LPN mistreated in dialysis

Valerie Salva, BSN, RN · Mar 26, 2009

the LVNs in my experience, are basically a tech with more responsibilities. I have to set up my 4 machines, put on my 4 patients, assess them, monitor them, give their meds, take them off, clean machines, restring, do it all over again, give the hypertonics and the tylenol because the RNs don't want to do it anymore, it's not important enough for them, now that I have my license. The RNs in my clinic don't take pts, unless there is overflow. they do meds, assessments and catheters. and deal with all the doctors. which is more than I care to deal with at this point in time.
But, I feel like for all the work we do, we should be paid more. can I get an amen? I am(was) the lowest-paid PCT in my clinic. My boss offered me, once I got my license, 2 dollars more than I KNOW some of our PCTs make. i was shocked. I went to school for 16 months, while working full-time for her, busting my butt every day and never sleeping, studying my tail off to get my nursing license, and she is going to insult me by offering me a pinch more than our PCT makes? absolutely not.
I'm not too bitter, In just had a bad day :banghead:

Your clinic is still using hyperonic Na+?

KDOQI considers this to be a dangerous and outdated practice.

workingmomRN · Mar 26, 2009

Yesterday I received a quarterly nursing journal published by our state BON. It has an article related to the LPN's scope of practice. It states that the roles of "administrator" and "manager" are specifically limited to the RN but the LPN can work as a "nurse-in-charge". The LPN can work in this role if 1) the time is limited to a specific 8-12 hour shift in a 24 hour period, 2) the environment is limited to a geographically defined unit or clinical area within the healthcare setting, and 3) the assignment is limited to patients whose healthcare status is stable (not expected to change over days or weeks).

With all this criteria in place, the LPN can delegate tasks related to staff assignments and validating that the work has been performed according to facility policy & procedures.

However, only the RN can supervise, counsel, and evaluate nursing staff. The LPN cannot indepently assess patients. They can collect patient data, but the RN is must complete the assessment & take appropriate action.

The LPN can counsel nursing staff regarding "administrative" issues such as tardiness, time schedules, etc, but only the RN can counsel & evaluate nursing practice.

The LPN that I had worked with told me a few months ago that she could now be charge nurse because the new Fresenius P&P allowed it, so now they (meaning her & the CM) didn't have to "hide it anymore". She now works 8-5 M-F. And they wonder why they can't keep RN's.

redknight · Mar 27, 2009

:yeah:Nice, it still leaves the fact that and LPN CAN NOT be over an RN.I work for the big F and iy dosn t matter who you work for in the private side of medicine. THEY ARE OUT FOR THE BUCK. They will use and abuse. The most secure job in this Co. is the trainers, because they always have new employees. I once said to a VP that if they spent the money in ways to reain people that they might be surprised as to how much they would save in training new employees. With that said I asked how much dose it cost to train a nurse. He did nt know. and they come at us in Acutes and say we need to cut costs? They now want us to report our hrs every day to keep it in line and when we are close to our 40 take a part of day off and be on stand -by with no call pay. Ya right, and thats gonna happen. I like doing diaylsis, but I m getting close to getting out and find something more secure. Can t deal with this corp. bullsnots any more. :banghead:

traveler RN · Mar 27, 2009

I am currently a traveler in a RRI clinic and this sounds a lot like this one. LPNs are low on the totem everywhere and it is getting just as bad for the RNs. How can this be I asked? As long as an RN is in the bldg this person can be charge! Wow! The nurses are expected to help in turnovers while the charge person is sitting down. What's wrong with this picture?

workingmomRN · Mar 28, 2009

It sounds as if it could be the same clinic. It is an RRI clinic, but they use Fresenius P&P. They use alot of travel nurses & PCTs. The travel nurses get their 40 hours first, then the regular staff gets whatever hours are left. There were some weeks that we only got 2 or 3 days. I asked the CM wouldn't it be cheaper to pay the regular staff some overtime instead of relying so much on travel nurses, and she agreed but said their contract with the travel company sayes that they have to give 40 hours each week to the travel nurses. So the rest of us had to use our PTO time (if we had any left) to make up the difference in our paycheck. Turnover time was really chaotic, The nurses had to bring in & weigh the patients, etc. If there was a call-out, the nurses had to take the pod & still assess everyone & give meds, etc. I always felt like something bad was going to happen, & sometimes it did.

There were some times if a nurse called in, the "CN/LPN" would have to call another nurse to come in & just be in the building so they could start patient treatments. Kinda crazy. I only stayed about a year, then left to work for Davita.

