RN's who cover an LPN - page 2
Just curious, does anyone out there who covers LPNs do you get paid extra for doing so? At our hospital we don't and when you do you actually have double the patients.... Read More
Oct 31, '06Quote from jill48couldn't have said it better. you hit the nail on the head. that's why I am going back to school, too.But lets say I have a patient who needs a blood transfustion. I am the one who looked at the H&H and found the results. I am the one who called the doctor and got the order for the type and crossmatch. I am the one who obtained permission from either the patient or his family. I am the one who starts and IV with an 18 guage needle and gets the saline going. I am the one who goes to the blood bank and gets the blood. I find an RN to check all the info with me against the orders and all that stuff. The RN comes in, starts the blood, and leaves me to do the million and a half vital signs. I'm not complaining, that is just the way it is. Which is why I am back in school, so I can just do it myself.
Nov 2, '06Quote from ktwlpnI've worked in acute care in several different hospitals-the rn's never got any additional pay for covering lpn's...If you feel that you "actually have double the patients" then you don't have a very good understanding of the lpn's scope of practice and you also maybe need to work on your communication skills. I have nearly always developed excellent working relationships with the rn's I have worked with-both in a team setting and primary care.There was very little the rn's ever actually had to do for my patients-even if I needed an IV push that I could not administer I always gathered the needed supplies.THe last time I worked in med -surg the rn's had to do an assessment at the beginning of the shift (no note-the flow sheet was sufficient) A few years ago an rn had to assess each patient once in 24 hours so the districts were divided up accordingly during each 24 hours.Of course every state is different as is every facility...I hope you can learn to appreciate the abilites of all of your co-workers.
I don't know what I said that made anyone think that I did not appreciate the hard work that an LPN does. I am sorry for any misunderstanding. I have worked and learned from some very good LPN's who do a very good job. I was simply asking a question. I may not have asked in the best possible way but it was meant to be a innocent question. I know that several of my co-workers don't like the fact that they cover an LPN. There are some very good LPN's like yourself that does get all the supplies needed etc., but there are some that don't. The RN's on my floor have to know what is going on with their patients plus those of the LPN. They co-sign the charts and there license is on the line just like the LPN's. I will be the first to tell you are anyone, that I learned a lot of skills from an LPN and I use them very day.
Nov 2, '06I will admit, as a new RN grad, it took awhile for me to learn how to effectively collaborate and cover the LPNs, with whom I work. There really wasn't much I learned in school about this, and orientation at work just gave me the basics. I work on a post-surgical/ortho floor with a lot of medicine overflow patients. We get everything from Neurosurgery to ENT, as well.
Nearing the end of my first year, I feel as if I am very comfortable collaborating effectively with my colleagues. Some of the things that help me the most are:
1) We are all nurses, except the scope of an RN is a bit different than that of an LPN, especially depending on the policy at the institution. We are both providing patient care.
2) As you get to know your co-workers, you get comfortable with some and learn to be a little more careful with others. There are some RNs that I dread following, as well.
3) We are not assigned patients based on acuity. If I am covering an LPN who has a patient who has a central line, on a heparin drip, needing IVP morphine almost every hour, who may need the physician called many times throughout the night, then I may switch patients with the LPN, since I may be in the room more often, anyway. Plus, I have noticed that when I am in a room performing tasks for a patient that I am covering, the patient is usually asking me to help him or her with other things.
4) If I am extremely busy, and an LPN needs me to do something like administer an IVP med or call an MD for an issue (ultimately resulting in a telephone order which the RN, not the LPN, must write), then I may ask the LPN if he or she would mind doing something else for me while I do that (a fingerstick, vitals, pass a med, etc). This greatly relieves my pile of things to do and allows me the time to get it done for them pretty quickly. I would prefer if this was offered to me, but it is not always, and it is my responsibility to speak up, and is very effective for us both.
5) If the patient is stable, and has been here for awhile, and the LPN knows this patient well, then I do not follow the LPN and conduct a full assessment. I realize that the LPN, as a nurse, is very competent to do this.
6) I do not believe that we should pit ourselves against each other as an RN vs LPN hierarchy, that seems to exist in some places. Speaking to each other in a non condescending tone or manner always is essential. I have personally witnessed some RNs talking down or being bossy, when in fact, it was the approach that was wrong. This eventually causes a rift, and is detrimental to the work environment and to patient care, in general.
7) I hear the RNs saying all the time, "I have to protect my license." But, the LPN has a license to protect, too. We are collaborators, the RN is not the one with final say.
8) One of the great skills of this profession is learning how we speak to people, whether it be our patients, the doctors, family members, pharmacists, or to our immediate co-workers.
9) LPNs have taught me a thing or two about nursing. I value their expertise and appreciate their practice.
10) It is all about making it work in your workplace. If the coverage gets too difficult, then this needs to be addressed to the superviser and the charge nurse, so that staff members can work together to devise solutions. If one is silent and harboring resentment, then it will eventually be made known.
Nov 2, '06When I come on shift, I get my report, check my e-mar for meds and proceed to care for the 6 - 8 patients that I'm assigned. There are either one or two RNs on shift with me. One of them is my "resource nurse" If I have any IV push meds, blood draws I have my resource nurse do it for me and I may do something for them if they need me to. I do all my own charting, 24 hr chart checks, co-sign orders with the RN etc. The RNs here know what to expect from the LPNs and know what we can and can not do. If the LPNs have questions or need to have certain things done by an RN, we just ask...it's all a team effort. I basically just do my own thing and if there is something I need an RN for, I find them.
Nov 2, '06sorry , but does everyone know about their states' nurse practice act????? IT IS OUR JOB as RNs to supervise LPNs!!!!
I actually work as a team with the LPN that I work with, and find very little reason (we are not in a hospital) to have to use the RN/LPN hierarchy .
If you are not prepared to be responsible for supervising the LPNs that you work with then you would be better off working in a different setting, IMHO.
not trying to be inflammatory, but I was an LPN for 18 yrs befor I became an RN, so i understand how both sides feel!!
Nov 2, '06I remember working on a floor with team nursing - one RN and one LPN for maybe 10-12 patients. At the beginning of the shift, we'd get report together on all of the patients, then I'd go through them and split up the team for primary nursing duties (of course I covered IVP meds etc). I gave myself the patients with higher acuity or who'd need more RN things done, and the LPN the others. By planning our team at the beginning like that, we tended to do very well and were able to be flexible if the acuity of a patient changed.
All in all, with a great LPN, it's easy to do! With a not so great LPN, it can be awful. That said, I've known some great LPNs to be teamed with a lousy RN and that's bad too.
However, I really DID keep in mind that it was MY name on each chart and therefore my license as well as the LPNs on "her/his" patients. So I really did do a thorough assessment and kept up with what was going on. Again, with good teammates, it wasn't really bad.
PS - and no, no extra pay for covering an LPN - it's just part of our job.
Nov 2, '06Quote from Sandi0302Ok point taken, after reading my message I do realize it sounds like I am downing the LPN's which I did not intend to do. I have much respect for all the LPNs I work with and would not offend them in any way. My point should have been that when helping any other employee I have learned to check records before doing procedures to insure errors do not occure.Oh geez, are you insinuating that because THIS LPN didnt know what she was doing that ALL LPNs dont? I didnt judge the RN that didnt know what to do when her pt's blood sugar was 54 , so don't judge someone just by the title.
Personally, I dont think it's worth ANYONE'S license to cover ANYONE.