a fairly nonacute intensive care unit. There is no way an LPN can survive in mine. Frequent Swan/ IABP/ CVVHD, etc. We do heart transplants, etc. I could possibly understand a chronic vent unit but beyond that still believe an LPN is not appropriate and only a drain on the other nurses unless there is a legitimate shortage in your area------meaning, not connived by the hospital to save money.
Apr 1, '05Quote from lee1I sympathize with the OP but I'm a little disturbed at some of the comments by RN's and LPN's alike here.Maybe you work in a fairly nonacute intensive care unit. There is no way an LPN can survive in mine. Frequent Swan/ IABP/ CVVHD, etc. We do heart transplants, etc. I could possibly understand a chronic vent unit but beyond that still believe an LPN is not appropriate and only a drain on the other nurses unless there is a legitimate shortage in your area------meaning, not connived by the hospital to save money.
I'll chalk it up to a lot of RN's who work ICU have little, if any, exposure to LPN/LVN's and therefore, do not completely understand their capabilities.
Then there are the LPN's who have little exposure to ICU, so they are scared of the unknown and that is where you get the previous comment about LPN's only taking care of "stable with predictable outcomes" patient. That same quote that this poster made (who didn't include this in their comment) is also followed up with "and/or assisting the RN with unstable and/or complex patients" in nurse practice act language in 2 states where I've worked as an LPN and is taught in most LPN programs.
I was floated to ICU as an LPN frequently and fortunately the staff didn't look at me as a burdon and I ended up learning a lot along the way.
Yes, I understand the reality of ICU life, and as an ICU RN now, I wouldn't always have time to "teach" non-ICU nurses who may float to my unit, I'd rather have ICU trained nurses who can jump in and help when we are swamped.
Lee1, how many new RN's have you known who were ready to take care of patients with swans and/or were on CVVHD right out of RN school, no OJT?
Or, how many RN's who have never worked in critical care areas would be able to float to your unit and take care of these types of patients independently? My guess is none.
My point is, it's not an RN/LPN thing, it's a training and skills thing.
First of all, you need to be in a state that does not restrict LPN practice so tightly, and although I'm disturbed at Mattsmom81's comments about possible new laws in TX, as an LVN in TX, I enjoyed a fairly broad scope of practice compared to other states.
If you live in a very restricted LPN practice state, then yes, I'd agree that LPN's could do more harm than good in an ICU.
But....LPN's can be trained to do a lot of these things. Just like Med/Surg RN's, it's just that the RN's get the benefit of the doubt of being able to learn these things and it's often assumed that LPN's couldn't grasp the concepts because of their limited education.
Many places hire "monitor techs" nowadays, so why is it such a strange concept to teach LPN's V-tach,V-fib, blocks, etc?
And what is so hard about titrating drips?
You can train an LPN to look at the monitor and recognize dangerous rhythms, and let's say that the patient is on a Levophed drip....well, LPN's are taught in school about what normal and abnormal pressures are, so if the order is to maintain a MAP >60, how hard would it be to teach the LPN to bump up the drip when their BP begins to drop? Or wean them off the drip?