LVN/LPN scope in your unit? - page 2

What are the duties and responsibilities of RNs, LP/VNs, and techs or other patient care personnel in you unit? What is safe? For Immediate Release February 20, 2003 ... Read More

  1. by   sanakruz
    Well, I think the testimonials here speak volumes;LPNs are clearly capable.
    This is more political emnity between CNA, a union that only represents RNs and the SEIU, a union that represents other healthcare professionals including RNs, not to mention housekeepers, receptionists etc.
    As I have stated before on this borad, I am a member of SEIU.
    From the reporting that spacenurse presented it looks like the BVNPT is cozying up to big business at the behest of the SEIU Come on!
    My spin on this is that The SEIU is just trying to keep its members gainfully employed.

    The CNA and the SEIU are at odds. Clearly the gloves have come off. The political agenda of both of these labor unions are not helping the big furry mess in our healthcare delivery system.
    Last edit by sanakruz on May 19, '03
  2. by   nursefiggy
    I am an LPN and give all my own meds, hang antibiotics and blood. Our techs give their own heparin boluses and we have heparin pumps for maintenance heparins. I can do just about anything an RN can do except charge full time. I can do relief charge.
  3. by   TRishW
    I work in a long term care facility and my DON says we can administer antibiotics and do the dressing changes. At my last job we weren't allowed to do anything with central lines..where can I find some info on this?
  4. by   smk1
    i am just wondering what the point is in having the 2 levels? (i am a student) it sounds like from a lot of the responses here that lpn's are capable and in many places are doing the "same" job (ie.. procedures etc..) if the lpn scope of practice expands to include most of the suties of an RN then i just am wondering what the point is for still having LPN schools? it seems like the lpn programs could be expanded into RN programs so that these nurses graduate with the same earning and advancement potential as the RN-nurse graduates whom they work alongside. I really hope i am wording this correctly because this is in NO WAY meant to be a flame against RNs or LPNs, I just am a bit confused as to the reason the 2 levels remain if the lpn scope of practice is continually being expanded, and many lpns are performing the "same" job as the RN's. any thoughts on this maybe i am just way off base......
  5. by   nurse dolly
    I am an LVN and have been in dialysis for 8 years. I can do everything our RN does and more ( in fact I have any trained a few who were completely new to dialysis. Yes the laws have changed as far as the way charge goes (back in 1997 when I first started after being there for 1 year I was the charge nurse). Our chrg nurse at present is an LVN ( I had left this clinic for a couple of years) and with out her the place would literally fall apart even the Dr. knows this. I am fixing to take the certification test at the urging of our company so that I can legally do alternate chrg. again. I give all IV medications and do all assessments . when we used to give blood at the clinic I used to hang that and monitor the patients while they recieved it, it was checked by 2 LVN"S because back then we didnt have an RN in the building at all. Now our policy is we do not give blood or blood products at our unit at all this was the company who changed this. LVN's are just as good as RN's some even better!! Some even make damn near what an RN makes!!!!
  6. by   Kathan
    I have 7 LPN's in my unit. Their job role consists of medication administration not included : TPA or IVP meds except for Venofer. The LPN's are instructed on taking care of central venous catheters. I also have 3 PCT's . All have undergone intense 12 week orientation with ongoing inservicing and instruction. They do not give medications since NY state does not permit this. They do not perform catheter care nor initiate treatment with any patients with catheters. PCT's are not trained to assess patients; but they are to report abnormalities. Everyone in the unit is certifide in CPR . Our equipment techs build and prime machines, order stock , etc. They soon will be mandated to maintain a CPR certification. However, the overall responsibility lies on the RN in charge.

    Quote from spacenurse
    What are the duties and responsibilities of RNs, LP/VNs, and techs or other patient care personnel in you unit?
    What is safe?

    For Immediate Release February 20, 2003
    Contact: Charles Idelson, 510-273-2246, or Vicki Bermudez, RN 916-802-3543

    CNA Sues, as Threat to Patient Safety, to Block New Rule Allowing
    LVNs to Administer IV Medications
    RNs Charge LVN Board Covertly Aided Dialysis Industry

    The California Nurses Association will file a lawsuit in Sacramento this afternoon to stop a new
    regulation that substantially expands the clinical role of licensed vocational nurses displacing RNs
    and putting patients at risk.

    In late January, California's Office of Administrative Law (OAL) approved a proposal authorizing LVNs
    to administer intravenous medications to patients in dialysis, blood banks, and other settings. It is
    scheduled to go into effect February 28.

