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.
In my facility (hospital) LVN's take vo's and to's - but NO nurse takes an order and then asks someone else to write it for her. If you take the order - you write the order. You write....
D/C Levaquin, advance to reg diet, benadryl capsule 25 mg Q6hours for itching---------------------------------------------------------------RS
This is then handed to unit secretary who puts in the computer, writes on the MAR, alerts other depts. she signs off that she has done so. Another nurse RN or LVN notes the order -
Ah - it's early....
Clarification: Benadryl capsule 25mg PO Q6hours for itching----------------
Not only are the job descriptions different from state to state , but also from facility to facility. I have an HST(Health Service Tech) working with me that came from the military. There they must let them do anything, or so he says....While I have seen other nurses let him do lots of things which I personally think do not come under his job description or (license?, do HST's even HAVE licenses?)..One day on MY watch, he was seen treating a patient. I blew a fuse, went to the administrator and said, "I don't care WHAT others let him do, NOT when I'm in charge.........There's still no REAL list of what an HST can do.....meantime....I"M not takin ANY CHANCES.
I am an LPN and in my hospital I can take VO/TO, hang blood, do IV push meds, access central lines, initiate and D/C foley's.
Hanging blood, IV push and accessing central lines cannot be performed by LPN's at the hospitals where I did my clinicals in school, but the hospital where I work is a MUCH larger facility and these duties are allowed.
In my state LPN's are not allowed to take telephone orders. I think it was inconsiderate of the LPN to take the order knowing what a terrible position it would put you in.
I work in a hospital setting and as an LVN I do take TO. I think the issue is accountability. If you take the order ,you write the order. If this person was aware enough to ask you to do the documentation, they were aware of their limitations. This situation is dangerous to you and maybe you should address it with her.
At my last job I worked with some LPNs. They weren't allowed to hang blood, start IVs, or push IV meds. This hasn't been mentioned yet, but the LPNs also weren't allowed to do care plans. Is this just an RN thing? I worked on a PP floor and we would print out care plans for each new pt. that came to the floor, both mom and baby. We had to do this for any of the LPNs that were working. I just remember it being a pain. I guess I wondered why the floor had LPNs working on it when there were so many things they weren't allowed to do. From the rest of the thread it sounds like at other facilites they are allowed more duties.
I am an LPN from Ohio I take verbal orders from Drs write them start IVs and am charge if no RN is on guess I am glad I work where I am at.All states are different , But if another nurse took the verbal order I would expect her to write and sign, I don't mind following thru but if I wasn't told it I would not write it and sign.
As an LPN in New Orleans on a med-surg unit I worked independently taking orders and all. Of course with some exceptions. In Michigan I learned as an LPN I would be a glorified CNA. I would not work in a hosp here for that reason.
But you did call the doctor back and get the order yourself, right? And then you wrote the order, right? And the doctor has co-signed it, right? That way, you're covered.
Let me start by saying that I was an RPN/LPN for many years before becoming an RN.
When it comes to verbal or telephone orders, YOU DO NOT write an order you did not take, you DO NOT implement an order you do not verify (yep, going to the chart and verifying that the order is written there), you DO NOT give medication another person has drawn up, as an RN you FOLLOW UP with your own assessment when it come to LPNs or CNAs reporting changes in a patient's condition. This is not an issue of trust, it is not a "team work" issue, IT IS A STANDARD OF PRACTICE ISSUE. These are things that BOTH LPNs and RNs are pretty much taught first semester, BEFORE they ever set foot in the clinical setting as nursing students. There is a reason nursing instructors pound these things into a nursing student's head. I don't understand why this is being made by some into an issue of trust or team work.
What RNs and LPNs are allowed to do within a facility or even within a practice setting within a facility is determined by their SBON AND their facility's policies and procedures. It's not about dumbing anybody down, it's not about insulting one's knowlege or capability, it's about following your facility's policies & procedures and SBON's Standards of Practice. In essence, simply because your allowed to do A,B, & C in one state, or at one facility within that state, DOES NOT mean you will necessarily be allowed to do so elsewhere. It is also not a collective reflection of RNs attitudes towards LPNs. It is understandable that LPNs as a group will be frustrated by the varying Standards of Practice from different states, and the even further restrictions that may be placed on their practice by different facilities. This frustration can also be compounded by the fact that there are RNs that do not understand what the LPN role is AND LPNs that do not understand the RN role and how their role differs. It's unfortunate when this frustration degrades to a personal level of LPN vs RN.