All of the companies are out for the money, but its the people you work with that make or break the clinic. Some are really good work environments & some are awful places to be in.

traveler RN · Mar 28, 2009

When you don't get the contract hrs. the company decreases your housing allotment and deduct it from your check unless you specify the facility was unable to provide the contract hrs. No overtime is fine with me, after working in a Davita clinic when I was perm. for 15-17 hrs a day, no other nurse and techs only, I am tooooo glad to go. :yeah: Saw no lpns on Sc, RNs only; in Ga lpns are techs only and no charge. In NC lpns in charge and on staff. I hear and see the frustration on the nurses faces when they are told the breaks are being too late. When you have a calloff, where is the CN? I have put on 6-7 pts myself and feel lucky if I get a pee break:banghead: The clinics are burning their nurses out and just don't care. I see new equipment, wasting of meds, mamdatory overtime and no thoughts of giving their staff a decent living wage and because we all have to work, we accept it.

workingmomRN · Mar 28, 2009

I have worked in 2 different clinics where I was the only nurse in the building & PCTs only. My main worry is if an emergency was to happen with my child at school, or another family member, how long would it take to get coverage before I could leave the clinic? Also, if an emergency happens in the clinic, you don't have much staff to help you. I have thought of trying to get into another area of nursing such as home health because the hours are more flexible, but it seems like there are no really good jobs out there anymore. Doctors offices don't want RNs anymore because of the pay, so they have mostly CMAs and 1 RN to oversee the nursing practice. Most of the hospitals around here have hiring freezes right now, so I figure the smart thing to do is to stay put until things start picking up. I have an ADN degree, and have been considering pursuing either a RN-BSN or RN-MSN degree and using Davita's tuition assistance to help pay for it, since I'll more than likely be there for a while. There is one other nurse that I work with that has been there for 2 years and she is so totally frustrated. But she has 2 small children and her husband's work has been short so their money is really tight right now. It is hard when you feel like you are stuck and can't go anywhere.

traveler RN · Mar 29, 2009

That's how I felt in my last year at davita, like the windup toy that keeps going even when it's in front of a wall and just keeps trying to go. I fell down the stairs one am rushing to get out the door and there's no one who can get there in enough time to get the clinic started without an hour or more delay in their time. So I went, pain and all. My releif didn't get there until 12:30, mind you this happened @ Odark30. My pts. felt so bad for me, they even had a family member bring me a thermal wrap cause I couldn,t move without tears and extreme effort. It's just as bad for a traveler cause you're miles and hours from home. I feel for the lpn but as a traveler, I've sometimes had to let techs know they are working under my license that day and I like to eat too well for them to mess up my rep and money. You have to learn every aspect of dialysis so you can hold your own no matter what. Like I tell them, I can do your job but you can't do mine, so we either work together or let the problem get bigger than it needs to be.

workingmomRN · Mar 31, 2009

I got called in one time when weather was bad because the other RN called out d/t the weather. The patients had to wait almost an hour to start because I had to drive almost 40 miles to get there. It does put you under alot of pressure knowing that everyone is waiting on you to get there, and how very impatient some of them are.

That was really nice for that family member to bring you a thermal wrap to help ease your pain. Just when you think no one appreciates anything you do, someone will do something like that & make you remember that what you do really does matter to someone.

I'm sure with you being a traveler that some of the PCTs try to see how much they can get by with when you are working.

kmom · May 8, 2009

In NC, lpns can do charge. There is only one LPN at the clinic that I work at, and she is good at dialysis but she doesn't know anything else. That is hard in case of a code or some other complicated situation. She enjoys sitting at the charge desk and rarely checks on her patients - she is a good "paperwork" nurse. The techs love her and talk about what a good nurse she is because she is "fast", not thorough, but "fast" The techs are a bunch of whining babies that enjoy gossiping and some days, I get to the point that I want to find another job. The manager knows what goes on but looks the other way. I feel everyone's pain!!!!!!!!

sissib · May 12, 2009

Sounds very typical for a dialysis unit. I see a lot of information on this specialty of techs running the unit. We have no unit clerk or janitor and our cleaning crew will not empty the hazardous trash. I am an LPN in dialysis 7 months and am still trying to get used to the insubordination of the techs. RN's and LPN's both do all the above tasks including the water room tasks too. None of the licensed staff asks a tech to do anything we have not done ourselves. The management keeps saying changes are coming but have not seen this completed since I have been there. Sounds like a thing licensed staff has to put up with if they want to work in dialysis. I know I am becoming very discouraged with this too.

DeLana_RN, BSN, RN · May 17, 2009

Sounds very typical for a dialysis unit. I see a lot of information on this specialty of techs running the unit. We have no unit clerk or janitor and our cleaning crew will not empty the hazardous trash. I am an LPN in dialysis 7 months and am still trying to get used to the insubordination of the techs. RN's and LPN's both do all the above tasks including the water room tasks too. None of the licensed staff asks a tech to do anything we have not done ourselves. The management keeps saying changes are coming but have not seen this completed since I have been there. Sounds like a thing licensed staff has to put up with if they want to work in dialysis. I know I am becoming very discouraged with this too.

I wish I could tell you it will get better, but believe me, it won't. You've probably been at the job long enough to know whether you will truly love dialysis - there are aspects of it that are wonderful, like the long term relationship you will develop with chronic patients. If so, you may just have to decide to put up with the staff dynamics you have observed. Otherwise, run before you invest too much in this specialty which can be very frustrating for nurses (especially the nurse/PCT relationship).

Best of luck to you,

DeLana