I am the charge RN in an innercity 40 bed ER that averages 250-300 patients per day. Many are hight acuity, telemetry or ICU patients since this hospital is a large heart - lung transplant center. I know many hospitals will not hire LVNs to work in the ER, but we do. We run a hefty "fast-track" business and the patients on that wing were appropriate for the scope of practice for an LVN staff and one NP. When we remodeled, someone had the bright idea to cancel the fast track idea and mix all patients into the one big new ER. The LVNs came with it. Initially the LVNs were dispersed equally on each shift, but over the last two years as bid for shift came around all the LVNs have come to nights. Now on each night shift we are down to 2 RNs and 3-4 LVNs. Since one RN must be the charge nurse and the other RN must do triage that leaves all LVNs to care for patients. It is not unusual for our ER to be giving three cardiac meds/drips at the same time or cardiac push meds at the same time. What a nightmare it has become when I am trying to go to each room and monitor the cardiac patients and their meds as well as run the department. We are a teaching hospital as well so I spend a great deal of my shift making sure the newbie residents don't kill any patients. In this week's charge nurse meeting our nurse manager asked that RNs cosign all LVN charts on tele and ICU patients. She says that their scope of practice doesn't cover these high acuity patients and that the RN should become familiar with these patients enough that we are comfortable with the care being given by the LVN and give all the cardiac meds and sign off on the chart stating that appropriate care was given and we agree with the LVNs care. I AM FURIOUS!!!!!! On the day shift where the staff is all RN with the exception of one LVN, this may not be a problem, but on nights this essentially means that I must essentailly take care of all the cardiac patients, ICU patients, run the department, arrange transfers to other hospitals, facilitate department flow, guard patients against dangerous residents and push all cardiac meds and manage all cardiac drip meds. AM I CRAZY, OR HAS MY NURSE MANAGER JUST HAD A TIA????? Would this bother you guys? Let me know what you think.
I am the charge RN in an innercity 40 bed ER that averages 250-300 patients per day. Many are hight acuity, telemetry or ICU patients since this hospital is a large heart - lung transplant center. I know many hospitals will not hire LVNs to work in the ER, but we do. We run a hefty "fast-track" business and the patients on that wing were appropriate for the scope of practice for an LVN staff and one NP. When we remodeled, someone had the bright idea to cancel the fast track idea and mix all patients into the one big new ER. The LVNs came with it. Initially the LVNs were dispersed equally on each shift, but over the last two years as bid for shift came around all the LVNs have come to nights. Now on each night shift we are down to 2 RNs and 3-4 LVNs. Since one RN must be the charge nurse and the other RN must do triage that leaves all LVNs to care for patients. It is not unusual for our ER to be giving three cardiac meds/drips at the same time or cardiac push meds at the same time. What a nightmare it has become when I am trying to go to each room and monitor the cardiac patients and their meds as well as run the department. We are a teaching hospital as well so I spend a great deal of my shift making sure the newbie residents don't kill any patients. In this week's charge nurse meeting our nurse manager asked that RNs cosign all LVN charts on tele and ICU patients. She says that their scope of practice doesn't cover these high acuity patients and that the RN should become familiar with these patients enough that we are comfortable with the care being given by the LVN and give all the cardiac meds and sign off on the chart stating that appropriate care was given and we agree with the LVNs care. 
I AM FURIOUS!!!!!! On the day shift where the staff is all RN with the exception of one LVN, this may not be a problem, but on nights this essentially means that I must essentailly take care of all the cardiac patients, ICU patients, run the department, arrange transfers to other hospitals, facilitate department flow, guard patients against dangerous residents and push all cardiac meds and manage all cardiac drip meds. AM I CRAZY, OR HAS MY NURSE MANAGER JUST HAD A TIA????? Would this bother you guys? Let me know what you think.