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?

[MAISY, RN-ER, BSN, RN]

Wow, I agree with those who said should be called how to deal with nasty coworkers.

After clarifying your post, I have got to tell you it sounds like BS to me. I don't care if LPNs are nurses, if assigned with an RN (her license-the RN's) is on the line for carrying out care. It seems to me that if you have to do all the charting, given out your own meds, perform assessments and whatever else...the least they could do beside med pass is provide patient care. I think it is BS that anyone would say otherwise.

For the LPNs the reason NJ has gone away from LPNs in the hospitals is due to the fact that they must answer to an RN and are so limited in their practice that is just isn't practical to have them. In many ways, those who were grandfathered into areas like oncology or critical care are more a hinderance than a help. This is especially true if they are going to do things their way!

While I say to each their own, I worked hard for my RN license. If we are a team we WILL work together or I'd rather work alone where I can guarentee the work performed is correct and not half a$$ed. No one should worry that their patients or their licenses will be at risk due to non-performance by a coworker.

As for the patient load, if I read the OP correctly 8 patients between 2 people-that would be a dream! There is no excuse why the LPN, or 2 RN's who are charting for 4 each or whatever couldn't perform full patient care. I am carrying 5-8 ER patients who need full assessments, workups,invasive procedures, emergencies, holds, and whatever else-if I can do it alone (although not happily or entirely safely) then 2 or more can handle stable patients easily.

For the griping LPNs with the mean RNs, upgrade your license so you get paid more, and have different types of work to do! What appears easy is not, RNs take on a lot of responsibilty by obtaining their licenses. What you perceive as easier isn't necessarily so! Until you walk in their shoes you have no idea.

For those who have been LPNs for years, I believe many of you would pass the NCLEX and should be given the opportunity to do so, many of the nurses I have met over time are excellent and should be both compensated and appreciated for their skills and abilities. Many say they have no interest, but gripe about the RNs....I say if you want what the RN has, become one.

Either way OP you must make your expectations clear to your team and if your manager. Until you do, you will have nothing but problems. Good luck to you.

[MAISY, RN-ER, BSN, RN]

Let's see, as an RN you make double then what the LPN makes. You have the higher education. At the same time, why should the LPN do more work then you?

The higher education bought the RN extra work as the charter, assessor, and the responsible party whether the LPN, or CNA does their work or in this case, does not.

You are right, the RN should just work harder and request the LPN not be in her team, but ask for her salary as well. If she has all the liability and must do the work, then she should take the LPN salary in addition to her own.

You know I always told my kids, you can work at McDonald's, do customer service, be aggravated and make minimum wage OR BE A LAWYER BILLING OUT AT $100.00 OF DOLLARS PER HOUR WITH THE SAME AGGRAVATION, and CUSTOMER SERVICE ISSUES. The difference was what you willing to do as a young person, suffer now or suffer later.

If you want more pay be an RN, if you don't like your job change and become the boss, if you haven't worked as an RN with full responsibility of all YOU HAVE NO IDEA AND ARE IN NO POSITION TO COMMENT....EVER!

[RN1982]

I don't think it's necessary to bash LPNs in this thread. Stuff like this could occur with any co-worker.

[Batman24]

Ok, usually when we have 8 patients and no CNA, we split the patient care (4 for me, 4 for LPN) and it works fine. In that scenario I do my own PO meds, patient care, IVs, assessment ect for my 4 patients, while LPN does the PO meds, patient care for her own patient. I cover her IVs and assessments as well as orders.

My only problem is there are some LPNs (who have been there for years) who only wanted to do PO meds for that 4 patients assigned to her and not patient care. They would complain to have no time to do it, play dumb, disappear or take their time giving PO meds where in fact those 4 patients are theirs to begin with. It feels like they want me to do patient care on their patients too (aint happening sister). Just want to clarify that part. I am just tired to dealing with these people. I really think that they are testing me, just because I am new and look young (people think I am 17).

You didn't explain this clearly in your original post. Part of the problem could be proper communication and making sure everything is clear and concise on your end. And pls know I mean that to help you out. Given this new info here's what I would do:

You don't ask anymore if they will do patient care but assign it to them in a firm but polite way. If they put up a fuss you let them know the patient care is being split because there is no CNA and you expect their patients to get the care you assigned.

If they don't do it you write them up and start a paper trail. This will make it harder for management to avoid. You continue to write them up every time they are insubordinate. If they are testing you and they might very well be, word will get around that the gig is up and that you've put your foot down. They won't like it but they will either do as they should, get fired or quit.

[lpnflorida, LPN]

I wish I had an answer outside of what has already been given. I find it truly sad reading all of these many posts.

The dumbing down of ones Scope of Practice. These Lpn;s are in no way being utilized to their full potential hence creating what is seen as a burden to the Rn.

May this never happen in my hospital, my state. I love being a part of the team. I love feeling like a valued member and professional in my own right. I harbor no resentment towards the Rn I work with nor they towards us.

