LPN scope in ED

[WonderRN]

I work in a very busy ED with high EMS volume that is a stroke, stemi and trauma center. We are trialing LPNs in the ED but nobody has been able to define their role for me. They are utilizing LPNs in triage, and having them be the primary point person to answer and triage EMS calls. We have both high volume and high acuity patients that arrive via EMS and this is concerning to me. I thought this was outside of their scope of practice? Curious if anyone had any more insight into this? Are you currently using LPNs in your emergency department and in what capacity?

[delrionurse]

When I worked ED, LPN's worked in fast track, holding or non trauma areas. Lower acuity rooms. Never (initial) traumas, or triage level 1's.  They never triaged or answered radio calls. 

[AnnieOaklyRN, BSN, RN, EMT-P]

Ditto on that last comment. When I worked ED LPNs were only allowed to do fast track, because I think in most states they are not allowed to do initial assessments, but I could be wrong.     I think it is high risk to have them in Triage though, unless maybe they have at least a year or two of experience in your ED first.  When I worked ED we weren't even allowed to work triage for at least a year!    

I would look at the board of nursing website in your state and look at the scope of practice for an LPN, that will possibly give you a more clear answer on what they can and cannot do. 

 

-Annie

[Nurse Beth, MSN]

Fast track, wound care, starting IVs, NGTs, foleys, blood transfusions (here in California), collecting specimens, administering meds-there's lots they can do in a supportive role with supervision.

Triage is generally considered an RN function. Typically, initial rapid triage, interpreting EMS radio calls, assigning acuity, performing independent assessments, taking orders for anything outside of their scope of practice, and patient teaching are not within the LPN scope of practice.

Ask for written clarification of LPN responsibilities from leadership (ED manager, CNO, Risk Management).

Check the Nurse Practice Act and the regulating body for LPNs in your state. Look for advisory opinions on LPN roles in emergency departments.

Advocate for clear protocols defining how LPNs should function, with appropriate RN supervision built in.

If the practice feels unsafe, consider reporting concerns to your unit council, shared governance, or leadership chain.

 

 

[WonderRN]

Thank you to everyone who responded. I took this to Leadership, expressed my concerns and they agreed we should not be staffing LPNs in triage/comms. 

[FiremedicMike, BSN, RN, EMT-P]

WonderRN said:

Thank you to everyone who responded. I took this to Leadership, expressed my concerns and they agreed we should not be staffing LPNs in triage/comms. 

Our ED uses zones, each zone has 2 RNs covering 4 patients each and then a tech, medic, or LPN in the zone as well backing up both RNs.

When we have an LPN in our zone, they'll be on the board looking for open orders and filling the ones they can (oral meds, labs, IV stuff, etc) and discharge patients. 

Essentially, they're techs who can give some meds and discharge.  When we have a good LPN in our zone, it's amazing.  

[floydnightingale]

When I first started as an RN, (level one ED year 2000) there were two LPNs who were grandfathered in and only worked in observation where they were allowed to pass meds from a restricted list, 25 years later I'm sure they are long gone, to consider hiringb LPNs for the job seems insane especially in an age when hopsitals are seeking BSNs for entry positions.

[FiremedicMike, BSN, RN, EMT-P]

floydnightingale said:

When I first started as an RN, (level one ED year 2000) there were two LPNs who were grandfathered in and only worked in observation where they were allowed to pass meds from a restricted list, 25 years later I'm sure they are long gone, to consider hiringb LPNs for the job seems insane especially in an age when hopsitals are seeking BSNs for entry positions.

Or we could rethink utilization of LPNs in the hospital and use them to help ease the burden.

I've seen it work.  When I come in and see my assignment and which (if any) LPN I have in my zone, it makes or breaks my day.

 

 

[Nurse Beth, MSN]

FiremedicMike said:

Or we could rethink utilization of LPNs in the hospital and use them to help ease the burden.

I've seen it work.  When I come in and see my assignment and which (if any) LPN I have in my zone, it makes or breaks my day.

 

 

I agree, LPNs could be used so effectively and help RNs work to the top of their license.