confused on lpn scope of practice

deegale · Feb 27, 2005

nursing scope of practice is regulated by the board of nursing. Each state has its own act.

RN34TX · Feb 27, 2005

I am in a reentry program at a local college, I found that there are lots to learn and lots that comes back. but, the specific what I can do, and can't do is a bit confusing. The instructors tell me to go the the web site for the state board of nursing for the correct information. All I seem to get there is Legaleez.
any info would be helpful. I'm a LPN in Ariz.
I know I have to be IV cert. and NG tube cert. any other cert"s ??

It is a lot of legaleez, I've been an LPN in different states and it can be quite confusing and hair-splitting as to what is allowed.

It is long and boring but really is important to read all of that BON legaleez. Then you need to read your facility policy because they can make further restrictions on your practice. Why they do this I don't know but they do sometimes.

For instance, I worked at a facility in TX that had a small list of drugs that LPN's were allowed to give IV push, even though the state of TX nurse practice doesn't forbid LPN's from pushing anything except conscious sedation. The facility just took it upon themselves to decide that LPN's weren't competent to push anything but their personally selected list of drugs.

MOST IMPORTANTLY, the reason that you should first read what your state has to say about LPN practice before you look at your facility policy is that I have worked at facilities that actually allowed LPN's to do more than the state allows. The state has the final say and the facility you work for can further restrict your practice from what the state allows, but they cannot EXPAND your practice from what the state allows.

I was ordered by my RN supervisors to pull out central lines and hang TPN in a state that specifically, not in legaleez, specifically stated that LPN's were not to discontinue central lines or hang TPN.

Why? Because in my near 7 year career and several states later as an LPN/LVN, I can tell you that most, not some, most of the RN's who will be your charge or supervisors have no clue as to what LPN's are allowed to do either by state practice or facility policy and that is sad but true.

How can any RN competently supervise an LPN and be ignorant as to what is allowed in their practice and what is not? I don't know but I can tell you first hand that it happens a lot. And they can pull that old "RN has ultimate accountability" stuff all they want. When push comes to shove, if you push a drug or pull a line that your state or facility policy restricts LPN's from doing, even though your supervisor/charge authorized you to do, you can bet that all those RN fingers will be pointing at you when trouble happens.

In any state, it is the individual LPN's responsibility to know what they are legally authorized to do regardless of what an RN or MD asks them to do.

Read your state practice act, I know it's boring, but believe me, your supervisors are not people you can count on to know what you are allowed to do.

LPNer · Mar 1, 2005

This is the kind of thing that makes me wish we had national licenses and a national BON!

I have run into the same problems working from state to state. I haven't seen it so much from facility to facility because I don't generally change jobs until I move on to another state, so I have to admit a fair amount of ignorance there. But state to state? WOW, the differences can make you crazy.

RN34TX · Mar 1, 2005

This is the kind of thing that makes me wish we had national licenses and a national BON!
I have run into the same problems working from state to state. I haven't seen it so much from facility to facility because I don't generally change jobs until I move on to another state, so I have to admit a fair amount of ignorance there. But state to state? WOW, the differences can make you crazy.

The only reason that I would be cautious of that is my fear would be that the people running the "national" level of licensure would be like-minded of those who are in the states that are more conservative/restrictive about LPN practice and the states where LPN's enjoy a wider scope of practice would suffer.

Now this info may have changed because it's been several years since I've worked there, but I remember that in Minnesota I wasn't even allowed to start IV's, only RN's could do that or even touch a central line (including dressing changes and flushing.)

I would not want people with that mind set being decision makers on some national license affecting all states.

Then I worked in a couple of states that not only were LPN's allowed to do those things, it was an expected competency of them.

Then I moved to the great state of Texas where LVN's on my Med/Surg floor only needed an RN for pushing a cardiac drug (ones like digoxin that are allowed on Med/Surg floors) or to hang a bag of blood.

Big change from Minnesota where I'm sure the RN's would be horrified to find out that LPN/LVN's in other states are allowed to push Ativan and morphine, I could hear them now.

LPNer · Mar 1, 2005

The only reason that I would be cautious of that is my fear would be that the people running the "national" level of licensure would be like-minded of those who are in the states that are more conservative/restrictive about LPN practice and the states where LPN's enjoy a wider scope of practice would suffer.
Now this info may have changed because it's been several years since I've worked there, but I remember that in Minnesota I wasn't even allowed to start IV's, only RN's could do that or even touch a central line (including dressing changes and flushing.)
I would not want people with that mind set being decision makers on some national license affecting all states.
Then I worked in a couple of states that not only were LPN's allowed to do those things, it was an expected competency of them.
Then I moved to the great state of Texas where LVN's on my Med/Surg floor only needed an RN for pushing a cardiac drug (ones like digoxin that are allowed on Med/Surg floors) or to hang a bag of blood.
Big change from Minnesota where I'm sure the RN's would be horrified to find out that LPN/LVN's in other states are allowed to push Ativan and morphine, I could hear them now.

I DO have that same fear. Ohio is one of the most restricted states I know of but it surely sounds like Mn is even more restrictive (unless they too now allow LPNs to start IVs but can hang only a limited number of solutions and the only piggybacks are antibiotics) However, we are allowed to take orders, verbal, written and telephone which is something Ohio didn't allow not so long ago in acute care facilities.

I will never understand why an RN must come into the room and complete the physical chore of pushing this or that and then leaving the room not to return until I hand her/him another dose. Isn't the important thing in drug administration knowing, recognizing and following through with untoward as well as expected outcomes? That's what I do! The physical pushing or hanging is no different from any other med. Yes, you push Lasix slower (as an example) but 30 years ago I had to know that to pass the NAPNES exam did I not remember or what?!