A personal example: As an RPN/LPN I worked in a setting within the facility I was employed at where I was allowed to remove staples and sutures. My unit manager made a point to discuss with me that this was the only area where I was allowed to do this, which meant that if I floated to a regular floor I was not to remove staples and sutures irregardless of whether or not I was requested to by an RN. This was not done to be insulting to be me, nor was it a reflection of her opinion (or the facility's opinion) of my competency. The purpose behind this conversation was simple: She knew that there would be RNs within the facility that knew I was allowed to this skill within one setting and would assume I should be able to do it within all settings within the facility. She also knew that if other RPNs/LPNs were to see me doing this in other areas outside of the specific setting I was allowed to do this in (even though I received the training and teaching), despite their lack of inservice/teaching they would ASSUME they should be allowed to remove staples and sutures. In fact, even if the facility and TPTB allowed me to utilize this skill in others areas because I had the training, there still would have been the same problem of both RNs and RPNs/LPNs ASSUMING it was OK for RPNs/LPNs to perform the same skill, despite their lack of training. Right now I currently work in Michigan as an RN at a facility where I AM NOT allowed to remove sutures or staples, only a phyician is allowed to this. I do not have an issue with this, it is the facility's policy, nor do I feel insulted or demeaned, nor do I feel in any way that this facility questions my competence because this was something I was allowed to do elsewhere.
Daytonite put it best:
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!
There is a problem with people not knowing the job descriptions of the different levels of patient care staff. Even as an RPN/LPN, I certainly encountered RNs that lacked the knowledge about what LPN role was. I've also seen RPNs/LPNs do things they WERE NOT allowed to do, that were against policy, for three reasons:
1. The RNs allowed them to.
2. RPNs/LPNs assuming they were allowed to do so BECAUSE the RNs allowed them to.
3. Changes in policies that RNs and RPNs/LPNs disregarded.
Whether it is an NA (or PCT, HCA, HST, etc) or an LPN, simply because an RN says it's OK, or allows you do something DOES NOT change your facility's policy, nor does it make it all right to disregard policy, not for the NA, LPN, or RN. This type of situation creates numerous problems, especially for the RNs, RPNs/LPNs and NAs that DO follow their facility's policies and procedures, unfortunately it ALWAYS SEEMS to brought down to personal level:
1. RPNs/LPNs or NAs assuming that the RN is questioning their intelligence and competence and/or behaving as if they've been offended/insulted on a personal level.
2. RNs assuming or behaving as if the RPN/LPN or NA is being insubordinate/difficult or questioning their authority/judgement.
Changes in a facilitys policies also create a lot of problems within a facility. For instance, at my current facility, NAs were allowed to insert/remove foleys, insert/remove NGs, perform trach care, and remove IVs. Policies changed and they are no longer allowed to do any of these tasks. This does not stop the occasional NA from making snide remarks to the effect of: "We used to be allowed to do A,B, & C, but THE RNs didn't think we were smart enough." Yet again it gets brought down to a personal level. The facility's policies and procedures DID NOT change simply because RNs have a negative impression in regards to the intelligence or competence of NAs performing specific tasks. Policies and procedures DO NOT change based on my personal opinion nor the personal opinion of other RNs, they change because of accreditation recommendations, sentinel events, risk management assessments, and trends in patient outcomes. BTW whenever a facility changes their policies and procedures as they relate to patient care, IT WILL AFFECT ALL who provide that care, INCLUDING THE RNs.
The bottom line is about educating ourselves on the different roles within our practice setting, following our facility's policies and procedures, and adhering to our SBON's regulations. It is not about LPN vs RN, it is not about NA vs LPN or RN. What it is about is providing competent patient care within our defined roles, and yes, the defination of those roles may vary state to state and from facility to facility.
sorry, couldn't resist!
Ashera, LPN
179 Posts
Ah - it's early....
Clarification: Benadryl capsule 25mg PO Q6hours for itching----------------