LPNs in ICU - page 6

Our hospital recently brought LPNs into ICU, and we are having some trouble adjusting to the change. They were brought in to our units because we have lost so many RNs recently, and have not been... Read More

  1. by   Brownms46
    Originally posted by StrawberryBSN

    I didn't say the plan was an end all to the situation. But instead of repeating past posts of frustration, I thought I'd offer another approach. The med-surg RN's won't be "new" forever...and it will take time to become familiar with CCU care. My suggestion for ER LPN's was becuase it was mentioned the CCU manager wasn't willing to remove them completely. If I HAD to work with an LVN, I'd rather work with one that can "anticipate" what might come next after any given emergent procedure or treatment, as opposed to being ???lost???. They can grab treatment equipment and set it up without me having to do it myself. One less step I have to do.

    A bigger issue here is that there aren't any CCU staff available. It's not like new nurses are jumping at the chance to train as CCU nurses, at least that's what I see in my neck of the woods. I myself don't care to strictly be a CCRN, though I'm occassionally floated to the unit. My suggestion WITH TIME would work, but the unfortunate thing about it all is staff gets burnt-out waiting for the "education" to kick in, let alone sub-standard patient care. I won't get into my frustrations, as I said, this had been addressed over and over again in previous posts. Can't add anymore to what has already be

    S_BSN....I have a hard time believing we are reading the same posts..!! So I guess I will remain by your post!

    Let's try this. Please show me where in the CA nurse practice act, where LVNs are restricted in the way, that you have post!

    PS...LPN's can hang blood, not antibiotics in my state.
    Why? You'll need to ask the State that question.
    In fact..I will even give you the website link to help you out a little

    Last edit by Brownms46 on Aug 3, '02
  2. by   StrawberryBSN
    brownms....i'm sorry you are so confussed...and yes...i have read what few other suggestions exsist on this bb. after many of your posts that you stated other episodes of confussion, i read your suggestion for us rn's to "band together", which is a great and basic concept.

    i couldn't copy and paste the california bvn section that discusses iv therapy/blood transfussions and lpn's, but please help yourself to read section 2542. and 2542.1. i'm sure this will enlighten you. please get back to us and let us know what you've learned and are no longer confussed about.

    again (x3...?) i will state, this is not a fix-all suggestion, just the possibility of the start of a solution i'm not here to debate how the suggestion will not work. i only offered an idea, that could work. its your option to disagree, if you feel the need.

    your statements towards my suggestion remind me of an inflexible person sitting at a meeting waiting for the chance to say "no...this is bs...it won't work!!! bah-humbug!!!! i hope i've simply read your posts wrong. the nursing field does not need more "nothing will work" attitudes. if you are to become a rn, please be more open to mere suggestions, and let's take further discussion that is not related to this post offline.

  3. by   Brownms46
    S_BSN...I won't even comment on the tone of your latest post...but let me say this...there was nothing in MY post meant to demean or belittle you...so please keep the sarcasum to yourself!

    Now...I may have misled you when I posted that link...

    Please check out the following link when you have time...and let me know what you think. It seems the board felt a need to clarify what it meant by" IVFs". I wonder why..?


    And who is "US"???

    OoOh...I almost forgot...I still haven't found the section that states an LVN must have verbal orders "signed off" off by an RN..
    Last edit by Brownms46 on Aug 4, '02
  4. by   StrawberryBSN

    my original response was really to rninicu. i'm sorry you don't get it, sorry you're confused and sorry you think "i'm" being sarcastic. maybe its your tone that is a little sarcastic? at any rate, i can't and won't battle the who, what, where and why of my meager suggestion. what you are refering to has nothing to do with this bb. again, let's talk offline.

  5. by   Brownms46
    :chuckle: I have long since stopped even referring to "your meager suggestion"! I was asking you to clarify a statement you made about what LVN's can, and can't do! It was you who brought it up...not me! So if I ask you to show me where the CA nurse practice acts says what you stated...it has nothing to do with this BB??? I will say it again...I'm totally by your posts! But I will also say again I will stay confused by them! Meaning...don't bother giving me an explanation! Sorry I didn't make myself clearer in stating that previously!!

    Remember YOU did tell me to read the very section of the link "I" posted, and get "back to us"! And it was YOU who stated ..
    ".,You'll need to ask the State that question"
    ... when asked why an LVN could give blood, and not ABX...(which is the most freq use of a secondary line)....and made no sense at all. So I did just that! But I guess...that you didn't expect the response to come back the way it did. If the board meant for LVNs to not give ABXs they would have clearly stated this. Since they decided to modify their original statement..it is clear this was never their intent! And still no evidence of your other statement of LVNs having to have verbal orders signed off by an RN! I dislike reading statements made that the nurse practice acts, says this or that...and it doesn't!

    Now as far as this having nothng to do with this BB...I have NO clue again as to what you're talking about! But again.. don't bother to explain! Because the nurse practice act is pertinent to this BB, and pertinent to this thread! Since RNinICU's original post stated, that it was the nurse practice act in that state, which restricted the LPNs in that unit from doing what they were capable, and trained to do!

