I knew it wasn't right while I was doing it...

[SheriLynnRN]

Last night, towards the end of the shift, most of the staff was either in the report room taping or busy in their pts rooms. We didn't have a secretary, and the charge nurse was away from the desk. One of the LPN's was charting at the nurse's station. When I came around the corner, she was just hanging up the phone. She said, "That was Dr. Soandso. He wants the foley in 716 to come out at 5 am. I repeated it back to him. Will you write it for me?" I know that it wasn't the right thing to do, but I wrote it anyway, signing my own name after the doc's.

I guess we should have called him back and explained that the nurse who took the telephone order was an LPN, and isn't allowed to do so, but we didn't.

I know I was in the wrong, but I am frustrated at her too. She should have told the doc that she couldn't take the order and put him on hold for a minute to find an RN. I've seen her do this once before.

Does this happen where you work too? Just wondering.

[PurpleHairUnicorn]

re; schroeders piano..the illinois lpn scope of practice is not currently defined,the Illinois Practice Act Task Force is currently working on defining the scope of practice for the LPN, therefore it is up to each facility to decide what it will and will not let the LPN do.The Illinois nurse practice act states at this time that an LPN works under the direction of a physician,or RN At critical access hospitals, LPNs CAN push iv meds, I just interviewed for a position at a critical access hospital one week ago (April 3,2006),and at this hospital LPN's do not give IV narcotics or change out PCA syringes, and cannot access a central line and do not start the blood transfusions, functionally the LPN does everything else a med-surg RN can do. They only have RNs in their ICU.(I specifically asked what was the expected duties of the LPN were, having moved here from another state where the LPN role was greatly (with proper training)expanded. I personally am IV certified, having taken a 52 hour classroom course with a clinical component of 25 successful iv starts before I received my certification.)As I stated earlier this was a CRITICAL ACCESS hospital, they get different reimbursement rates, and are basically allowed to set up their own scope of care guidelines. I got that information from the administrator himself. Here is the link to the Scope of Practice Minutes http://martenology.com/dpr/viewtopic.php?.p=75&sid=25c7bb01f4b9d90f6cc037259d27d2e1

The January 06 meeting notes have not yet been posted.

[PurpleHairUnicorn]

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[color=#006699]scope of practice minutes, minutes october 20, 2005

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joined: 29 aug 2005

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posted: tue nov 08, 2005 4:01 pm post subject: scope of practice minutes, minutes october 20, 2005 2007 illinois nurse practice act task force

scope of practice minutes

thompson building idpfr 8th floor room 8-031

minutes october 20, 2005

members present: pam robbins, chair, rosemary meganck, co-chair, mary ann alexander, lori anderson, teri berriman,

susan duda-gardiner, lois hamilton, jeremiah loch, kathleen pankau, pete polachek, lanise sanders,

rosemarie suhayda, mildred taylor, sandra webb-booker

members not present: julie atkins, dale beatty, teresa garcia, connie hardey, lynn lenker, marjorie maurer, mary muse,

linda olsen, kate o’toole, sandra pfantz, faith roberts, marion summage, carol wilson, tamara wojciechowski

the meeting was called to order 10:30am

i. welcome introductions

• members introduced themselves and the group or groups they represent.

• if members present know how to reach members not present, they should give that information to the chair.

ii. review of goal statements

we will be successful by september 6th if we:

1. create a new nurse practice act that:

a. promotes the public health safety and welfare of the citizens of illinois

b. defines the responsibilities and scope of nursing practice

c. clearly articulates regulation of nursing education, licensure and practice.

2. create a new nurse practice act that is supported by the illinois nursing community

3. create a user friendly nurse practice act by aggressively developing objectives and meeting time lines.

• members were asked to review the goal statements.

iii. decision by consensus

• mary ann reminded members that decisions should be reached after discussion. if necessary decisions will be agreed by majority present. once a decision is reached, everyone must support the decision.

iv. review pertinent sections of the current act

• lpn scope of practice is currently not defined in the act. after discussion, a subgroup was formed to develop draft language to define the lpn scope of practice. the subgroup members are terri berriman, lanise sanders, mildred taylor and sandra webb-booker. the group is to present their draft to this workgroup (scope of practice) at our next meeting in january.

• rn scope: the workgroup decided that we would start with the scope of practice defined in the ncsbn’s model practice act.

• apn scope: a subcommittee was formed to discuss scope of practice for apns. the subgroup members are lori anderson, jeremiah loch, rosemary meganck, pete polachek and rosemarie suhayda. the subgroup will present their draft to this workgroup (scope of practice) at our next meeting in january.