    The regulation was proposed by the Board of Vocational Nurses and Psychiatric Technicians
    (BVNPT) at the request of major dialysis companies and blood banks, and backed by the Service
    Employees International Union (SEIU) which represents LVNs.

    The ruling was seen by many in the health care industry as a foot in the door to extending the LVN
    scope of practice - the legal authority that governs what a health professional can and can not do - to
    other essential medical services now provided by RNs.

    'Dangerous and unwarranted expansion'

    CNA is seeking a temporary restraining order against the BVNPT to block the decision which CNA
    President Kay McVay, RN called a "dangerous and unwarranted expansion of role of LVNs
    regardless of the harm to patient safety."

    Last April, the OAL threw out a similar BVNPT proposal ruling that the board exceeded its authority
    to enlarge the scope of LVN practice, the proposal was "inconsistent" with California law, and that
    patients would be jeopardized.

    None of those concerns were addressed when the BVNPT resubmitted its proposal with only
    perfunctory changes, says CNA. Two factors probably influenced the abrupt U-turn by the OAL,
    according to CNA:

    * Intense political pressure by the health care industry and SEIU. Three major multinational dialysis
    companies that operate in California, for example, Fresenius Medical Care, Gambro Healthcare, and
    DaVita, Inc. combined for $17.3 billion in sales and $373 million in profits in 2000-2001.

    * Back door assistance provided to the dialysis industry by the BVNPT staff.

    In its 2002 Legislative Highlights, the California Dialysis Council, the industry trade association,
    described how "we worked throughout the year" with the "BVN staff (which) suggested the adoption
    of a new set of regulations." Then, "we worked closely with staff at the BVN in an attempt to get a
    favorable position from the Department of Consumer Affairs (the consumer protection agency over
    the BVNPT) and the Office of Administrative Law."

    After the initial proposal was rejected by the OAL, noted the Council report, "We then worked
    closely with the staff at BVN to provide additional information to consider and use in connection with
    the resubmitting of the regulations."

    Dialysis Council: 'We worked closely with the BVN staff'

    "We sent out a request that all CDC members provide information to the BVN," the CDC reported.
    "We have been working closely with the BVN staff in an effort to be sure they have sufficient
    information and support to maximize our potential for success on this important issue."

    "It is scandalous and outrageous," said McVay, "that an agency created to protect consumers, the
    BVN, would be in open collusion with large corporate health care corporations that make greater
    profits by employing lesser skilled staff."

    Notably, in its first ruling last April, the OAL had held that "consumer protection is an issue of the
    utmost importance when administering intravenous therapy. Hemodialysis medications are
    circulated rapidly through the patient's system and may cause potentially lethal reactions."

    Yet nothing had changed in the BVNPT proposal to address that concern, says McVay.
    Growing numbers of patients receive medication through IVs, "which requires a substantial amount
    of clinical skill and pharmacological knowledge and the continual monitoring of its effect on the

    "Dialysis patients are seriously compromised, often with complications of diabetes, severe cardiac
    disease and other serious ailments. The administration of medications through an IV involves
    pumping them directly into the vein or through a catheter in the neck directly into the heart - and
    mistakes are irreversible," McVay said.

    McVay noted that RNs are only permitted to administer medications under an order from a physician
    and only after conducting a direct physical assessment of the patient.

    An LVN, who has far less scientific knowledge and clinical expertise than an RN and in all other
    settings can only work under the direct supervision of an RN, will be permitted to administer
    medications as long as an RN is in the "immediate vicinity." The regulation does not define
    "immediate vicinity" leaving it to the company to determine. "An RN may never see the patient before
    the medication is given by the LVN," said McVay.

    "Again, a consumer agency, the BVNPT, with the approval of the DCA and the OAL, are allowing the
    health care corporations to set all the parameters for a crucial patient care decision - and they are
    doing so through a regulation rather than the public legislative process," McVay said.

    In minutes of its meetings, the Dialysis Council noted that it sought to carry out the change through
    the regulatory process rather than the legislature due to the vocal opposition of CNA. "Our best
    chance for success is via this route as Michael (Arnold, the CNC Legislative Advocate) feels we will
    have little chance if we face off with the CNA in the legislature," state the June 21, 2002 CDC

    Most 'egregious example of regulatory abuse'

    "Sweeping changes in scope of practice that have such a significant effect on the quality of patient
    care should only occur through the legislature, the arena where the public can directly participate in
    hearings and hold their legislators accountable," said McVay.

