LPN practicing outside of scope

[Anonymous7118]

Hi, I work in an ICU. We are fully staffed with RN's, with the exception of one LPN. In my unit, this LPN is treated like an RN and assumes total patient care for 2 patients, just like all the other RN's. She has worked there for many years and is good friends with one of the ICU managers. She not only assumes total care of two patients, but she also gives medicines through central lines, hangs blood, and titrates pressors on a routine basis. Our manager has recently decided that it would be okay for her to start doing CRRT as well. We are a level one trauma center and this is definitely a patient safety issue. I am also concerned that the RN's who work with her, especially the Charge RN who makes patient assignments is at risk of getting in trouble. There are only 6 nurses on any given shift and she is scheduled as the 6th nurse every time she works. This forces the charge RN to give her 2 patients and there is no way around it. I need to know the best way to go about reporting her. Obviously since she is good friends with some of management, I need to go outside the hierarchy at work. How do I report this to the state board. Thanks for your help.

[classicdame, MSN, EdD]

just call them.

They may have an email address too. All reports should be considered confidential, but ask anyway.

I believe you have an obligation to do this.

[himilayaneyes]

Go through your chain of command. If you're afraid of repercussions, you can make an anonymous report to your risk management dept. They'll be most grateful b/c this is a lawsuit waiting to happen. Also report to your state BON. I have a lot of respect for LPNS, but every nurse should practice only within her scope.

[heron, ASN, RN]

My experience with this is limited and occurred a while ago, so I may be outdated.

In MA, LPN's worked in ICU in the hospital I worked in ... they were trained and their practice formally covered by the facility, including malpractice liability ... BON at that time had no issues with it.

Do you have concerns about this nurse's skills or judgement?

[tyvin, BSN, RN]

In Hawaii LPN's cannot hang blood as last I knew. I don't know about your state but as said previously it is your duty to report if this is indeed not something an LPN can do in your state.

I have a concern with the LPN as well if she is practicing outside the scope of practice and does it knowingly. I know why management is doing it but why is the nurse when she probably doesn't get paid enough anyway.

I understand why you're concerned and you should follow through with previous suggestions.

[ktwlpn, LPN]

have you checked your state BON website to see exactly what the LPN's scope of practice is? It varies widely from state to state.Before you report anyone you should certainly check it out. In my state I can access central lines,I can't hang blood or titrate pressors or do IV pushes.

[Fiona59]

I've got to chime in on the blood bag thing. Technically, in my province it's out of my scope to hang blood. BUT it does require a TWO nurse verification procedure. Both nurses (RN & LPN) check the bag, the RN pierces the bag, walks back to the patient with the LPN who has the patient, hangs the bag and walks away. Same process with travisol. Legalities met.

It may be done this way in your ICU. How far is it between patient pods and is an RN's shift really that disrupted by hanging a bag on an IV pole?

There is a very fine line between the scope of practice in my province and it's getting finer by the month. PNs are educated to the old diploma RN level. Does this mean in your eyes that RNs who are diploma holders shouldnt be doing these duties also?

[Flying ICU RN]

The answers to all of your concerns, can easily found within your own facilities published policies, as well as online within your states nurse practice act, and the B.O.N, online portal.

You should have facts, and specific examples of what, if any, regulations may be in violation prior to proceeding.

[misschiatia]

You can kill to birds with one stone. You can both check with your board about what your state's actual scope of practice is for LPNs and report it, all with one phone call to your state board. If nothing has been done wrong, then no wrongdoing will be found(they can't find whats not there, right?). But if it is as you say, leave it up to the board to investigate and address the situation. In my experience, you may remain anonymous as well. I think they have to investigate all complaints, but greater weight is given if they are able to follow up with the complainant(did i spell that right?)

You don't want anything bad to happen, then have to try to sleep at night knowing that you were aware of the potential for harm and did nothing.

[jjjoy, LPN]

I'd suggest avoiding the patient safety angle initially and focus on state and hospital policy in regard to LPN scope of practice. An LPN could be a perfectly safe practitioner in that role (through experience, self-study) but whether or not their license allows them to fill that role without an RN license is the issue at hand. Your personal view on whether or not it's good policy to allow an LPN to do X or Y won't hold much weight. If it's determined that it's okay for LPN to be in that role, then think about addressing any concerns you may have about whether or not *this* nurse has what it takes to do *this* job.

[iwanna]

I am not aware of other states cope of practice. In PA and OH, an LPN is not allowed to hang blood or push IV meds. Every facility has their own policy, but they all need to practice within the scope of practice for the state. LPNs are allowed to do more now, but we are still not allowed to hang blood or push IV meds.

[caliotter3]

just call them.

They may have an email address too. All reports should be considered confidential, but ask anyway.

I believe you have an obligation to do this.

My state has a form on the website that any Joe Blow can download to fill out to make a complaint about any nurse. If that is not available, just write out the specifics in a detailed letter and send it to the address of the Board and be done with it.