Patient acuity staffing mix

Nurses General Nursing

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I am a charge nurse in an LTAC, and in our facility, the LPN must take six patients - but are supposed to be the easiest six on the unit. I am looking for an acuity tool to quickly make assignments based on the acuity or time patients require that takes into account activities such as dressing changes, bolus or tube feeding, toileting, etc. so that my LPNs are not overwhelmed and the RNs are sitting around unproductive.

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I think it's unfair to the RNs to make it so only the LPN gets the "easiest" patients. But I understand the scope of practice piece so I get why it needs to be done that way.

I guess anything with central lines, TPN, IV push, blood, trachs etc etc. I guess anything outside of the scope of an LPN should impact what an easy patient is.

Extensive dressing changes shouldn't be a problem for LPN,I've worked with some wound care specialist nurses who were LPN.

Why not have a team nursing model when an LPN is on so they can work with an RN?

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That is also my thought--team nursing. One med nurse, one treatment nurse, one charge nurse, one float nurse....whatever you need to have happen then a nurse for each item.

If it is LTC, I am not sure that you have patients who have needs that are not within an LPN scope. However, if that is not the case, then of course the RN's would have to do the treatments for these residents.

Most BON websites have acuity tools. I would look on your state site and see if that is the case.

Another thought is to use your staff to their strengths. If a strong LPN can take care of any 6 residents, then by all means, make that assignment. Ask for their input. Some of your more experienced LPN's can perhaps take a number of residents "in their sleep" they are so familiary with the resident.

Seemingly, this has come from comments regarding LPN's workload, with "RN's sitting around" situation. Maybe even a staff meeting to brainstorm ideas for assignments?

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Specializes in Med/Surg, LTACH, LTC, Home Health.

I think he said LTAC, instead of LTC. I had to reread the post to understand why there was an issue. But I see now. LTAC is like a stable ICU....at least the one I worked in was. It could be a nightmare most nights with the vents, IV piggybacks, wound care, isolations, etc. I said stable but we had more codes there during the summer that i did agency at the facility than I've been a part of in my entire career!

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Specializes in Med/Surg, LTACH, LTC, Home Health.
I think it's unfair to the RNs to make it so only the LPN gets the "easiest" patients. But I understand the scope of practice piece so I get why it needs to be done that way.

I guess anything with central lines, TPN, IV push, blood, trachs etc etc. I guess anything outside of the scope of an LPN should impact what an easy patient is.

Extensive dressing changes shouldn't be a problem for LPN,I've worked with some wound care specialist nurses who were LPN.

Why not have a team nursing model when an LPN is on so they can work with an RN?

Where I work, LPNs do all of this. That's how I learned before I became an RN. The LTAC that I worked at here had LPNs working those patients like a real champ! But I do know every area is different and the issue with the blood requires at least one RN on the case...again the actual task varies by the facilites' interpretation of the nursing law for the state. I was surprised that at one hospital as an LPN, I only had to have an RN check the blood with me; another: the RN only had to spike the bag; and yet another, the RN had to do EVERYTHING for the first 15 minutes. Three different facility interpretations for the same state.

LTAC requires skills as a nurse to even be there. If the LPNs are there, I'm guessing they are fully competent to be there and if team nursing is not an option, I would suggest dividing the patient load up evenly and fairly, with the understanding that LPN X has this RN-related task going on with Patient X and will need one of the RNs to step for a moment and handle it.

Just a suggestion.....

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Where I work, LPNs do all of this. That's how I learned before I became an RN. The LTAC that I worked at here had LPNs working those patients like a real champ! But I do know every area is different and the issue with the blood requires at least one RN on the case...again the actual task varies by the facilites' interpretation of the nursing law for the state. I was surprised that at one hospital as an LPN, I only had to have an RN check the blood with me; another: the RN only had to spike the bag; and yet another, the RN had to do EVERYTHING for the first 15 minutes. Three different facility interpretations for the same state.

LTAC requires skills as a nurse to even be there. If the LPNs are there, I'm guessing they are fully competent to be there and if team nursing is not an option, I would suggest dividing the patient load up evenly and fairly, with the understanding that LPN X has this RN-related task going on with Patient X and will need one of the RNs to step for a moment and handle it.

Just a suggestion.....

Agreed with all the different policies and laws regarding LPN scope, but I still think if an LPN is involved in this floor a team nursing model would be the most beneficial

. Some RNs might get upset when the LPN is always given the lightest load. This could be avoided if the LPN was working one shift, the RN would join them and have a combined patient load. Especially in LTAC where there's so much you probably need to cosign or at least double check or have 2 nurses involved in (blood transfusion) I think it could work well.

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