dialysis charge nurse in acute care facility an LVN?

MJB2010 · Jan 14, 2013

What is your issue with it? That she is an lvn? Apparently if she has the position it is allowed. Rather than focusing on her degree, maybe see if you can learn something from her. She must have a lot of experience to be in the charge role. Your post came across as sour grapes, sorry if I misread it. But whether or not an LVN is allowed to do something in your state should be easy enough to look up, just curious why you would open a can of worms.

sweetlander2003 · Jan 14, 2013

So i found out that the charge nurse at a LTAC in houston is an LVN. Actually they have two charge nurses but she is one of them and she's only an LVN and she dialyzes there without the charge RN. I thought in acute dialysis LVN's were not allowed?

If the state regulation and the hospital policies allows LVN to be in-charge then there is really no problem with it. I know of many LVNs who are competent in their work more than some RN's so frankly I don't see any issues with it. remember it is not the initials after their names but rather the person him/herself that counts.

jadelpn, LPN, EMT-B · Jan 14, 2013

If one were to look on the BON website of the state that they are in, a number of them talk about competency and facility based scopes of practice. Combined with "LPN's in an expanded role" facilities determine what that role entails. Most BON websites will also reference their stand on LPN's in a charge role with RN's--and that also varies by state and facility. As licensed professionals, it is also clear on most BON regulations that an LPN is responsible for his/her own practice standard--in other words, we do not "work under the license" of an RN. So with all that being said, are you against this arrangement? On what grounds? Obviously this LPN has shown compentency in skills. Are you planning on applying there? Or are you just against the thought of an LPN in that type of role because......

I know in Massachusetts, it is stated in the LPN scope that we can do anything that a facility allows us to do (which dispels the "can't do pushes, can't do transfusions" myth--we can do it but will a facility allow us to do it) and that we show competency in.

nursingisok · Jan 17, 2013

I don't have an issue. I'll be done with my masters degree in less than a year. My issue is that dialysis companies in texas gets away with murder if they can. Literally. I've been working in dialysis a long time and i think they get away with what they can and when they get in trouble they try to blame the nurses.

I don't care that she is an lvn...but I do not think an LVN can ever be charge over any RN's. Thank you!

nursingisok · Jan 17, 2013

thank you all for your comments. I wrote JCAHO so they could investigate into it:)

MJB2010 · Jan 17, 2013

I am not an LVN, but I assure you LVNS can be in charge in many settings in many states. I have met a lot of LPNS who are not only more qualified, but the go to person on the floor. An education is always a good thing to have, but it does not always make someone a better nurse. I am sure we have all seen evidence of that. I have worked kin hospitals and dialysis and the best nurse with the most experience is who should be in charge.

jadelpn, LPN, EMT-B · Jan 18, 2013

Acutally, you must have an issue with it, or you would not be reporting things to JCAHO. In any event, it varies by state. In my state, as I understand it, LPN's can be in charge "over" RN's as in the charge role they are administrative in nature, and do not clinically direct RN's. (although no one has issue it seems with LPN's clinically TEACHING RN's...story for another thread...) Sounds as if you have more of an issue with LPN's that are doing acute dialysis. Depending on the state, LPN's scope of practice (again, just as I understand it) is largely based on competency, and restrictions are those put on them by the facility. But YAY! Good for you for attempting to take someone's job away!! I have also understand that there are dialysis techs....that do all kinds of stuff that I was a bit amazed a non licensed person could do. But not irritated about it enough to start calling agencies about it.

Trauma Columnist · Jan 18, 2013

In an LTACH setting, its not always considered acute care nursing, but rather chronic dialysis. The reason for admission to an LTACH is usually not related to dialysis but other healthcare issues. If the pt meets criteria for ACUTE dialysis needs, they are usually in the hospital. so an LPN as charge at an LTACH HDU wouldnt be so unusual. In IL, we have no LPNs (any longer) in HDUs.

Erikadawn RN · Jan 21, 2013

I have been a dialysis R.N for a year in acutes. In my city Philly I have never seen an Lpn do acutes, probably because hospitals here no longer utilize Lpns in the hospital setting. As far as charge over Rn, I was a Lpn for 3 years and I was the charge over rn plenty of times. Sometimes Lpn charge over me, but if it was a clinical decision then I made the decision. No big deal

NurseRies, BSN, RN · Jan 29, 2013

I don't have an issue. I'll be done with my masters degree in less than a year. My issue is that dialysis companies in texas gets away with murder if they can. Literally. I've been working in dialysis a long time and i think they get away with what they can and when they get in trouble they try to blame the nurses.
I don't care that she is an lvn...but I do not think an LVN can ever be charge over any RN's. Thank you!

I just finished a travel assignment in Texas. I was doing dialysis in LTACHs. They actually allowed a CHHT (dialysis tech) to do acute treatments under the supervision of an RN. We would usually be next door to one another. So maybe the rules in Texas are completely different. Some hospitals did not allow techs, but others did. We floated to 10 faculties. The techs usually had 10 years experience and I would have trusted them with anything! They were better then some of the nurses (as far as dialysis goes). The problem I saw was that, when something went wrong with the treatment, the hospital always blamed the tech and wanted to know why there was a tech in there. One time the patient was moving around and infiltrated their needle. This tech was VERY competent, but the nurse manager banned her from coming back there. Big mistake, a lot of RNs in dialysis there only had 6 months experience and were not nearly as proficient with cannulation.

So anyways, I think that in the dialysis and probably other specialties, we can't always look at the title. The techs teach the RNs in the clinics and the LPNs sometimes know way more! I met an LPN in the cardiac ICU during nursing school that everyone went to for answers.