LPN scope of practice

[Quark09]

I realize this can vary a bit from state to state, but in general, I thought that in a hospital setting, an LPN/LVN cannot do an initial assessment, hang blood, do IV pushes, or do initial patient education (they can reinforce it though).

In light of this, I was a bit surprised to come across an ad for a hospital seeking an OB LPN; duties to include the following:

Obtain initial health data of patients with a wide range of specialized medical and surgical conditions. Provide educational service to patients and their families for health promotion, prevention and/or detection of disease. Conduct initial interview, provide appropriate referrals and lab panels per protocol for new maternity patients. Perform electronic fetal monitoring as needed. Document patient information in record, computer, and log as appropriate.

The ad called for a year of experience r/t the field. Regarding the obtainment of initial health data and conducting the initial interview, is this the norm in some of the places you've worked? I've been on med/surg, OB, ICU, and PACU, and while LPNs worked in med/surg and OB, they didn't do initial interviews or assesments.

[DogWmn]

It really varies significantly from state to state and it also depends upon the facilities policies.

This review state by state is a bit old but as you can see some states like Georgia have no restrictions.

http://nursing.advanceweb.com/article/lpns-and-iv-administration.aspx

The BON of each state determines what the LPN can and can't do and the laws are in flux at any given time.

When I graduated from school in 1972 we weren't allowed to touch an IV except to monitor the rate...back in the day with glass bottles:rolleyes:, and DC an IV. BUT, we were responsible to KNOW about all the meds/blood going in to watch for reactions etc.

Scope of practice has changed over the years for LPN's but also for RN's...it's ever evolving.

[Jules A, MSN]

when they let LPNs do whatever an RN can do why would they bother? It certainly doesn't make it so that one would feel limited enough as an LPN to feel like they needed to go back for an RN let alone a BSN.

I can answer that question. My motivation to go back to school was the $15 an hour increase I got for getting my ADN while basically doing the exact same job.

[red2003xlt, LPN]

The state of Florida greatly expanded the scope of practice for LPN's.

Something my instructor's in my nursing school(accelerated LPN) were pleasantly surprised.

[prettyinblu]

you have more freedom than we do at our hospital as an lpn. We still monitor the vitals and everything. The RN cosigns and then leaves, once the first unit is finished the RN returns gives the IV push lasix verifies the next unit and is gone again?

[SweetBabyLPN]

not for nothing but i don't get how the training/prep/schooling is not the same and yet it sounds like in some places lpns are doing the same things as an rn.....just putting this out there as a thought but for those out there trying to push that all nurses should be rn/bsn--when they let lpns do whatever an rn can do why would they bother? it certainly doesn't make it so that one would feel limited enough as an lpn to feel like they needed to go back for an rn let alone a bsn. and me personally i don't like the idea that the law says lpns can't assess so they go ahead and assess and just call it something else to get around the law. when something is missed and the lpn did the "observation" isn't that a huge liability for a facility if the patient/family decides to sue.

--as far as ob in ny--when i worked in l&d they didn't hire lpns. too much working independently and assessing constantly to have lpns and have to get stuff co-signed.

--when i worked on an inpatient medical floor we had a few lpns and they couldn't do anything with piccs unless they were already running ns they could piggy back.

--blood they couldn't hang but could be a second check (all blood had to be checked by 2 nurses, at least one being an rn)

--they couldn't do iv pushes either--of any med.

first of all, they don't "let" lpn's do whatever an rn can do, we are trained to do those things in ns (like you) so we are always practicing within our scope. it's not the same thing as an ma in a doctor's office who is really not trained to do certain things but does them anyway because "the doc lets me".

secondly, you're right that plenty of lpn's don't feel limited enough as an lpn to go back and become an rn, but trust me, most of them do. why, you ask? well, like someone else stated, the $15 an hr pay difference is a big motivator along with the fact that we usually can't take any other position in nursing other than staff nurse or other low grade positions. there is also a major stigma surrounding lpn's, that we are "little pretend nurses", while rn's are "real nurses". i could be wrong but something that i read in the tone of your post gives me a feeling that you are one of the people that harbor these feelings and would rather see lpn's get pushed out of the acute areas in nursing.

finally, lpn's do not "get around the law by assessing and just calling it something else". the law states that an lpn data collects and observes while an rn assesses. at least in my state it does. when i was in ns, i learned that the lpn nursing process is different than that of an rn in that we "collect data" as opposed to assessing. and when we get out in the real world, that's exactly what our employers expect us to do! on admissions forms, all the sections are appropriately labeled "data collection tool" and only require the signature of a licensed nurse which we are, therefore, it would not be a liability if the facility got sued as we are not doing anything illegal, we are practicing within our scope. so please don't make it seem as though we are being dishonest in some way.

