Flu Clinics-LPNs Should Investigate

[pagandeva2000, LPN]

i have seen many threads of people asking about flu clinics. in fact, i used to do them myself...they are fun, easy work and easy (at least for me), to get. however, due to a situation happening, i had to contact the bon in new york, and was told to be careful, and i want to warn my fellow lpns the same.

the situation for new york is this: lpns can independently administer flu and pneumococcal vaccines for patient-specific orders written by a doctor, physician's assistant or nurse practitioner, because they have (allegedly) assessed the patient prior to writiing the order. however, for non-patient specific or standard orders, the lpn cannot administer them unless they are screened by an rn. now, my hospital did something insane...no flu or pneumococcal vaccine can be administered, no matter if it is patient specific or not to an adult unless it has been screened by an rn, however, they can be freely administered to pediatric patients. this has been going on since i became an lpn in 2006. now, last year, due to acknowledging that the rns were already overworked and stressed, i (and the other lpns) basically took a risk by asking the screening questions, checking to see if they received the vaccine before and if they did and there were no contraindications, the rns and we have basically worked it out that we would give, write a list of the shots we gave and then they would do the screening later. let me also say that we have computerized charting. i would not chart until they did their screening in the computer. but, this year, we have different rns, those that i do not trust, and i started to question my practice and decided not to do this courtesy for them any longer. i told them that until they screen, and place it in the computer, i will not administer the vaccine (this was even before i decided to email the bon that same evening i had the bad feeling).

this dumb rule plagued me, because i felt bad for the rns, and decided to investigate by inquiring with my state bon. their response was that as long as there is a patient specific order placed by a licensed practitioner, we can administer, however, when there is a non-specific order, that an rn must screen because the patient has not been evaluated by a doctor. because we do not have assessment priviledges, we cannot make that judgement independently. this, is what lead me to inquire about my darling flu clinics. i did them every year, and enjoy them immensely. however, there are no doctor's orders, only standard orders. most times, rns were not sent with us, because the flu clinics at this particular agency paid both lpns and rns the same (so, the salary was not attractive for the rns). the bon strongly advised me not to do them, because if something happens, i am working out of my scope of practice...period, because these orders are not patient specific, and that many of these agencies fly under the radar by hiring cheaper nurses to do them. i was floored! in addition, the bon stated that the hospital has the right to make their own rules to limit the lpns, however, they cannot expand our role further than what the state allows (that i was aware of, already). if something happens to a patient while working the flu clinic, and the patient decided that they have a case, the bon will say to you "why didn't you inquire?". i remember while in school, we were told that it is our responsibility to know about our scope of practice-ignorance is not acceptable...i remember that, well!!

i just wanted to warn lpns of this. this may not be the same for your state, but before you take that easy, fun money on, be sure to ask about this, or you may just be putting your license in jeopardy if something happens to a patient. while i do believe that the bon consists of ivory tower nurses that do not relate to real life, i had to compliment this woman for fully and accurately explaining the situation and she answered within 8 hours of my email (i sent it 1am in the morning), and answered my further inquiries within hours.

[akanini, MSN, RN]

Thanks so much for this. I was hoping to do flu shots after passing the Nclex because I did them in school and enjoyed it.

[txspadequeenRN, BSN, RN]

i had heard of this several years ago and think it is ignorant. first thing is you have a blank order to give the flu shot provided that the patient does not have allergies to xyz or had xyz...you cant just be running around giving flu shots without orders from somewhere. i just don't understand this issue but then again i live in a wide open state and have been doing flu clinics rn free now for 10+ years...

[pagandeva2000, LPN]

i had heard of this several years ago and think it is ignorant. first thing is you have a blank order to give the flu shot provided that the patient does not have allergies to xyz or had xyz...you cant just be running around giving flu shots without orders from somewhere. i just don't understand this issue but then again i live in a wide open state and have been doing flu clinics rn free now for 10+ years...

heard of which some time ago; that orders have to be patient specific for lpns or that lpns cannot administer non-specific, or standard orders? just wanted clarity on what you were hearing about, because i want to know how the other states are standing on this issue.

[txspadequeenRN, BSN, RN]

oh sorry that there are some states that require a rn to assess the patient prior to receiving a flu shot. last year my parents got theirs from the pharmacist at the corner drug store out in the car...

heard of which some time ago; that orders have to be patient specific for lpns or that lpns cannot administer non-specific, or standard orders? just wanted clarity on what you were hearing about, because i want to know how the other states are standing on this issue.

[txredheadnurse, BSN, RN]

I was wondering about how the pharmacists were doing this....giving flu shots that is. I assumed they were doing it from standard orders because their job description generally doesn't include doing an assessment above the usual are you allergic to eggs, chicken products, latex, etc.

And I have never had an on site RN supervisor for the 15+ years I have done flu clinics in either a community setting or at a business.

[Gr8Dane]

I have my resume up on Monster and have gotten close to 20 e-mails from different flu shot clinics.

I never responded to any but this does make sense what you are saying and thank you for the post. (Id find doing a flu clinic even for much needed spare $ boring as heck).

[pagandeva2000, LPN]

It might be that each state has their own rules. I am interested in knowing that as well. I was naive...thinking that it was okay when I did them for two years, come to find out that they may just be flying under the radar, but if something happens, the bomb drops on the poor LPN trying to make an extra buck. I do like the flu clinics. I am more of a laid back person who took advantage of that quiet time by reading books while waiting for interested parties. However, though, when most of the customers found out that they had to actually pay, they usually lost interest, anyhow. I would be paid for 8 hours and maybe see 10 people a great deal of the time. Places in my own neighborhood, or areas I had not went shopping in a long time and had an excuse for being there. Oh, well...