LPN Scope of Practice: First aid vs Initial assessment

[ilovewoundcare]

There is a bit of controversy at my workplace currently over an LPN's scope of practice.

Our boss is requiring the LPNs to go to people who have passed out, had a seizure, got a head injury, etc. The LPN is then supposed to bring the patient back to the building in which the RN works and transfer care to the RN.

Our boss says all the LPNs have first aid training, so it is within their scope. The LPNs disagree, stating that this counts as an initial assessment on an unstable patient.

Does anyone have any insight? Has anyone encountered a similar issue? What are your experiences?

[caliotter3]

Makes me wonder why LVNs are expected to deal with these situations in LTC facilities.

[ilovewoundcare]

It's not an LTC... It's more like... a campus... with a sick bay... I don't want to be too specific. There's usually an RN and an LPN on duty at night. The RN is supposed to take care of the unstable patients. The LPN takes care of med pass and stable patients. The controversy is who leaves when there's unstable people who need brought in.

[caliotter3]

You are misreading the intent of my previous comment. If LPN/LVNs can do that aspect of the job in one venue, why not in another? In LTC facilities there is usually at least one RN assigned, but they don't take over the care of a resident assigned to an LPN. In some small facilities, there is only one LPN/LVN at night. When a resident falls, they don't call the DON to come assume the care of the resident that fell. Same thing when LPN/LVNs work in home care.

[ilovewoundcare]

I think I understand what you're saying, though an LTC facility is a care facility whereas this place isn't. The person who had some event occur isn't a patient. They are just a person at a non-medical building within walking distance of the medical building. An RN hasn't done an assessment on the person first. No one has assigned or delegated the patient to the LPN after assessing the stability of the patient and the predictability of the patient's outcome. That's why the RN is supposed to take over the patient after the patient arrives- to do a full assessment and determine the patient's stability, take steps for further referral, etc.

[Floor_Nurse]

I voted "yes". Although it seems odd to have one nurse be the "first responder" then hand it over to another nurse, an LPN can respond to the things you stated... passed out, seizure, head injury.

If the situation is severe, like cardiac arrest, why would an RN just sit around and wait for an LPN to do an initial assessment? In other words, which ever nurse is the closest should respond.

[Hello_Pretty, RN]

You were pretty vague about the type of place you work at... I would have the RN stay. What if there are multiple patients who are unstable, will the RN leave those patients and ALL the patients in the sick bay just to run out and grab someone?

[NotMyProblem MSN, ASN, BSN, MSN, LPN, RN]

Employers can say what they want; but what does your company's policy state? And is that policy in line with your state's Nurse Practice Act?

Aside from above, anyone (licensed or not) can be a first responder onto an accident/incident scene; and they always transfer care over to someone more qualified.

[xoemmylouox, ASN, RN]

You aren't doing a complete assessment in this situation. You are triaging based on current symptoms then transferring care for a full assessment to the RN. Each state has it's own Nurse Practice so I would refer to that, but in my state this is allowed.