ER Nurses...RN's only?

We have LPNs on practically all shifts in our small community hospital ER. They generally function well and can do just about everything the RN can do (with a few exceptions such as access central lines or ports, hang IV's with magnesium, dopamine, etc). We cosign their assessments (just a formality). The NC-BON doesn't really have clear standards as to where an LPN can or cannot work, so it is legal, even though it is questionable practice. It just depends on your facility's policies. In my facility, the LPN cannot be left "alone" in the ER - the RN has to be present at all times. As to liability for the RN, I am not sure about this. If an incident were to occur (in which a patient is harmed by actions of the LPN), I do not know if the RN would also be implicated.

I can't address anything legal, but I can tell you NYS has a very stringent scope for LPN's and my rural CAH uses them everywhere, including the ED. There's always a supervisory RN on, but she (or he) covers the hospital and SNF as well.

LPN's are highly used in this rural community.

Our ER is staffed with 5 nurses per shift and all are RNs so if an LPN is pulled to help cover the unit they are never alone. We've been told that an LPN cannot assess the patient but the patient is assessed initially by the triage nurse who is an RN so I don't think this is an issue. Our med-surg/telemetry unit is usually the unit we have to pull from and approximately 30% of the nurses are LPN's so we don't always have the luxury to be able to demand that an RN be the one that goes to the ER. It's just frustrating when you are told you "can't leave the ER staffed with only 4 nurses" but then you are told you can't let them use an LPN when that is sometimes the only option on weekends or holidays when part-timers aren't available. Then you're told by another person that "sometimes you just have to do the best you can and if all you can send is an LPN then they can either use the LPN or be short-staffed." I don't know of any specific policies that address this issue in our facility except they will not hire an LPN for an ER staff position. Thanks for the replies and look forward to more...

CEH