Do You Have LPN's in your PICU?

fergus51 · Aug 8, 2004

No................

needdynurse · Aug 15, 2004

If not -why not,so I'm asking why so many defib's? instead of precordial thump

Question :rolleyes:

Pediatric Critical Care Columnist · Aug 17, 2004

Hi everyone! Thanks for taking the time to answer. I am just wondering if you have LPN's on your PICU.
The reason I am asking was because I was watching a coverage thing on tv today and they were in the PICU...the PICU had a LPN working and I was just wondering how common that is.
Thanks again!

No we don't have any LPNs working in our PICU and will likely never have. Our jobs are heavily skill-dependent and LPNs don't have the skill set needed.

doozie12 · Jan 21, 2005

Yes we have Lpn's in our picu and Nicu and I have worked bouth ends and yes I do have the skills to work there. Making that statement lpns don't have the skills is to broard I have met some RNs that didn't have the skills needed to be on a regular floor nor would I want them to be my nurse. Every nurse is capable they just need to be orintated.

xmaxiex · Jan 21, 2005

Where do RN's attain their skill sets for PICU? In school ? I didn't realize that you aquired these specific skills in school .

Pediatric Critical Care Columnist · Jan 22, 2005

In Alberta, the following common skills required in our PICU are not within the scope of practice of LPNs:

IV drug administration (particularly cytotoxics and anaesthetic agents)

IV starts

short-term central line care

arterial and intracardiac line care

care of the patient with an open sternum

administration and monitoring of vasoactive drugs

monitoring and care of the patient on ECMO

endotracheal tube suctioning and maintenance

monitoring and care of intraventricular drains

monitoring and care of intracranial pressure monitoring devices

bladder catheterization

small bowel feeding tube placement

and probably several others I can't think of off the top of my head.

Assessment skills are also extremely important. The depth of assessment taught to LPNs just isn't the same.

Many of these skills are not acquired in nursing school but through a lengthy orientation to PICU. There are courses available across the continent for nurses wishing to learn the theoretical and practical skills required to care for the critically ill child, but the individual will still require an orientation and gradual introduction to more complex skills.

Fiona59 · Jan 22, 2005

I'm an LPN who worked post partum, (and ante-partum until it became an all RN unit) and can honestly say I've never had the desire to work NICU. The students' I trained with all wanted to work with babies for some reason. But after working, I've never ran into any of them in maternity. The assessment training that Alberta LPN's obtain is superior to that offered in many provinces. I've seen it on this site that BC LPN's have to retake Physical Assessment to obtain an Alberta License. I have assessed many newborns in the "regular" nursery when an LPN has been on coverage for an RN, the only thing we couldn't do was the administration of Vit. K because we can not perform an IM on anyone under 5yo. (Provincial Regulation)

As, Jan says many of the skills are not in our scope of practice. However, having said that, Jan, LPN's in Alberta can take the IV start course offered at GMCC, however most employers will not let us utilize that skill. IV meds were added to our scope of practice last November, and the youngest person I've ever catheterized was a baby girl at the Children's Hospital when I was a student.

The rest are things I have no desire to ever do. This wasn't meant to start a "war" but to let you know what we are capable. of.

fergus51 · Jan 22, 2005

It's important to note there is a HUGE difference between Canada and the US in this matter. In my experience American LPNs can do a lot more in the hospital setting, but even here I don't see them in NICU or PICU. Peds or special care nursery will use them, but not the intensive care areas.

mac23 · Jan 22, 2005

I don't think this was meant as a knock on LPN's. In our hospital we have a few that have been there for 15+ years but they don't hire LPN's to the unit anymore. For us, it's because of hospital policies, scope of practice issues that say an RN has to do certain things. It varies from state to state. For example in my state an Rn has to do all IV meds, has to do all initial assessments (so even though our LPN's were perfectly capable of doing those things, an RN had to come behind them and do it again), if an LPN was assigned to the patient an RN had to be assigned to that patient after the LPN so that two LPN's couldn't be assigned to the same patient back to back, an RN had to hang blood etc etc.

I've done both NICU and PICU and often these kids can turn on a dime and need IV meds, blood etc stat. I could see it being an issue if an LPN is assigned to a crashing patient and can't do those things ( hospital won't allow it; not they aren't capable) it could be a problem. Just my observations.

**SKM-NURSIEPOOH, BSN, RN** · Jan 22, 2005

i don't think this was meant as a knock on lpn's. in our hospital we have a few that have been there for 15+ years but they don't hire lpn's to the unit anymore. for us, it's because of hospital policies, scope of practice issues that say an rn has to do certain things. it varies from state to state. for example in my state an rn has to do all iv meds, has to do all initial assessments (so even though our lpn's were perfectly capable of doing those things, an rn had to come behind them and do it again), if an lpn was assigned to the patient an rn had to be assigned to that patient after the lpn so that two lpn's couldn't be assigned to the same patient back to back, an rn had to hang blood etc etc.
i've done both nicu and picu and often these kids can turn on a dime and need iv meds, blood etc stat. i could see it being an issue if an lpn is assigned to a crashing patient and can't do those things (hospital won't allow it; not they aren't capable) it could be a problem. just my observations.

lpn scope of practice unfortunately varies from state to state...but many will allow lpns to do more advance nursing procedures as long as said lpns have been educated & oriented to those advance tasks as well as being directly supervised by (either a rn or md) while doing them. many sbon have left lpn's scope of practice vague in order to make allowances as needed....institutions who want to keep jacho certification/accreditation, for example, will follow suggested regulations from that entity & write policies accordingly. i'm don't quite follow the rationale for having uaps in the units but not lpns. seems like in this day & age of the *nursing shortage*, hospital would take another look at the large, untapped lpn pool of nurses. perhaps the 'shortage' isn't that bad yet, but one day soon, lpns may make a come back in the units.......heck....lpns are already slowly making a come back in acute/hospital settings...it'll only be a matter of time.

cheers!

moe

xmaxiex · Jan 23, 2005

Oh definately no dispute here . I was curious because as an LPN who is persuing her RN I would eventually like to go into NICU and was wondering what skills were required that were different .