• subgroups are to consider ncsbn model act and rules, barbara saffriet’s notes and ana’s code of ethics that were handed out by pam as well as other states. mary ann will share with us a short list of other states that may have language that could help us in illinois.

v. advisory opinions

• a lively discussion took place regarding the bon’s ability to produce advisory opinions or white papers. this workgroup is asking the bon to seek clarification from idfpr’s general council about this.

• a discussion also occurred about the possibility of adding an appendix to the act that discusses the incorporation of new procedures and skills into nursing practice. rosemary will share a copy of acnm’s position paper on incorporating new procedures into practice. this may serve as a template for developing similar language in our act.

• members were also asked to review illinois hospital report card act that was recently passed.

vi. suggestions to other workgroups

• for the violations workgroup: please consider defining “where” and “how” a nurse can report violations of the act, esp. regarding rules 1300.42, 1300.43 and 1305.

• for the licensing workgroup: please consider addressing emergency licensure of nurses in disaster situations, such as hurricane katrina.

• for the definitions workgroup: please consider adding a definition of “delegation”. please refer to ncsbn 2005 annual meeting mission possible: building a safer workforce through regulatory excellence “draft model language: nursing assistive personnel chapter eighteen: article xviii of the model nursing practice act (mnpa) 18.1 a-e. most notably please consider 18.1 (e) nursing tasks/functions/activities that inherently involve ongoing nursing assessment, interpretation or decision making that cannot be logically separated from the procedure(s) are not to be delegated to nursing assistive personnel.

vii. future meetings

• the full npa task force will meet:

november 9, 2005 in bloomington

february 8, 2006 in chicago

may 10, 2006 (location tba)

august 9, 2006 (location tba)

• the scope of practice workgroup will meet at 10:00am on:

january 25, 2006 at idfpr in chicago

april 26, 2006 in peoria (lois hamilton to arrange location)

july 13, 2006 at idfpr in chicago

• the lpn subgroup will meet on:

january 10, 2006 at 5:30pm. (location tba)

• the apn subgroup will meet

december 14th at 6:00 pm in justice illinois.

viii. the meeting was adjourned at 2:45pm

respectfully submitted

rosemary f. meganck[color=#006699]back to top[color=#006699]

bonnie elliott-zahorik

joined: 07 nov 2005

posts: 9

posted: wed jan 11, 2006 10:58 am post subject: military trained lpns hb4278 "amends the nursing and advanced practice act. provides

that an applicant for licensedpractical nurse licensure may have

graduated from a united states military program that

emphasizes nursing. effective immediately."

these applicants are nurse trained and not core

persons without nurse training according to

sandra webb-booker, phd, a coronel in the

reserves. bonnie[color=#006699]back to top[color=#006699]

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here are the minutes, the link doesn't work from here for some reason

[traumaprincess]

I found something out today that makes this whole situation even more maddening in my eyes! I usually work evening shift, so the LPN in the OP is the only LPN I end up working with 95% of the time. Today I worked days, and happened to be chatting with a different LPN about what our Nurse Practice Act does and doesn't allow them to do. (I didn't mention the situation in my OP.) I found out that LPNs CAN in fact take verbal and phone orders in my state, and can set up and adjust PCAs! She mentioned the LPN from the OP by name as said "but Susie absolutely refuses to do those things, she won't even check her own MARs." Turns out that when the laws changed over 15 yrs ago, "Susie" refused to change with them.

This is a nurse who NEVER fails to punch out exactly on time, even if one of her pts codes during her shift! No wonder she is so efficent, she just gets everyone to do her work for her. Too bad it took me 5 mos of working with her to figure it out. Stupid me, I just thought she was a good delegator.:angryfire

That is interesting, then if she does not want to take phone orders and write them herself she needs to tell the doctor to hold while she gets someone who can do it. Because no matter what the NPA says the person who hears the order should be the one who writes it. Maybe someone needs to talk to her about what her responsibilities are. That is frustrating. Maybe next time you should politely tell her that she needs to write the orders she took. It cannot take that much time out of her shift, and it will eventually avoid a mistake being made when the order goes from dr to her to someone else to the chart. There are too many chances for error in communication.

[thumperRN]

In IL - LPN's can't take telephone or verbal orders either!

I work in IL and at the hospital I work at NONE of us can take verbal orders, but LPN's take telephone orders all the time - I've never heard that they couldn't. Is this a state law?

