How to deal with nasty LPNs.

[arabella205]

Hi, I am fairly a new RN. In our floor we do team nursing. Usually in one team there is an RN, LPN and CNA. We usually get 6-8 patients per team. RNs usually do IVs, assessment, blood, orders; LPNs PO meds and CNA do the patient care. There are times that we don't get CNAs and we have to do patient care ourselves. If that happens I always try to delegate those jobs to LPNs because they usually have alot of free time (I usually help out after I finished all my RN responsibilities). Some of these LPNs have been there for a long time and they refused to do pt care (they only want to do PO meds) and they are usually pretty rude when I asked them. I am not a rude person and I tend to ask nicely. How do I deal with these people. I mean they can't just be giving PO meds and that's it, and I can't be spending half of my shifts doing patient care, while I could be using that time to do my RN responsibilities.

any advice? write them up? talk to my manager? be more in your face ***** myself?

[caliotter3]

If you offer to split the patient care 50/50 with your LPN, then they can't say you are not being fair. Then you can utilize your disciplinary measures if need be. If you have done all this and you are still getting attitude, then when you go to your supervisor with the problem, s/he will see that you have been reasonable and should back you up to get the LPNs to do their share. Surely, they don't think that you are going to do it all while they lounge around when they don't have to pass meds? But then, they could very well be trying to see if they can bully you into doing just that. Don't let them do it. Not fair to you or to the patients to spread yourself so thin. Good luck with this.

[chevyv, BSN, RN]

They must be responsible for more than just passing meds to a few pts. It would be nice to work together to get the cna type cares done on the heavier pts. You can assess while doing the cares. Maybe the long term lpns are testing you a bit. People get so set in their ways (I'm no exception). I would work best if you told me that we have no cna and these are the pts that really need cna type cares done and then give me what I'm responsible for. If they have a problem with it, I bet they'll let you know. Be strong, yet cool. Team work starts with me!

[Bossy Boss]

Sounds like they are trying to brake you in. As an RN you have all the IV's, new admissions & first assessments when working with LPN'S and the fall guy if anything goes wrong. While keeping all your Pt's from going "south" on you during your shift. As a team leader you set the tone on the floor, be fair but not a push over, people will try to get a way with as much as they can. Patient care is not just yours alone. Everyone from a CNA,CMA,LPN & RN knows how to empty a bedpan.

[lpnflorida, LPN]

Why are the LPN/s only doing po medications? Do they not hang iv piggy backs or flush their own lines etc?

I once worked with an Rn yes we had 9 patients on the team. I was to do all the medications and treatments. They did all of the assessments. We also had a Cna. Let me tell you with this particular Rn I ran all day long as there were multiple medications and iv piggy back, iv solutions to be hung and multiple wounds to be dressed not including tube feedings etc. In addition I would help the Cna with transferring a pt from bed to bathroom etc. This Rn got her charting done uninterupted while we ran our behinds off. Then she would sit at the desk and continue to delegate and gossip.

Working with another Rn, we would split the assignment so that we each passed the morning meds to the patients, we each did our own wound care, we each did our own charting on the patient. We use to say we were mostly nurses until noon thereafter we were mostly aides doing what was needed. If she got busy I would do for her and vice versa. Our team back then ran smoothly.

So it all depends on the team members in play.

[tmesk]

I've had the same issues with LPN'S. I would contact your floor manager and make them aware of the situation. It does no good to complain about it amongst yourselves, bring it to someone who can fix it. Lack of teamwork is a performance issue that needs to be addressed with that employee. The LPN'S should have more patients than the RN. I would assume you are responsible for taking their orders off, ivp med, blood, plt's etc. Check the state guidelines and the hospital policies to see exactly what they can do. Your RN license is on the line when dealing with LPN's. Good Luck!