    And if you wish to take this offline...go right ahead! But "I" will continue to seek the facts out...no matter that it conflicts with someone's else's version of the truth, and post it on this BB...whenever I see fit to do so! !

    Thank you for the enlightening discussion...however confusing..!
  6. by   RNinICU
    originally posted by strawberrybsn
    rn inicu,

    i've been a lpn and now bsn (12 years). i currently work in the er where there are lpn's who are acls and pals certified. they can start an iv, hang ns & lr ivf's, transfuse blood and im, sq & po meds. they can't do initial assessments, triage, iv antibiotics or pushes. there are also other things they cannot do, but what they can do, they do very well.

    i would not have been comfortable working as a lpn in the ccu, but i think lpn's can work in the ccu. as a rn, i would be more comfortable with an experienced er lpn or an experienced med-surg rn with credentials (acls). i'd start by figuring out and documenting what your lpn's can do per your state laws, versus what your med-surg rn's can do per your hospital protocols, versus what your ccrn's can do per your hospital protocols. (this will make sense in a minute). you'll have to determine how staff is budgeted in your unit. is it by $$, acuity or patient specific scores that determine acuity? why? because one of the reasons lpn's are considered in the ccu is their lower salary. they can fill the shortage need at a cheaper rate. your manager is lpn "friendly" so show her that by creating an alliance with the er, she can float er lpn's to your unit based on your current patient census and acuity's. if your hospital "calls off" med-surg rn staff for low census, find out who's experienced with credentials and float those nurses to other needed departments (i.e. your ccu). your lead or charge would determine day-to-day acuity's based on your manager's direction (she'll need to make guidelines) and determine if staffing an er lpn to pick up patients that need less rn specific care is appropriate. or, if a rn is more suited for your census acutity. since your manager is lpn "friendly" no use in never saying a lpn is appropriate. her guidelines should clearly validate when to staff a lpn or rn from the float or call off pool. and i know, "float" staff can sometimes be burdensome too. but once specific staff is floated to your department, but after time they become familiar and its not so bad.

    this solution has holes to fill in too, but it's a blueprint start. you and your management's decision for lpn's can gain from it. let me know if you need clarity on something i might not have elaborated on -and- if it's considered and works for you!

    i had to think about this a while before i responded. i am also not sure what you are suggesting. i don't see how floating er lpns to icu would help. they would be working under the same restrictions as the lpns currently working in our unit, and would be further hampered by the lack of icu training.. the problem right now is that our acuity has been so high, that there are no patients the lpns can handle without a lot of help from the rns, which just increases our workload. our er staff, even the rns could not handle a lot of our patients. the er staff stabilizes patients, and sends them to us. they do not manage iabps, vents, or dialysis. when they have a vent patient waiting for transfer to us, there is an rt there with the patient at all times. and our rn staffing is so low throughout the house that there is no one else to float into icu.

    the original inquiry was for any suggestions on how to organize care and allow the rns and lpns to support each other, instead of resenting each other. i appreciate your very thoughtful response, but i don't think it can be applied in our unit.
  7. by   mattsmom81
    I agree, RNinICU, and I typed a similar response as yours earlier and got booted offline...LOL!

    ER and ICU are different practice arenas and we're not interchangeable... I did some ER when I was younger, and my ER will always welcome me in a pinch to help out....BUT I'm SURE they would much rather have a CEN with them than me when a multi- trauma rolls through their doors...! LOL!

    My thoracic surgeons fully expect me to be able to set up a 'mini OR' and open a sternotomy under sterile field when necessary. A postop CABG/MVR who develops a coagulopathy and tamponades... cardiogenic shock, IABP, TTP and 6 vasoactive titrating drips...being kept alive with little boluses of Epi while we reopen her and suck out huge clots around her heart...she's in ARDS, I'm pumping blood products in like crazy, she's acidotic in DKA... she's hemmorhaging peripherally and clotting centrally....these are busy, busy patients and need nurses who can see the big picture...now, helpers to task are GREAT here, (keep up with bloodsugars, measuring CT bleeding, controlling peripheral bleeding, help keep track of labwork, etc) ...but as EXTRAS not as part of the staff mix!

    Scary thought to think I might have a patient like the above in RNinICU's hospital....PLUS be responsible for 3 OTHER patients and have 1/2 my nursing team not recognizing how serious this is!

    (And yes, this patient is one of many who MADE IT and is doing OK!! Makes all the hard work worthwhile!!!

    I'm proud to say our metroplex stats just came out...the heart program I work in is rated 2nd in the area..(and we're up against Baylor and Parkland...and the rest of the 'big guys'). We're small but we have great results and it's great to be a part of that!

    But I'd hate to try and give this great care with your staffing dilemna, RNinICU...I've been thinking about you ever since you started this thread and my heart really goes out to you.