[thumperRN]

Nevermind about the above - I quoted to soon - question answered. :smackingf

[Daytonite, BSN, RN]

if you feel uncomfortable working with lpns you should bring your complaints to the ptb and rearrange your working days so that you will be separate

I did this very thing in my second hospital position as an RN. Had an LPN who just did all kinds of things that were screwy. She was sullen, a loner and kept herself separated from the rest of the staff. She basically did things the way she wanted and didn't follow directions--very difficult to work with. I won't deny that I had a bit of an attitude about her myself then. I was still new to nursing and had a lot more to learn about getting along with people and being a supervisor. However, the straw that broke the camels back was when I had to run off to get a unit of blood from the blood bank (only an RN could do it in that hospital) and in the 5 minutes I was gone she gave 30mg of Dalmane to a patient. This was 4:30am in the morning. It was all I could do to hold my temper. Her reasoning was that the patient was asking for the sleeping pill, it was ordered as a prn, so she gave it to him. I went to the PTB that day. To my knowledge nothing was done to her, but I can't know for sure. I ended up being so disgusted with the responses I got from both my head nurse (who was a former classmate) and one of the nursing administrators that I was the problem and not the LPN that I ended up saying, "I quit" and left. This was around 10am, almost 2 and a half hours after my shift had ended. I could be quite a hot head in those days and 25+ years later I realize that I handled the situation totally wrong, but I won't give in on my main beef of the patient being given a large dose of a hypnotic at 4:30 in the morning. Her rationalization was totally off the wall. Had she bothered to check, I had told her, she would have found that the guy had indeed been snoring away for most of the night shift.

Not that I'm trashing LPNs (my mother was an LPN), but I've worked with a number of them who mistakenly believe that they possess the same assessment and judgment skills as an RN and that simply is not true. In addition, some will voice anger that they aren't paid near as much for doing the same job as an RN. Say what? It is so interesting to watch the transition of an LPN to an RN. Then, they see the difference themselves. However, unless they go back to school, there is no way to show the rebel and rambo LPNs where they are wrong because they just can't see it. There is a reason that most states don't permit LPNs to perform as fully in acute hospital settings as they do in nursing homes. Even in nursing homes, and I've worked in plenty, I saw LPNs make some serious errors of judgment that an RN wouldn't. They are not schooled in the critical thinking skills to the degree that RNs are. There has been talk since I was first licensed back in 1975 about grandfathering all LPNs to RNs. Hasn't happened yet and I doubt that it ever will unless the cirriculum of the practical nurse training programs changes significantly to focus on those two elements of critical thinking and decision making. Most of us RNs agree that in nursing school every other sentence out of the mouths of our instructors was something like, "now as the nurse, how are you going to put all this information that you know together, and what are you going to do for this patient?" We are taught to understand the "why" of what we are doing.

[schroeders_piano, RN]

re; schroeders piano..the illinois lpn scope of practice is not currently defined,the Illinois Practice Act Task Force is currently working on defining the scope of practice for the LPN, therefore it is up to each facility to decide what it will and will not let the LPN do.The Illinois nurse practice act states at this time that an LPN works under the direction of a physician,or RN At critical access hospitals, LPNs CAN push iv meds, I just interviewed for a position at a critical access hospital one week ago (April 3,2006),and at this hospital LPN's do not give IV narcotics or change out PCA syringes, and cannot access a central line and do not start the blood transfusions, functionally the LPN does everything else a med-surg RN can do. They only have RNs in their ICU.(I specifically asked what was the expected duties of the LPN were, having moved here from another state where the LPN role was greatly (with proper training)expanded. I personally am IV certified, having taken a 52 hour classroom course with a clinical component of 25 successful iv starts before I received my certification.)As I stated earlier this was a CRITICAL ACCESS hospital, they get different reimbursement rates, and are basically allowed to set up their own scope of care guidelines. I got that information from the administrator himself. Here is the link to the Scope of Practice Minutes http://martenology.com/dpr/viewtopic.php?.p=75&sid=25c7bb01f4b9d90f6cc037259d27d2e1

The January 06 meeting notes have not yet been posted.

Your information is greatly mistaken. If you will go to the IL Dept of Professional Regulation website you can find the IL LPN Practice Act which governs the practice of ALL LPNs for IL. Just because a facility is Critical Access, it does not mean they get to redefine the nurse practice act. Critical Access designation does have some rules that comes along with it, however those rules do not trump state practice acts. I am currently a supervisor in a critical access hospital. I know the rules and regulations inside and out. Just because we are critical access, it does not mean we get to set up our own scope of practice for our LPNs.

As far as the IL Practice Act Task force, the nurse practice acts are sunsetting in the very near future and they are currently working on revisions and improvements to the current practice acts.

Schroeder

I apologize for hijacking this thread. I just wanted to correct inaccurate information.

