Confused about LPNS role

Silverdragon102, BSN · Jul 26, 2008

Moved to the LPN/LVN corner

Each state will have their own requirements on what PN can do. Is there any state particular you are looking at regarding PN's or just general stuff?

gutcheck · Jul 26, 2008

here is how I think of it.

LPNs cannot reassess. with blood products lpns cannot even check the blood product. that requires 2 RNs. and you have to stay with the pt. for 15mins. to reassess, evaluate how the are responding to the transfusion. same with tpn, that is an RN responsibility. the LPN can do some sterile produres. like dressing changes, trach care. but these should be simple procedures, which won't require the RNs assessment (that is the key, does it require reassessment). anytime you have a pt. with a sign or symptom, like restlessness, confusion, pain, headache. it requires the RNs assessment. the RN needs to assess the level of pain, are they confused/restless because they are short of breath. this requires the RNs asssessment skills. The RN is also responsible for admission and discharge. admission requires you to assess the pt. and discharge requires teaching in some ways. both of these only the RN can do. as long as the situaiton requires you to assess, reassess, plan care, evaluate, admit, discharge, teach, it will be the RN responsibility. so you have to think about are they needing something requiring me to reassess. before you give pain med. you have to assess there pain. after you give the med you have to reassess. so if it is a prn med or a med that requires reassessment. then that is the RNs patient.

lacool · Jul 26, 2008

Thank you soo much!!!!

pagandeva2000, LPN · Jul 26, 2008

here is how I think of it.
LPNs cannot reassess. with blood products lpns cannot even check the blood product. that requires 2 RNs. and you have to stay with the pt. for 15mins. to reassess, evaluate how the are responding to the transfusion. same with tpn, that is an RN responsibility. the LPN can do some sterile produres. like dressing changes, trach care. but these should be simple procedures, which won't require the RNs assessment (that is the key, does it require reassessment). anytime you have a pt. with a sign or symptom, like restlessness, confusion, pain, headache. it requires the RNs assessment. the RN needs to assess the level of pain, are they confused/restless because they are short of breath. this requires the RNs asssessment skills. The RN is also responsible for admission and discharge. admission requires you to assess the pt. and discharge requires teaching in some ways. both of these only the RN can do. as long as the situaiton requires you to assess, reassess, plan care, evaluate, admit, discharge, teach, it will be the RN responsibility. so you have to think about are they needing something requiring me to reassess. before you give pain med. you have to assess there pain. after you give the med you have to reassess. so if it is a prn med or a med that requires reassessment. then that is the RNs patient.

It really depends on the state you live in, the scope of practice of the LPNs and policy/procedure of the facility. It is true, that an LPN is not to assess. However, in my state, if trained, we can initiate blood products, but the bloods have to be signed with an RN, not an LPN. Some states say that the LPN cannot do an initial assessment, but can do follow-ups (on the same situation if they are stable), and if there is a new situation, then, this is where consultation with the RN takes place.

Again, I am speaking of my state only, but we can do teaching for common place situations that are already established, such as diabetes, hypertension, etc...(no new and exotic diseases). Some nursing homes will have an LPN create an initial care plan, but it has to be countersigned by an RN; so, it can change based on the RN's judgement. Some states have a broader scope of practice for their LPNs, some are more limited.

I keep hearing about some places were their LPNs are not allowed to medicate their patients at all...that astounds me. What on earth can they be learning for 9 months to a year only not to be allowed to adminster basic medications is beyond me, but I guess it happens.

Hopeslayer · Jul 26, 2008

here is how I think of it.
LPNs cannot reassess. with blood products lpns cannot even check the blood product. that requires 2 RNs. and you have to stay with the pt. for 15mins. to reassess, evaluate how the are responding to the transfusion. same with tpn, that is an RN responsibility. the LPN can do some sterile produres. like dressing changes, trach care. but these should be simple procedures, which won't require the RNs assessment (that is the key, does it require reassessment). anytime you have a pt. with a sign or symptom, like restlessness, confusion, pain, headache. it requires the RNs assessment. the RN needs to assess the level of pain, are they confused/restless because they are short of breath. this requires the RNs asssessment skills. The RN is also responsible for admission and discharge. admission requires you to assess the pt. and discharge requires teaching in some ways. both of these only the RN can do. as long as the situaiton requires you to assess, reassess, plan care, evaluate, admit, discharge, teach, it will be the RN responsibility. so you have to think about are they needing something requiring me to reassess. before you give pain med. you have to assess there pain. after you give the med you have to reassess. so if it is a prn med or a med that requires reassessment. then that is the RNs patient.