I have to agree with you about fear of loosing scope with a national license.

Indiana LPNs hang blood, do they elsewhere?

RN34TX · Mar 1, 2005

I DO have that same fear. Ohio is one of the most restricted states I know of but it surely sounds like Mn is even more restrictive (unless they too now allow LPNs to start IVs but can hang only a limited number of solutions and the only piggybacks are antibiotics) However, we are allowed to take orders, verbal, written and telephone which is something Ohio didn't allow not so long ago in acute care facilities.
I will never understand why an RN must come into the room and complete the physical chore of pushing this or that and then leaving the room not to return until I hand her/him another dose. Isn't the important thing in drug administration knowing, recognizing and following through with untoward as well as expected outcomes? That's what I do! The physical pushing or hanging is no different from any other med. Yes, you push Lasix slower (as an example) but 30 years ago I had to know that to pass the NAPNES exam did I not remember or what?!
I have to agree with you about fear of loosing scope with a national license.
Indiana LPNs hang blood, do they elsewhere?

New York allows this.

Texas does not forbid LVN's from hanging blood but the facilities I've worked for had their own "RN only" policy on blood administration.

And boy do I remember your frustration. I always heard this song and dance about RN's needing to do these things because they were better able to monitor for side effects, assess before, during, and after administration, etc.

What a bunch of crap.

Never once in nearly 7 years of being an LPN/LVN did any RN come see my patient or even bother to ask how my patient was doing after pushing a drug or hanging a bag of blood. Some assessment!

I remember filling out a transfusion reaction report at the desk and the RN who hung the blood (who decided to go to lunch right after spiking the bag) saw me doing this, all in a panic "Oh my god, did you stop the blood??"

I looked at her and pretended that I hadn't-- "Oh, I must have missed class that day in LPN school, it's almost completely infused now."

LPNer · Mar 1, 2005

New York allows this.
Texas does not forbid LVN's from hanging blood but the facilities I've worked for had their own "RN only" policy on blood administration.
And boy do I remember your frustration. I always heard this song and dance about RN's needing to do these things because they were better able to monitor for side effects, assess before, during, and after administration, etc.
What a bunch of crap.
Never once in nearly 7 years of being an LPN/LVN did any RN come see my patient or even bother to ask how my patient was doing after pushing a drug or hanging a bag of blood. Some assessment!
I remember filling out a transfusion reaction report at the desk and the RN who hung the blood (who decided to go to lunch right after spiking the bag) saw me doing this, all in a panic "Oh my god, did you stop the blood??"
I looked at her and pretended that I hadn't-- "Oh, I must have missed class that day in LPN school, it's almost completely infused now."

That reminds me of the admission assessment that only RNs can perform in Ohio. Yep, I admit my pt, and sit down to a PC that an RN logs into and put the info in. LOL Then there are the few RNs who take my notes and enter that admission assessment themselves. But did they make the assessment? NO, I did and I do a very good job! Oh well, off to work, have a 12 hr shift tonight and no internet access there, don't believe I'd have time to log on much less interact after I did. Have a great evening!

If I ever do manage to get my RN (I want that money), I pray to God that I do not forget what great nurses LPNs can be!

RN34TX · Mar 2, 2005

That reminds me of the admission assessment that only RNs can perform in Ohio. Yep, I admit my pt, and sit down to a PC that an RN logs into and put the info in. LOL Then there are the few RNs who take my notes and enter that admission assessment themselves. But did they make the assessment? NO, I did and I do a very good job! Oh well, off to work, have a 12 hr shift tonight and no internet access there, don't believe I'd have time to log on much less interact after I did. Have a great evening!
If I ever do manage to get my RN (I want that money), I pray to God that I do not forget what great nurses LPNs can be!

I don't believe that I've ever met an RN that used to be an LPN who forgot what great nurses they are.

I've met one LPN who went straight to BSN because when she was an LPN she didn't feel like she was a very good nurse. But I think that's an individual thing.

Unfortuantely, after getting my RN I got a job in a hospital that only uses LPN's in the outpatient settings so I no longer have contact with them except for my old friends.

As far as the money goes, damn right. My old LPN instructor always told me and I found it to be true myself:

Keep going for your RN, you will work just as hard as an LPN but for less money. Period.

michelleicu · Mar 6, 2005

I don't know whether to pursue a career in nursing as an lvn or become a medical assistant which is more faster.I don't have alot of time to be studying i have three girls 12,6,3.

RN34TX · Mar 7, 2005

I don't know whether to pursue a career in nursing as an lvn or become a medical assistant which is more faster.I don't have alot of time to be studying i have three girls 12,6,3.

You may have to ask other medical assistants or those who used to be MA's. I don't know that much about it except I think that the programs are about equal in length so I'd say to do the LVN program. I believe that the pay is better and there are more areas you can work, MA's primarily work in outpatient settings, never seen one in inpatient hospital settings. Plus I think it's easier to keep going on for RN if you decide to do that later.

LPNer · Mar 7, 2005

I don't know whether to pursue a career in nursing as an lvn or become a medical assistant which is more faster.I don't have alot of time to be studying i have three girls 12,6,3.

The only place I've ever known Med Assits to work is in the outpatient setting. That, to me would be way to restrictive!

LPNs (LVNs) work in acute care, long term care, home care, and outpatient care. So many different options in each of the areas too.

I've seen an AD recently in the Med Assist area, seems a long time to go to school to be a med assist but they may be educated to be the Docs office manager as well as pt assistant. But I would almost bet they don't make as much as LPNs do. Just my guess, I could very easily be wrong about that, you know what they say about "assume"ing.