    That is also one of the points raised in the CNA lawsuit. CNA charges the BVNPT lacks legal
    authority to promote the regulation which violates all existing laws and repudiates the legislative
    history of statutes governing LVN practice in California. "There couldn't be a more egregious example
    of regulatory abuse," McVay said.

    SEIU: 'the proposed regulation is necessary'

    While CNA fought the proposal, SEIU campaigned for the ruling in testimony by the SEIU Nurse
    Alliance and a legal analysis by the SEIU attorney who wrote that since the duties of LVNs in those
    settings were "not covered by any other statute or regulation ...the proposed regulation is

    In its October 18 minutes, the CDC, the industry council, also noted the contrast. "The California
    BRN (Board of Registered Nursing) and CNA both still oppose the concept. However, the Service
    Employees International Union, which is trying to organize LVNs, may be supportive."

    "Eroding RN scope of practice has long been a major goal of the health care industry," said McVay.
    "Now, regrettably, they have the assistance of a major union and a state agency whose mission is
    to protect public safety."

    The lawsuit will be filed in State Superior Court in Sacramento.

    (Copies of the CDC minutes and the letter from the SEIU attorney to the BVNPT in support of the
    proposed regulation are available to the media by calling 510-273-2251.)
  7. by   ondegoRN
    Quote from babs_rn
    Our LPNs can do anything the RNs can do except charge and give blood products. Our techs cannot touch the caths, do assessments (other than v/s), draw up or give heparin, make the baths. All they can do is stick, pull needles, monitor, and give saline boluses (co-signed, of course).

    Are the LPN's in your clinics limited by GA law or by the facility.
  8. by   Farkinott
    I am an RN and have been watching these developments from across the Pacific with a keen eye. I work in a dialysis unit that employed an "Endorsed Enrolled Nurse" who seems to have the skills and license to do what your LVN's do. This person is the only nurse of that "grade" employed in the last 2 yrs or so. I think this person ws originally employed as "cheaper" labour. I think due to accountability issues this person is the first and last Enrolled Nurse employed for haemodyialisis.
    I understand that LVN's ( I am not familiar with your USA terms and responsibilties) are similar to the endorsed enrolled nurses here. They are able, (or allowed) to do most things apart from assess the pt and develop a nursing care plan and at all times must work under the supervision of an RN.
    I was an enrolled nurse so i I am fully aware of how emotional the discussion can get when talking about the capabilities of differing levels of nurses and what they can and cannot do (whether within the law and without).
    In Australia a licenced nurse is responsible for their own practice, but in reality if there are any "stuff ups", you will be brought to account as, as an RN, you are "supervising" the lesser qualified nurses, whether "remotely" or by your physical presence.
    The experiment of lesser qualified nurses where I am employed has not worked and I fear for the future when the bean counters attempt to determine care. They will try to minimise RNs and increase the lesser qualified people's numbers to minimise the expenses that dialysis units, whether public or privately funded, pay.
    Companies which supply dialysis products are now providing (free of charge) Registered Nurses to home train peritoneal dialysis patients, free of charge.
    I think this may be a step towards bypassing good nursing care and marketing an educational product direct to renal physicians/consultants. The physicians won't need to rely on you and me to provide a training service. Eventually nurses like you and me will have to pick up the failures as I am sure the training role will go to technicians, and with their narrow minded service delivery, will be unable to provide the complex care and coodination of services that nurses can.
    At present all of my colleagues (bar one) are RNs. Dialysis patients are complex and require an expertise of care that can only truly (and wholistically) be provided by an RN.
    I am sure that the time has come to draw a line in the sand in regards to the nursing care provided to dialysis clients.

    In closing, imagine the scenario:- 12 dialysis clients, 1 Rn, 4 LVNs (or in the future), 4 technicians.
    Can the RN assess and prescribe a plan of care for 12 patients in a truly comprehensive and timely manner? I think not. An RN is the only person legally permitted to presribe a plan of care. Thank goodness that, at my workplace, only RNs are allowed to work!

    The whole scenario can get very scary when you start stripping back the rhetoric and start dealing with the realities!

    "Eternal vigilance"......................didn't George say that?!

    No disrepect to nurses other than RNs, but we need to be vigilant of large companies influencing leislative bodie!
    Be Active!
    Ciao :uhoh21: