A little history,
I have been an LPN for approximately five years in the state of Arkansas, the first three of those in the adolescent/adult acute mental health setting. I quickly became disenfranchised with my role (pill pusher) and finally decided I would go back to school for my ASN.
I thought it would be in my best interest to gain some of my skills back before going back to school, so I applyed at a local hospital to work in their med/surg unit, I chose this hospital because it still did primary care nursing versus team. My orientation was very brief (approx. two twelve hour shifts) I was very uncomfortable given my lack of experience on medical floors but I am a quick learner and I caught on rather quickly.
I was quite frankly amazed at the amount of duties I was not only permited, but required to do. I explained to my NM that I had no experience inserting, maintaining or administering meds through an IV, CVL etc. I was promptly scheduled for what they call out here a LPN II class. The class consisted of two eight hour days of instruction on how to insert IV cathters, push meds, drop NG tube, maintain and draw from CVL and a few more things I don't remember.
Suffice it to say I didn't really feel comfortable doing all the things I was taught in 16 hours to sick REAL patients, so I would usually drag another nurse with me the first few times I performed a new procedure. I quickly realized that the buck stopped with me, I was responsible for ALL of this patients care, no RN safety net to fall back on. Yes I could go to the charge nurse if I was unsure about something etc., but if the proverbial ****** hit the fan it was my ass on the line.
I started to wonder if all this was copacetic with my scope of practice as an LPN, in Arkansas LPN's are technically not permited to "assess or evaluate" only report objective findings. Yet here I was doing admission assesments, head to toe assesments, neuro checks etc. Once a shift the RN was required to make one narrative entry in the chart, they would basically come by and write Pt. resting quietly, eyes closed 0 s/s of acute distress noted. (I worked night shift).
I called my state board and did various other reasearch and was basically told that the majority of duties I was performing were in my scope of practice as long as I was under the supervision of an RN. I guess supervision of an RN is a rather subjective term and the hospital justified it by having a "Charge Nurse".
Now don't get me wrong, I enjoyed the autonomy but then it struck me one day, here I am pushing morphine, dropping NG tubes filling out assesments, starting IV's etc. basically functioning as an RN with all the responsbility and legal liability minus hanging blood/blood products and doing care plans but have only received 16 hours training in a few traditionally RN type duties and am only being compensated as an LPN.
I began to wonder what if something really bad happened, I made a mistake or I didn't catch something in an assesment would the charge nurse have been responsible also, since I was technically working under the supervision of an RN? Why would an RN take that responsbility?
I soon after put in my two week notice, I had planned on leaving anyways due to the "new" unit manager refusing to hire nurses stating that 1:9 nurse to patient ratio was perfectly okay on a med/surg unit.
I hired on at a few agencies and eventually took a position at a Long term acute care facility (no not a nursing home, are average patient is on a vent, receiving TPN with a MRSA infected decube lol). This facility employed team nursing, and the average nurse to patient ration 2:7, 1 RN and 1 LPN to seven patients. I was only reponsible for PO meds, IVPB meds and chart checks, the RN was responsible for Nursing assesments, charting, IVP meds and dressing changes.
I am a little wiser now, I no longer wish to take full responsbility for patient care, yes I "CAN" start an IV, do an assesment, drop an NG tube, push IV narcotics etc. and many times I have been asked to by the RN I am working with but now I say NO and explain myself if the RN cares to hear my explanation. I am not compensated to do this, I have not received the amount of training you have to do this and most of all if I do it and screw it up its your ass for delegating it to me.
Am I wrong for thinking like this? Yes I will still assist a new RN with a difficult IV insertion etc. but I refuse to play RN while being compensated as an LPN! I am currently working towards receiving my ASN via excelsior, and once I pass state boards and am a Registered Nurse I will gladly take that responsbility, in the mean time I will gladly work under the SUPERVISION of my RN.
chad75
112 Posts
ktwlpn.
I never questioned, nor implyed that yours, or my SBON didn't allow the things that your SBON has listed in the NPA so I'm not quite sure in the point of your last post
Sekar
So your typical ADN RN is inserting IJ's in NC? I imagine that would fall to the advance practice who is trained and compensated better out here in AR.
Maybe thats the crux of the debate, what is your idea of the role of the LPN?
brownms46
Care to expound on that statement? I feel I have been reasonably specific in my statements backing up what I say with reasons and at times concrete examples. Yes, it is easy say someone is wrong or misinformed the difficulty lies in proving your statements
What are you not understanding? I will gladly be more specific regarding my statements if you are having difficulty understanding the content.
First off I never said "I don't feel comfortable performing procedure x" The basic theme was appropriate training, compensation and recognition for the tasks. After doing the aformentioned procedures numerous times, reasearching on the side and having succesful outcomes from the procedures I did I eventually become comfortable with them. I see a theme of you and a couple others stating I don't feel comfortable with procedure x. I am not quite sure where you derived that.
Secondly, you are right in the matter of excelsior providing no clinical experience but guess what? I've already done my clinical via one year of med/surg hands on 36 hour weeks giving approximately 1800 hours of clinical not to mention my other year working at various hospitals/satelite units etc. via agency. Does that change the fact that as an LPN I felt I wasn't provided the appropriate training, compensation and recognised for the liability and increased skill level I brought to the table? Wouldn't I be a fool not to capitalize on that and turn my previous lemons in to lemonade ?
Thirdly, excelsior doesn't hand out ASN's you work for them, after doing all the appropriate theory and being tested you have to pass the clinical portion. You have to prove you can do these skills you learned you get two mistakes, on the third one you are out. A mistake can be something as simple as not introducing yourself properly when you enter the room or swabbing a CVL cathter counter clockwise versus clockwise when changing a CVL dsg.
In actuality excelsior doesn't discriminate in the amount of hands on clinical nursing experience they require, you could be an LPN that just graduated and has never set foot in a hospital or an RT that primarily did teaching. There are obviously some issues with this, hence the CA SBON having a hearing on this issue but hell if you are the type of person that can study theory then demonstrate correctly without flaws under the scrutiny of a nurse examiner then I say more power to you.
How does it not make sense, we were trained in theory the administration of a variety of IVBP drugs and the appropriate procedure to administer them. In this state it is also a traditional duty of the LPN to administer IVPB drugs, where dropping NG tubes and pulling Central lines is not a traditional duty of your average LPN in "my" state.
LoL you are not getting away that easily !! :) Lets not try and sugar coat your message by the last sentence at the end