as far as missing something during an assessment and getting sued, rn's are human and miss things too. i don't think that that would have so much to do with how much schooling you've had as much as it would be about your experience level and critical thinking skills, knowing what to look for and such. a new grad rn cannot "assess" better than an experienced lpn can "data collect" .

a brief history lesson if i may. lpn's were bourne as a clever way to manage the "nursing shortage". it was taking too long to produce rn's and so the idea was conceived to train nurses in a shorter amount of time, mostly in hands on things. . . thus, the lpn. lpn schools are heavy in clinical hours and many skills are learned. the difference in my area between an lpn program and an rn program is 8 months. in this time, the only classes taught that an lpn hasn't taken are psychology and a plethora of management and research classes. also, to my understanding, rn schools go more in depth as to why you are doing something. this is why they say an rn must always be in charge (even though tbh, where i work this doesn't always happen. we have lpn unit managers and rn staff nurses.).

whether you like it or not, lpn's are nurses so why shouldn't we be able to function at full capacity in regards to delivering good bedside care? you need to remember that there is more to being a nurse than what skills one can perform and realize that an lpn having a wide scope of practice does not make an rn any less of an rn, nor does it negate from the hard work you put in while in nursing school. although in many states we can perform all of the same physical tasks as you, we will probably never be able to move up the ladder like you can without returning to school. your additional education affords you that extra grain of salt, so hopefully that helps you feel better. anyway, it should make you feel good to know you are getting paid significantly more $$ to do almost, or in many cases, exactly the same job. trust me, you came out on top with this one honey.

while i sympathize with your frustration, i must say that as an lpn, i don't make the laws, i just follow them.

by the way op, i just had a baby 3 weeks ago and my best nurse by far was an lpn (postpartum), although almost all of them were good.

[indigonurse]

When I have questions I call the nursing board and speak to a consultant. Believe me like you I have wondered about things before.

[Quark09]

By the way OP, I just had a baby 3 weeks ago and my best nurse BY FAR was an LPN (postpartum), although almost all of them were good.

I was in no way calling into question the care that is provided by LPNs; I have worked as one myself. My question was regarding how this particular ad defined the expected role of an LPN in that particular setting. In every place I've worked, there were certain things (IV pushes across the board, hanging blood, initial education of the patient, initial assessment, etc) that I would not have been allowed to delegate to an LPN, no matter how competent. I have heard from a few friends who work in other settings that their facilities (non-Magnet hospitals, in most cases) were hiring LPNs in place of needed RNs, who then had to take on additional responsibility and cover certain procedures, such as hanging blood, assessments, etc on patients assigned to those LPNs. Conversely, in the L&D settings that I've worked in, LPNs were just not hired because the normal patient level was lower, and all care was simply handled by the RNs since most of the work was, as another poster wrote, carried out independently. It would not have been practical to have nurses on the floor who could not perform all needed tasks legally for each patient.

[SweetBabyLPN]

I was in no way calling into question the care that is provided by LPNs; I have worked as one myself. My question was regarding how this particular ad defined the expected role of an LPN in that particular setting.

I know. I didn't think you were. I was just just commenting on it because it's also in OB so I thought I would mention it. Sorry if you misunderstood my intent. :):):)

[Quark09]

I know. I didn't think you were. I was just just commenting on it because it's also in OB so I thought I would mention it. Sorry if you misunderstood my intent. :):):)

Ah, gotcha!! Cool then; it seems like online communication can get lost in "translation" sometimes, so just wanted to make sure!

[nursel56]

It sounds to me like it might be a clinic or OB's office job, as I didn't think maternity patients would normally show up in Labor and Delivery with zero history.

So if you look at it that way, doing an initial assessment and interview and ordering labwork per protocol on otherwise healthy people isn't that complex a thing to do.

"Patient Education" in that setting might be a video, or a simple pre-memorized spiel and some brochures, FAQs, "what to do ifs" etc.

The statement "the LPN gathers the data and the RN assesses the patient" might be true in some cases, but isn't a blanket rule. We are taught to assess. If we only needed to be trained to collect data, you could cut LPN school down to a few weeks. If the LPN "collects data" and listens to the patient's breath sounds or checks for peripheral pulses - the data is subjective and the RN would therefore be relying on the LPN's assessment skills.