    (((HUGS))) Let us know how this all turns out....hope you can convince the big wigs this is not good....if they don't listen they will lose all their good nurses....cuz they won't want to work unsafe with zero support. They'll end up with the nurses who don't care, or don't really recognize the gravity of the situation...Good luck!!!
    Last edit by mattsmom81 on Aug 5, '02
    Well this is another one I will say good luck to,
    The spectrum of care in an ICU is beyond the care and LPN can give, not because they dont want to but just that they dont have the Knowledge base to draw from as an RN does. I dont say this with any sort of resentment towards your LPNs that work in your ICU but I speak from experience . I was an LPN before I was a RN and when I realized the difference I almost wanted to be a LPN again. If they have a base in which they can work from and draw from the resources that are not hostile , then they would be an asset to the area. But if they recieve subtle as you call it actions towards them , then it will only cause a friction in that area.
    One in which does not belong there. Apparently they have the will to jump into such a critical area, and I applaude them for that , but Its like having a 6th finger , its there and wants to help but just doesnt have what is needed to get the job completed on its own behalf.
    Watch thier backs because they are truly the low men on the totem poll
  9. by   MishlB
    STRESSEDLPN.................YOU ROCK!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
  10. by   norinradd
    If a nurse's hands are tied and are unable to perform the job that needs to be done then in my opinion those nurses should not be there. The pt standard of care comes before any other considerations.
    That said... the rules need to be changed. LPNs are not LPNs because they couldn't do the work in an RN program but many times it is because of monetary or time limitations. We accept that in the way it reflects on our salaries. However it is poor utilization of resources to not allow each member of the team to function at the highest level of their competency.
  11. by   Brownms46
    I will say this one last time. No where did RNinICU state the LPNs didn't not have the ability to work in ICU! You ...ITSJUSTMEZOE, may not have had the knowledge base to draw from....but I do! I again will say, and repeat what RNinICU said so well!
    RNinICU - The original inquiry was for any suggestions on how to organize care and allow the RNs and LPNs to support each other, instead of resenting each other

    RNinICU - The two that have come in to the unit are sweet wonderful girls with a lot of knowledge and they work very hard. The real problem is the limitations placed on them In our state LPNs are not allowed to give IV pushes, hang blood, or hang and titrate drips. They cannot measure hemodynamics, and cannot take verbal orders from a physician
    mattsmom - My state of Texas is very liberal with LPN's practice...and many facilities here only limit them in terms of charge capability, so I don't mind LPN's caring for ICU patients at all, (as long as they are competent ICU nurses.)
    Please let's not make this about something it is not! It's not about LPNs having enough knowledge base. It's about the fact that the LPNs in RNinICU's unit, are restricted from doing what they're capable of doing! And because these LPNs are restricted..this places a horrific weight on the RNs in that unit! Because of the restrictions placed on those LPNs in that unit...it's makes the unit a dangerous place to be, for the pts who shouldn't have to have a nurse who is spead between possibly four different pts, because of these restrictions placed on the LPNs in that unit!

    I feel that the LPNs in that unit shouldn't be there, or any other unit, where they're thus restricted. NOT because they're aren't qualified...but because of the restrictions placed on them....nothing more!

    I worked ICU from the time I qraduated from school, and have never had a single RN express any distress after working even one shift with me in an ICU. With every contract I have worked in an ICU, I have been asked to extend, and once extended at least THREE times! It was the RN's in that unit, that decided whether or not they wanted me there! Before giving me a contract, they worked me per diem, and offered the contract after having worked with me! If they hadn't thought I was competent, I wouldn't have been offered the contract. I also wouldn't have been offered $5,000 to come on board permenantly. An offer that was supported by the RNs I worked with.

    Everyone has a right to their own opinion....and you're welcome to yours.... But please...let's not start the age ole arguement, that LPNs are not knowledgeable enough to work in ICU...based on your personal knowledge of what you did or didn't know. I know many LPNs who have no where near the experience, and or knowledge base I have, and I have know just as many who far exceed my own knowledge, and or experience.

    I have racked my brains for a solution to this problem, that would keep the LPNs in their positions. But I can find none! As mattsmom said...the RNs in that unit, don't need helpers. They need nurses who have the ability to perform independently. They don't need to have to monitor hemodys on four pts, and they don't need to manage four vents, or possibly calling four different MDs!! I feel it's just plain wrong, to expect these RNs to operate until this continued pressure!

    The only solution I can see at all, is for this hospital to bring in competent ICU RN travelers, who can take the load off...and give this hospital time to search, and agressively recruit competent ICU RNs! Yes the hospital will say they can't afford this measure. But they also can't afford to lose anymore nurses! As I agree with mattsmom, when she wrote that this is where all of this will evidently lead.
    Last edit by Brownms46 on Aug 5, '02
    I was a LPN and I can tell you that the knowledge base is limited for the spectrum of care in the ICU!, I didnt say that you werent quailified nor would I ever . Dont drag me into this cat fight!
    The limitations placed on a LPN in the ICU restrict the type of care needed in a Critical Care Unit, its nothing against the LPNs at all its the fact that they cant do what needs to be done in the critical care setting, its spectrum of care ,not LACK of care.