Jeeeeesh! What state do you live in? Why even bother being an LPN wherever you are? I constantly assess my patients every time I see them. Administer PO meds, Injections (IM and SC) IV meds (Can't push) All kinds of dsg changes, from bandaids to Wound Vacs. Do admission assessments. Discharges, including pt teaching.

I see these posts all the time. I have to wonder if some of the responses are true or not. If they are then get the hell out of those states, lol.

gutcheck · Jul 26, 2008

I am only speaking in terms of nclex. nclex is a national test. state laws do not apply. for example, some hospitals in my state allow the NA to insert foleys which is a sterile procedure. but, if it were an nclex question, I would get it wrong on the test, because one has to think broadly on the nclex. and accordingly, NAs cannot perform sterile procedures.

I am not saying that you won't encounter LPNs or NAs functioning beyond their "scope" in the work (hospital) setting. I am only answering this question in terms of nclex. nclex doesn't refer to state laws. in some states things may be able to be delegated. but this doesn't apply to nclex. for nclex it is the nurses job to teach, assess, etc., it can't be delegated. the LPN can not assess. doesn't matter how your state allows you to function. like the previous poster said you would have to get more training as an LPN to do blood products, etc.

gutcheck · Jul 26, 2008

sorry this question was in the nclex forum and moved. I was posting my answer only in terms of nclex. now I see it has moved to the lpn forum.

Hopeslayer · Jul 26, 2008

I am only speaking in terms of nclex. nclex is a national test. state laws do not apply. for example, some hospitals in my state allow the NA to insert foleys which is a sterile procedure. but, if it were an nclex question, I would get it wrong on the test, because one has to think broadly on the nclex. and accordingly, NAs cannot perform sterile procedures.
I am not saying that you won't encounter LPNs or NAs functioning beyond their "scope" in the work (hospital) setting. I am only answering this question in terms of nclex. nclex doesn't refer to state laws. in some states things may be able to be delegated. but this doesn't apply to nclex. for nclex it is the nurses job to teach, assess, etc., it can't be delegated. the LPN can not assess. doesn't matter how your state allows you to function. like the previous poster said you would have to get more training as an LPN to do blood products, etc.

http://www.mass.gov/Eeohhs2/docs/dph/regs/244cmr003.pdf

Please read.

gutcheck · Jul 26, 2008

I am glad mass. allows you to function as such.

according to the national council state boards of nursing rns cannot delegate the nursing process. which includes assessing. this however, may differ in state nurse practice acts (such as mass). I am only speaking in terms of nclexrn, and the national board.

https://www.ncsbn.org/Joint_statement.pdf

Fiona59 · Jul 26, 2008

When I read stuff like that I'm glad I'm in the great white north. LPNs in my province, do inital admission assessments (both from the community and transfers from ICU and fresh post-ops). All dressing changes including wound vacs. IV start, med administration. Initiate PCA pumps with a co-sign, change syringes in pca and bags for epis with a co-sign. Co-sign for blood and TPN. All meds (except for a few chemo drugs, which we don't see in my area). Precept and write assessments on PN students. Buddy up with new RNs to get them acclimatized to the unit. Patient education/teaching is a large part of any nurses job. The best diabetes eduator I've listened to was a LPN.

What skills that are restricted are restricted by the health authority employing us.

LPNs can obtain post grad certification in orthopedics/casts, the OR role, dialysis, advanced foot care, and immunizations. The immunization course is more in depth than the one taught in the BScN programme.

I've worked with LPNs who have held all of the above certifications obtained at their own expense and they have been the best all round nurses I've ever met.

You need to determine what the scope of practice is in your state and find an employer who permits you to use it to the full.

pagandeva2000, LPN · Jul 26, 2008

I am glad mass. allows you to function as such.
according to the national council state boards of nursing rns cannot delegate the nursing process. which includes assessing. this however, may differ in state nurse practice acts (such as mass). I am only speaking in terms of nclexrn, and the national board.
https://www.ncsbn.org/Joint_statement.pdf

What is interesting about that is the nursing process is taught in LPN programs. While the LPN is more responsible for the implementation portion of the nursing process, technically, my observations are that we still have to incorporate the nursing process even within the implementation portion of it. For example; the RN has made an assignment and told me that I am responsible for the patient in room 502, I see the MAR has an order for digitalis. I check the calcium, magnesium and potassium levels to see if they are within range to avoid toxicity, do the 5 rights and say, the patient tells me that they have green halos, and their pulse is below 60 bpm. I have gathered data (which is an assessment for the RN) and I cannot administer that medication (the main implementation) and I hold the med, inform the RN and physician and wait for word on what to do next. Based on that, I see that the nursing process, no matter how abbreviated, has to be the framework of practice for both, LPNs and RNs.