LPN's in CCU, a vent

I've looked around and didn't see a thread discussing this problem so I started my own. Excuse me if it's been done to death. I just need to vent. :stone My anger is directed at the hospital not LPN's...so please read this with that thought in mind.

I work in a medium sized CCU in a community hospital. We have RN's and LPN's working in the unit. I'm about to lose my cotton picking mind. We had a rough night last night...scratch that...every night is rough. I've never worked with LPN's before. I had no clue what their scope of practice was. I've come to the conclusion that LPN's in a unit creates incredible stress for the RN's. Their limited scope of practice leaves the RN's with ALL the admissions, ALL the sickest pts, ALL the codes, ALL the PCI's, plus covering the desk which monitors tele's from the tele floor.....AAAARGH! Last night there were 2 RN's and 3 LPN's. One RN had the desk and I was the only RN actually working in the unit. I had the 2 sickest pts plus admitted a code from the tele floor, plus covered the LPN's iv meds, (all ICU pts are on IV drugs...what the heck is up with having nurses on board who cant give iv drugs??) transfusions...then a PCI was called. Give me a freaking break!

OK, vent over. :uhoh21:

Yes, I think you need to look up your state's scope of practice for LPNs. It is NOT appropriate for them to work in ICUS as that requires frequent assessment which they are NOT allowed to do. So, YES, that puts incredible stress on the already overworked RN to have to validate their assessments plus give half of their meds or more than half.

Maybe this should be reported to your state nursing association, board of nursing, labor board, etc.

Yes, I think you need to look up your state's scope of practice for LPNs. It is NOT appropriate for them to work in ICUS as that requires frequent assessment which they are NOT allowed to do. So, YES, that puts incredible stress on the already overworked RN to have to validate their assessments plus give half of their meds or more than half.

Maybe this should be reported to your state nursing association, board of nursing, labor board, etc.

Not so true. I work ICU and CCU from time to time, and our LPNs are very valuable members to both areas. An LPN can give meds--PO, IM, SQ, rectal, via tubes, and IV ATBs if IV cert.. An LPN can do an assessment on a patient, as long as one has been done by an RN Q12H. An LPN can do the baths, vitals,TLC, etc.... Our LPNs do not take a team, per se; they do help out tremendously to all teams. I know it might not be like this everywhere, but I just want to let the readers know that there are some places that LPNs can help tremendously. I do think however that the original poster's situation should be looked into. That does sound unsafe and unorganized.

My unit currently has 2 LPNs. I think they are wonderful. Yes, they are limited in what they can do, but that doesn't not have to stress you. Generally, if there is a drip to be tirated, before each titration, the LPN and I discuss the goal to be achieved with the titration. They know the patient better than I do as they are the one doing the on-going assessments and cares. It is rare that I need to redirect their thinking/rational about what needs to be done. And then I make the needed adjustments and the LPN knows what to expect from the titration. Questions/concerns are addressed immediately when they arise. Ultimely, my decisons are the ones acted on.

Where I'm at we do just about every thing. Start drips, blood, shock, codes and so on. Last nite I had a pt on diprivan and neo. I make all the decisions on titration and so on. No RN needed here, nut we do have one the on hand if needed, but I can handle p[retty much anything without the RNs input.

Well, covering all the iv meds/transfusions of the 6 pts cared for by the LPN's.......

As someone else pointed out, the ability of an LPN is governed by the local Nurse Practice Act. Our LPNs (both are IV certified) can (and do) give many IV meds (they can't titrate pressors/dilators, insulin drips, give certain cardiac/HTN IV drugs or give blood products). They are only limited by our state's NPA and our facility policy.

If your state does not allow any IV meds by LPNs, has anyone gone to administration about the practicality (sp) of LPNs in a unit?

As someone else pointed out, the ability of an LPN is governed by the local Nurse Practice Act. Our LPNs (both are IV certified) can (and do) give many IV meds (they can't titrate pressors/dilators, insulin drips, give certain cardiac/HTN IV drugs or give blood products). They are only limited by our state's NPA and our facility policy.

If your state does not allow any IV meds by LPNs, has anyone gone to administration about the practicality (sp) of LPNs in a unit?

We titrate them kind of drugs where I am in NC.

not so true. i work icu and ccu from time to time, and our lpns are very valuable members to both areas. an lpn can give meds--po, im, sq, rectal, via tubes, and iv atbs if iv cert.. an lpn can do an assessment on a patient, as long as one has been done by an rn q12h. an lpn can do the baths, vitals,tlc, etc.... our lpns do not take a team, per se; they do help out tremendously to all teams. i know it might not be like this everywhere, but i just want to let the readers know that there are some places that lpns can help tremendously. i do think however that the original poster's situation should be looked into. that does sound unsafe and unorganized.

so in a 12 hour shift, the rn has to assess her own two patients (the sickest on the unit), assess all of the other patients in the unit once, the iv meds for the lpn and be responsible for the monitors of the lpn's patients. so there's one rn working the unit, and 3 lpns. the one rn does 8 assessments, watches 8 monitors and passes out the iv meds for 8 patients. as we all know, it isn't just a matter of waltzing into that patient's room and hanging the med or squirting the push into the tubing -- you have to understand what you're giving, why the patient is getting it, whether that dose is appropriate for that patient in that situation, and you have to monitor for results.

i agree that in some situations, lpns can help tremendously. i don't believe that the intensive care setting is one of those places -- at least not in the ratio that the op is dealing with.

ruby

Get all your nurses together and approach your managers to see if you can have special policies in your unit...this is what we did.

Check with your BON to see how your state limits them. If its just hospital policy limiting them, you can possibly change that with a unit specific policy of your own.

On the general wards of my hospital, the policy was the LVN could not hang blood, could not admit, push IV drugs, yada yada. BUT we convinced our powers that be that it was not necessary to limit h competent , certified critical care nurses who happen to be LPN's. We won, and policy allows them to do everything now (except charge), once they have been certified competent by our education dept. :)