The answer is not to keep taking away what the Lpn is capable of doing, but to push for them to work up to capacity and Scope of Practice.

For those of you who work with those of us who have less restrictive practice you understand how we are a team and help. To those of you who work with those of us restricted I can see the hardship it might cause.

It is sad.

[winterallsummer]

Just my 2 cents... why should they have to do all the PT care? Because their degree didn't take as long as yours? Do they have less work experience? It seems disrespectful to delegate that to them.

You should have to do your fair share, if they have to do more due to time allotment that is one thing, but if you expect them to handle it because their degree is less impressive, that seems rudimentary of you.

[Gr8Dane]

I do just as much as you RN's do. I chose to do LPN first to make sure nursing was for me. I am planning to start working towards RN this summer.

I also accomodate my RN's as much as possible. Since you have to do my IV pushes (Narcotics mostly since we LPN's can do certain pushes now like lasix, Solu-medrol, pepcid, etc), admission assessments, and central lines, I will take more patients (7-8 vs. your 6-7).

I also don't complain when RN's cry about getting the more critical patients even tho they have the higher education.

This thread is nothing but LPN bashing RN's whom I am damn sure glad I don't work with.

[tmesk]

In the midst of all of this refusal....who is caring for patients? That is the reason we are there in the first place. We had a few LPN'S on our oncology division and recently displaced them all. It wasn't a good fit when your hanging blood,plt. and chemo all of which an LPN's can't do. For the most part they were hard working but one certainly had an attitude and took no repsonsibility...everything was blamed on the RN. I agree, if you want the pay, go back to school. Don't blame others and complain for one's lack of motivation. I'm curious, has management ever addressed this issue? If it's continous, why are they allowed to work there. My hospital as quit hiring LPN'S. Our LPN'S always took 6 while the RN'S started with 4, but then they had to have coverage. THe charge nurse who was out of care ended up covering anywhere from 6-12 patients. That's a lot when your dealing with oncology patients who can turn on a dime. Please address this with your mgt.

[SuesquatchRN, BSN, RN]

Just my 2 cents... why should they have to do all the PT care? Because their degree didn't take as long as yours? Do they have less work experience? It seems disrespectful to delegate that to them.

You should have to do your fair share, if they have to do more due to time allotment that is one thing, but if you expect them to handle it because their degree is less impressive, that seems rudimentary of you.

This, in a nutshell, is the issue.

She DOES have a lot to do and DOES do her fair share. She must cover all of the LPN's IV's and assessments and a lot of their charting, all of which are time consuming.

It has nothing to do with who went to school longer and everything to do with legal scope of practice.

[barefootlady, ADN, RN]

No, NO, NO! If I am working as the wing nurse with an RN supervisor working, then it is the responsibility of the LPN to assess the resident and then call the supervisor for back up. If the LPN needs my input or assistance then I will attempt to give it, but she has to do her part of the job. If I am the only RN then yes, I am technically the supervisor and will step up and do what is necessary. The problem is, there are 2 LPN's who just want to talk not work, and the RN supervisor does not project a strong

image of knowledge, so it's can you help with this about 25 times a shift, while they just gab, gab, and GAB! I have never seen so many stopped up tubes, no way they have been flushed and no way meds could have been given. I have literally taken the ends off, soaked it in H2O2, then soap and hot water, a final rinse then reapplied the end cap without assistance or input from that LPN the last 3 shifts I worked. That was on 5 tubes. Last shift I told the LPN's and the supervisor, if you do not want to learn how to do this then too bad, I will not show/do it again while you gab at the desk and ignore my lights. One family told me no one had been in the room all shift, so no wonder the tube was stopped up, no flushes. Too bad the hardworking LPN's are getting clumped in the whole bunch with the lazy 2. Sorry for the rant, but I hit the floor running at 06:30 and do not stop for literally hours while these 3 have a gab session. No more, not going to continue.

[merri666]

New RN's have to go through the "trial by fire". If your LPN sees you get in there and help with the grunt work you will probably gain some respect. I hate to open a can of worms but as a RN I really get tired of some (not all) new nurses thinking that they should not get their hands dirty.

Before you start writing people up think about the ramifications: you are the new kid on the block and you will be perceived by some as a troublemaker. Nurses can be vicious...your team can set you up very easily.

My advice would be to talk directly to your LPN. Have your LPN assist with the assignment (I know: as RN's we have all the power, yadda, yadda, yadda). While you are at it, get input from your CNA as well. If people are all on the same page with an assignment there is no reason for everyone not to do their jobs. If that doesn't work talk to your nurse manager. Depending on your nurse manager one of two things will happen: the manager will deal with it or you will be the bad guy. If all else fails, ask if you can be assigned another LPN.

Some of the best nurses I have worked with are LPN's. I don't know what I would have done without them at times when I had questions and the seasoned RN's would just roll their eyes.

Patients do have to have care...assessments, meds, IV therapy, treatment, procedures, etc. However, in the final analysis you are just as responsible for the direct bedside care as the LPN and CNA. Why? Because you are the RN!