LPN job in Hospice entails not much, why?

tencat · Sep 13, 2007

It's really silly because the LPN's I know in my job are WAY more knowledgeable than I am. I am constantly asking them questions about managing symptoms. I'm not sure what our company's official policy is (ie, can LPN's call docs, etc.) but the unofficial policy is that the RN signs off on any official paperwork like recertifications, and the LPN's aren't given their own caseload, officially. There is so much to learn in hospice as it is truly a specialty area of nursing.

Hospice Nurse LPN, BSN, RN · Sep 16, 2007

In Louisiana, the LPN does everyting the RN does EXCEPT admits, alter the care plan, and re-certs. We DO sit in on team meetings and make suggestions. The RN makes a supervisory visit q 2 weeks and the LPN does all the others. I've returned to LTC for more stable hours (no call) while I'm back in school and I feel my hands are tied there! Call the doc to get an order to send to ER so the pt can be pronounced....gimme a break! THE MAN WAS DEAD! Oh well, another vent for another day!

Sharon :lol2:

sharona97, BSN, RN · Sep 16, 2007

kstec,

I am just starting to introduce myself through this forum. I am an LPN, but do not work in hospice. Yes, I have taken care of dying people while on the floor or in the cath lab. Which was very hard for me and frustrating; I think now, because of the unknowns to me at that time.

Do you like what you are doing for nursing care? Inspite of the limitations you expressed. Maybe reading some of these posted articles and commentary posts will pump you up for your expressed need of continued nursing.

Just a thought. I find this information to strike me in a new light and I am seriously thinking of bringing what I have to offer into this specialty of nursing. What are your thoughts about engaging into the learning spectrum of what you are already doing? Let me know! :idea:

doodlemom · Sep 16, 2007

I had my first two visits today and they went well (head to toe assessment and a couple of dressing changes), but from orientation I get the vibe that is all we are allowed to do. An RN has to do one visit per week and then the LPN can do the 2nd or 3rd if there is one. Lpn's are not allowed to do admissions, live discharges, pronounce death, write orders, call doctors and the list goes on and on. I've worked in LTC so this is a big adjustment. I guess I can say it'll be easy money, but not very challenging. When I was interviewed the DON told me there was not much difference in job description between LPN and RN, boy was that a lie. I'm gonna give it a go, but if I'm becoming brain dead from lack of learning, then I'll have to move on. I'm one that needs to be busy and learning something constantly, otherwise I get bored and easy money is not worth the boredom.

Medicare requires an RN to assess the pt at least every 14 days, do admissions, and initiate/update care plans. Calling a physician and writing orders is something that LPN's do all of the time. This must just be r/t your agency. Since the RN is the case manager, in order to have better communication between you and the case manager, they may be requiring that you call the RN so that she/he knows what is going on with the patients.

aimeee, BSN, RN · Sep 17, 2007

Some of the difference may be due to state law where you are. In our state, LPN's cannot pronounce a death. As Doodlemom stated, it is Medicare that has decreed that an RN must assess the patient at least every two weeks and must be the Care Manager and do the care planning. Our LPN's can call the physician and get orders and enter them, but they must be signed off by an RN.

a21chdchic · Sep 18, 2007

9-18-2007

Actually, in AZ, it is not within an LPN's scope of practice to do an assessment without an RN signing off on it. When she does an 'assessment', it must be labeled 'nursing observation' when documenting. Admissions, discharges, recertification, utilization reviews, pronouncing death are all RN functions. The hospice agency that I was with found it was not in the best interest of the agency to have LPN's (time or money), and so phased out the use of LPN's. Also, if the LPN wanted an order for a change, she/he had to go through the RN to get the ok to call the MD, because the patient is the responsibility of the RN case manager. Lpn's are not allowed to do discharges as they cannot do teaching. So basically, all the LPN could do was to make visits for the RN. The LPN's quickly became frustrated with the restrictions. I have known and worked some LPN's who were very knowledgable and experienced enough to do alot of these things, but it is still not within their scope of practice. I suggest you check with your state's scope of practice for an LPN, and this may explain the restrictions. The LPN's complained so much to us about wanting her own caseload, and all of the restrictions, we finally told her if she wanted to do the job of an RN, she should go back to school and get the credentials and qualifications to do the job.

This may seem harsh and cold, but honestly, it was just as much a pain for the RN's as it was for the LPN. Why bother hiring an LPN when she/he is so limited and we have to go behind them and redo alot of what they could not do. It would have been much easier to just do it ourselves. Sorry. I'm not trying to be mean.

aimeee, BSN, RN · Sep 18, 2007

It was much the same for us and we have gone from utilizing LPNs to not to back to it again. We have found some really terrific LPN's and when you have the right RN and LPN teaming together it can work pretty well.