[CathyLew]

I can't believe that all the LPNs do is pass meds. They must have other responsibilities other than passing meds.

actually, over the years, that is what our LPN's have fallen into. PO meds and VS. And many will push the VS machine at the RN, and say, since you are going in to do your assessments anyways... can you get the VS, and I'll start setting up my meds. You get the VS, do the assessments, as well as anything else that needs to be done while you are in the room. When you come out, the LPN has a list of IV push meds that need to be given, the DR's start rounds, you haven't charted a thing. Many of the LPN's have done the AM insulins, then go to break before starting their 9am-10am meds. Many of the LPN's do not start IV's. They can't hang the initial antibiotic on a patient. They don't do assessments. Some if they do the VS don't chart them, they hand a list to the RN, since the RN has all the charts anyway. They don't do admits, or Discharges. They don't do patient teaching.

Some have become experts at making po med pass a full time all day job.

[Katie82, RN]

Why is your facility underutilizing their LPNs? LPNs in most states are allowed to do a lot more than pass PO meds. I agree that I would split the patient care.

[linzz]

Just wondering if the LPN's do any assessments or are they just not allowed to do the initial one. It's a bit different up here, some hospitals have an IV team on days and afternoons and others expect the LPN to start the IV's and monitor them. Pushes are still done by an RN. We have no CNA's up here although a very few hospitals are starting to use them. I can see somewhat why an RN would not want to do a push on patient they don't know.

[eriksoln, BSN, RN]

hmmmm, this is like.........Who's burried in grants tomb?

How do I deal with nasty LPNs?

Same way I deal with nasty CNAs, nasty RNs, nasty MDs, nasty cashiers, nasty accountants, nasty pilots and so on.

[rngolfer53]

Hi, I am fairly a new RN. In our floor we do team nursing. Usually in one team there is an RN, LPN and CNA. We usually get 6-8 patients per team. RNs usually do IVs, assessment, blood, orders; LPNs PO meds and CNA do the patient care. There are times that we don't get CNAs and we have to do patient care ourselves. If that happens I always try to delegate those jobs to LPNs because they usually have alot of free time (I usually help out after I finished all my RN responsibilities). Some of these LPNs have been there for a long time and they refused to do pt care (they only want to do PO meds) and they are usually pretty rude when I asked them. I am not a rude person and I tend to ask nicely. How do I deal with these people. I mean they can't just be giving PO meds and that's it, and I can't be spending half of my shifts doing patient care, while I could be using that time to do my RN responsibilities.

any advice? write them up? talk to my manager? be more in your face ***** myself?

If they refuse, say "OK, since you're refusing, I'll ask the charge nurse to assign someone else."

BTW, this has nothing to do with LPNs in particular. It happens with RNs CNAs, SWs, etc. It might be worthwhile to examine critically your own attitude and style of interactions with your co-workers, especially when you are new.

[leslie :-D]

i agree that the title would be more appropriate with "how to deal with uncooperative staff".

that said, you people are a team, with the burden being on the rn.

if it was me, i would jot down my responsibilities and the lpn's...

then divide the remaining workload equitably.

show the lpn your attempt at being fair and reasonable.

if s/he still refuses, go up the chain.

leslie

[tmesk]

I would pull up their job responsibility list. I forsee in the future that LPN'S will be a glorified patient care tech. If the future of nursing is headed toward the BSN prepared nurse, where does that leave the LPN'S? Not much opportunity there except for them to go back to school. When people refuse to care for patients and lack teamwork, it's a performance issues. I would address the situation with the person first, if that didnt' help go to the manager. It sounds like it is disruptive to your team! The goal is to care for the patient. I've worked with very good LPN'S and one's who needed to be out of healthcare all together. If you dont' want to care for patients, then go go work at Walmart. Imagine what your patients' feel like having someone with that kind of attitude come into their room. THey probably feel like their a burden to care for. Take care of the real problem...their performance. Don't be afraid to address the issues with the mgr. They may not be aware of the problem. If they are, ask what the plan is for improvement.