[PurpleHairUnicorn]

Sorry I didn't mean to hijack the thread either.... From Il nurse practice act... (i) "Practical nurse" or "licensed practical nurse" means a person who is licensed as a practical nurse under this Act and practices practical nursing as defined in paragraph (j) of this Section. Only a practical nurse licensed under this Act is entitled to use the title "licensed practical nurse" and the abbreviation "L.P.N.".

(j) "Practical nursing" means the performance of nursing acts requiring the basic nursing knowledge, judgement, and skill acquired by means of completion of an approved practical nursing education program. Practical nursing includes assisting in the nursing process as delegated by and under the direction of a registered professional nurse. The practical nurse may work under the direction of a licensed physician, dentist, podiatrist, or other health care professional determined by the Department.....From the minutes of the Illinois Nurse Practice Act Task Force minutes - IV. Review pertinent sections of the current Act

• LPN scope of practice is currently not defined in the Act. After discussion, a subgroup was formed to develop draft language to define the LPN scope of practice. Like I said earlier, I got MY information as to what their LPNs do from the hospital administrator and the CNO for this very small, very rural hospital. ( I also turned down the job ) I really would appreciate it if you or someone could provide a link or paste a list of tasks that LPNs (with advanced training) CAN do.(I have been all over the internet and the Dept. of Professional Regulation web site and the above was all I could find) I really think that these hospitals are taking advantage of nurses who have moved here from out of state, and have board/NLN certified IV therapy certification,(which, according to the dept. of professional reg. DOES transfer to your Illinois license)and advanced training. I think they are trying to get RN work for LPN pay. I also think they are taking creative license with the "under direction of a physician provision.Again sorry to hijack the thread. This is the kind of information that is being given out by PHSK("people who SHOULD know") to those of us who NEED to know. Schroder feel free to e mail or pm me and I will tell you word for word what I was told I could do by these PHSK

[Daytonite, BSN, RN]

Oh, Wow! I'm reading all these posts and I am just sitting here with my mouth hanging open in shock! Most of you need to take a look at not only your official job description (it's most likely in the facility policy manual or the human resources manual), but the job descriptions of the other levels of nursing staff who you work with. Each of you should have received your own job description in writing, either at your hiring interview or during your official orientation to the facility. It was so you would know exactly what you are expected to do. Whenever a question of wrongdoing/discipline or a lawsuit comes up one of the first places human resources goes is to the written policies and job descriptions to verify a transgression. If you aren't doing, or are doing something beyond, what you're officially allowed and a patient ends up getting injured in some way your head is going to roll--big time. And you can probably kiss your job bye-bye as well. How can you all go to work each day not knowing what each of you and the people on the staff you work with, and in some cases supervise, are responsible for? The question of what you can and can't do is there in black and white. This is unbelievable! You wouldn't hesitate to look up a drug you didn't know before you gave it. Your facility defines in writing what you can or can't do on the job as long as it doesn't overstep or defy the boundaries of your state nursing licensing laws. Oh, wow! A state law can say an LPN can take an order from a physician, but if the facility they work for says only an RN may take an order from a physician then that's the rule they have to follow while they work for that facility--it's that simple. (Actually, a lot of these rules are driven by accrediting bodies and MediCare rules and regs.) For years I've suggested that new employees need to have a follow up orientation day 6 months after they start working to re-interate hospital policies, protocols and procedures. I've yet to find a place that does it though.

[PurpleHairUnicorn]

I agree with Daytonite, although I would suggest a yearly review of policy and procedure to cover those who have "been there since the doors opened" and equal enforcement of the policy and procedures, and make sure they are up to date. I have been in some facilities where the last "update" in their p&p manual was..(I'm not kidding) 1986! This is at a ltc facility here in central illinois. I can say that although I have advanced training, I do NOT consider myself on an educational par with RNs. I know how, the RN knows why and yes, I know....:deadhorse

[TracyB,RN, RN]

Having been an LPN and currently an RN, both titles in the state of IL, I have taken many TO's & VO's as an LPN.

Most facilities are trying to avoid VO's. If the doc is there to give the VO, the doc can WRITE the order, unless an emergent situation.

The Illinois General Assembly has a copy of the IL Nurse Practice Act online. However, it is not as detailed as the paper copy.

To the OP, get a copy of the FULL nurse practice act for your state & keep it nearby for reference in situations like yours. CYA CYA CYA!!

Good luck

[smk1, LPN]

this may be slightly highjacking the thread, but what is the big deal with telephone or veral orders? Not to be facetious, but do most LPN's have hearing loss or something? (joke) As a student i have no idea of the rationale for why they can't take TO or VO. To my young nursing mind i would think these are the best types of order for an LPN if the argument is they may need additional info due to less education, because the practitioner is there or on the phone for easy clarification. What's all the hoopla over it? Teach me! lol