I wish RN schools would quit teaching the RN students LPN's can't do anything!

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I am getting so frustrated with some RN students in these NCLEX review groups. They keep saying that LPN's can't do any assessments, they can't do any patient teaching, or evaluations, that it is illegal. I think it is important that RN understand the real scope of practice of the LPN. To hear them talk LPN's are no different than medication aids. It makes me sad that they are taught to think so little of our education and training.

It was illuminating for me to complete an RN bridge program after working for a few years as an LPN. I really came to understand the distinctions between what an LPN can and cannot do.

LPNs cannot do assessments. They can gather data for an assessment, but an RN always ends up signing off and taking responsibility. LPNs cannot do primary education. They can reinforce education delivered by an RN. In other words, the first person to teach a new colostomy patient how to change their appliance should not be an LPN.

In practice this is not always followed. Care planning is supposed to be done by an RN, but at my facility the LPN often add items to the care plan. There is a distinction though. Final approval of the care plan lies with people higher on the food chain, and not with the LPNs who work the floor.

The RNs are right. LPNs will seem to have more autonomy in an LTC setting, but in fact it is always an RN who signs off on everything.

Your analogy is only accurate in some states. Having worked in multiple states, it truly is interesting to note some of the differences from state to state. Hilarity can often ensue.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

Related to the fact that, I too, was taught in school that LVNs can't do assessments, how does an Lvn, such as myself, document my "data collection"

e.g. Say that I assess a pt and find them diaphoretic, febrile @ 101.0 temp and lethargic.

If I'm not supposed to chart, "writer assessed client and found x, y, x", what should I write?

"Writer observed the client to be diaphoretic, febrile @ 101.0"

Or, "write collected the following data on the client: febrile @ 100.0, diaphoretic, etcetera"

What do you all think is best practice?

There's no RN around in my LTC non medical facility. (In pt psych)

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Related to the fact that, I too, was taught in school that LVNs can't do assessments, how does an Lvn, such as myself, document my "data collection"

e.g. Say that I assess a pt and find them diaphoretic, febrile @ 101.0 temp and lethargic.

If I'm not supposed to chart, "writer assessed client and found x, y, x", what should I write?

"Writer observed the client to be diaphoretic, febrile @ 101.0"

Or, "write collected the following data on the client: febrile @ 100.0, diaphoretic, etcetera"

What do you all think is best practice?

There's no RN around in my LTC non medical facility. (In pt psych)

As things stand currently, I'd go SBAR:

Situation: What were the circumstances that caused you to interact with the patient (less is more).

Backround: Always essential. Brief synopsis of diagnoses by providers. Reasons for patient stay at this time.

Assesment: Your objective data goes here. Subjective data from the patient can be helpful as well. But I stick with the objective almost always. Let the provider or your co-worker or supervisor draw their own conclusion. Leading them is bad and impedes care imo. A provider or higher license is going to second guess you anyway, they are trained to do so.

Reccomendation: Keep it generic. Politely agree or disagree with the party communicated to. Standing orders solve most of these issues, however, clear concise communication regarding any interventions *without* hinting at a diagnosis works well for me. I like letting the provider or supervisor make the same recommendation for diagnostic work or intervention that I've been thinking is necessary. As my first supervisor used to say, " Let *them* be the hero... be satisfied with being the bridge"

In this way you are not unintentionally overstepping the boundaries of your license by diagnosing the obvious. And the teamwork ethic is upheld. I like this method better than SOAPE these days as it avoids that troublesome A word. Objective data gathered within the scope of practice is unquestionable.

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Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

I understand what you're saying about the importance of the S and the B and the R, thanks. (-:

I am referring to the fact that the A in SBAR stands for Assessment, which (tongue in cheek) we LVNs aren't supposed to. It's kind of ironic, I think.

My question relates more to, How best to document an assessment, without saying the fact that you indeed assessed..... (Cause LVNs can't assess)

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Specializes in Geriatrics, Dialysis.

OK...the quote button on this thread seems to be stuck! Just endlessly loading, so in response to above by vintagemother...

substitute the word observed, or observation everywhere you would use assessed or assessment. Create something new, the SBOR format!

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Specializes in psych.

I'm finding it interesting to read the differences everyone is stating between LPN and RN in other states. I'm almost surprised that the description hasn't been standardized across all 50 states. We were taught in my college program (that does both LPN and RN) that LPN's cannot do things like IV push meds, anything with blood products, do teaching, care plans, initial assessment (but can do ongoing assessments). I found this on my states BON page.

The Arkansas Nurse Practice Act A.C.A. §17-87-102 (a)(5)

and (7) require the LPN and LPTN to work under the direction of

an RN, APN, licensed physician, or licensed dentist and allows the RN or

APN to delegate nursing tasks to the LPNs, LPTNs, or other assistive personnel. The LPN and LPTN are prohibited from performing any nursing tasks that require the specialized skill, judgment, and knowledge of an RN.

Position Statements 95-1 and 98-6 define the scope of practice for each

licensure type. The LPN and LPTN scope of practice includes, observa-

tion, intervention, and evaluation. The RN scope of practice includes

assessment, diagnosis, care planning, intervention, and evaluation.

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Specializes in OR, Nursing Professional Development.
I'm almost surprised that the description hasn't been standardized across all 50 states.

I'm not. Each state sets its own practice act, and doesn't consult with any others. That's why if you apply for licensure in some states, you have to do more education or maybe not even be allowed to become licensed in that state (thinking some states who won't license Excelsior grads). States aren't willing to give up that autonomy- that's why we will likely never see a single universal scope of practice and licensure.

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I understand what you're saying about the importance of the S and the B and the R, thanks. (-:

I am referring to the fact that the A in SBAR stands for Assessment, which (tongue in cheek) we LVNs aren't supposed to. It's kind of ironic, I think.

My question relates more to, How best to document an assessment, without saying the fact that you indeed assessed..... (Cause LVNs can't assess)

Understood. Perhaps I wasn't clear enough so I'll try wording it a different way. Assessment is a four letter word for us. Instead of using that particular debate inducing word (and mother of fear and loathing in nursing practice), I choose to include my objective data there. Sometimes I include relevant portions of the subjective data obtained from the patient at point of care.

This in fact is an assessment, but not worded as such. Detailed objective data combined with the other portions of SBAR allow ample opportunity to allow a provider or higher license to convert that into an assessment or diagnosis. The long and short of it is that it both is, and isn't an assessment. And since it's not explicitly worded as one, there is no danger of overstepping the boundaries of your current license in the eyes of your peers.

Does that help?

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I have worked in home health for 5.5 years and usually the LVNs pretty much do everything in the home except central lines, I.V. antibiotics unless certified.

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I have worked in home health for 5.5 years and usually the LVNs pretty much do everything in the home except central lines, I.V. antibiotics unless certified.

Again, this is where you live and practise. It's not correct where I live.

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When people ask what I do, I say I am a nurse. "Oh, you're a RN?" No. I am a real nurse. I am a LPN! I do assessments every day.I add to the care plans. I once had a supervisor tell me once that LPNs are over-achievers because LPNs have 3 initials while RNs only have 2. LPNs are nurses. We may not go to school for 2-4 years but I have worked with some nurses and wondered how they made it through school. I have been a LPN for 20+ years and proud of it. We should all work together, side by side, and forget about the initials behind our names. If you treat me with respect, I will return the same. If not and you look down your nose at me, well, good luck with that patient you need help with.

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And by responding no I am a real nurse you are no different than the RN's that you are complaining about. How can you fault them for thinking they are somehow better than you when by your statement you claim you are somehow better than them.

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