LPN's in CCU, a vent

Specialties CCU

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I've looked around and didn't see a thread discussing this problem so I started my own. Excuse me if it's been done to death. I just need to vent. :stone My anger is directed at the hospital not LPN's...so please read this with that thought in mind.

I work in a medium sized CCU in a community hospital. We have RN's and LPN's working in the unit. I'm about to lose my cotton picking mind. We had a rough night last night...scratch that...every night is rough. I've never worked with LPN's before. I had no clue what their scope of practice was. I've come to the conclusion that LPN's in a unit creates incredible stress for the RN's. Their limited scope of practice leaves the RN's with ALL the admissions, ALL the sickest pts, ALL the codes, ALL the PCI's, plus covering the desk which monitors tele's from the tele floor.....AAAARGH! Last night there were 2 RN's and 3 LPN's. One RN had the desk and I was the only RN actually working in the unit. I had the 2 sickest pts plus admitted a code from the tele floor, plus covered the LPN's iv meds, (all ICU pts are on IV drugs...what the heck is up with having nurses on board who cant give iv drugs??) transfusions...then a PCI was called. Give me a freaking break!

OK, vent over. :uhoh21:

We also don't utilize LPNs in our critical care areas. And I empathize with the OP... I remember at my last position (on an oncology floor), it wasn't uncommon for me to be the only RN with 3 LPNs... I'd have to be charge, have my own 8 patient assignment, do their initial admission assessments, careplans, IV bolus medications.. it was very difficult.

I agree, speaking to management about this. Is staffing really sporifice on your floor (as it is everywhere)? Would it be possible to work with 2 RNs on the floor and 1 LPN?

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I was an LVN and I went to RN school to be able to work in ICU.

I have seen some great LVNs in ICU. But the fact is I invested 5000 hours of my personal time to meet the state requirement to be able to take care of the critically ill. And they should too. Our new Texas NPA specifically states LVNs can only take care of "stable patients with a predictable outcome" and that pretty much precludes the vast majority of ICU patients I have seen in my 7 years of LVN experience. They are still there but I think that will end once a team of attorneys explains it to Mgt on behalf of a dead or disabled person because an LVN was involved in the care. And no doubt the RN charge who assigned said LVN will be working at Walmart.

btw

I went to RN school because I got tired of being beat up for being just an LVN.

and to be clear I respect the LVN. they are valuable in many areas

I still have my LVN license

But the ICU should be an RN only area...because thats what the law says and for no other reason.

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Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.

Our ICU doesn't have LPNs. Heck ours doesn't have any CNAs either.

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[quote name=bcjams. Our new Texas NPA specifically states LVNs can only take care of "stable patients with a predictable outcome" and that pretty much precludes the vast majority of ICU patients I have seen in my 7 years of LVN experience. They are still there but I think that will end once a team of attorneys explains it to Mgt on behalf of a dead or disabled person because an LVN was involved in the care. And no doubt the RN charge who assigned said LVN will be working at Walmart.

[/quote]

Wow I just moved out of Texas and did not know the BNE had ruled on this. Thanks for the update. The last ICU I worked utilized LVN's heavily...but I suspect that will change with the new rulings. But most of those LVN's were in RN school so they may have remedied their own problem already. :)

I hope this will not result in higher nurse patient ratios with hospitals further crying 'nurse shortage'.

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Here is the file from the Texas BNE...

ftp://www.bne.state.tx.us/lvn-guide.pdf

The is RN vs. LVN Chart is about half way down the page.

it all really comes down to three words. "Unpredictable Health Status".

We had some long discussions on this in my school....ie. if you know some is going to die anyway can you assign an ICU lvn to their care..yes...but if they might live then it has to be an RN.:uhoh3:

I can tell you now there are definitely some LVNs I would prefer over some Rns if my life was in the balance.... but I think its pretty clear that the ICU LVn days are numbered if not already done....its just one big lawsuit away.:o

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I am probably going to get flamed from some LPN's for this statement. I am an LPN and love it. There are places that LPN should not practice and I have to say critical care areas are places that LPN do not need to be. I know there are some LPN who have been practicing for years and are very knowledgable but they are not RN and do not have the assessment skills that most Rn have. If LPN wants to work in these areas they should go back to school for RN. I do believe there are places for LPN in nursing. We are still nurses, we just do not belong in every field of nursing. One problem I see is that LPN wants to be recognized as a nurse and sometimes feel that they are not preceived as nurses and are not always treated professionally by RN. We all need to learn to accept our limitations with the type of nursing that we have chosen. Someday I might go back to school for RN but for now I am happy with where I am in life. I hope that someone has a fire extinguisher when the flaming starts. :flamesonb

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Specializes in OB.

I am an LVN as well and I agree that LVNs/LPNs should not be in certain areas of nursing because of our "scope of practice". However, we are allowed to work in some areas and maybe (instead of always getting angry because we can't take a certain patient or do certain things) the RNs can just work together with the LVNs and do the things that isn't within their scope of practice and delegate them to do things for you that is with in their scope of practice. It's called teamwork... and it makes for a more nicer work day/night. The RNs I work with seem to like it.

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Let the burning begin! :D

I have ER and Critical care exeperience. Many RNs I work with are of lesser skills then some of our LPNs. RN doesn't mean better care or better assessment skills, just means register nurse. of course, the law recognizes a difference and with that difference it can mean additional responsibilities, but I think it should be, if there going get paid more.

Most situations can be handled by more teamwork and maybe someone changing there mindset.

Nursing profession has many whiners and complainers, not saying no real concerns exist but often it's exagerated, IMO. :kiss

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I also agree that LPNs do not need to be in critical areas.

I'm NOT an RN and I KNOW that. I do NOT have all the training, knowledge, skills that they have, and so therefore I do NOT want to be put in a position that could be dangerous for me or the patient.

My license doesn't permit me to do the things an RN can, plus I don't get paid to do what they do.

However, it doesn't mean I don't want to learn or be a team player.

I will assist my RN in any way that I can.

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The P&V for practical/vocational mean just that...care of the patient with common conditions that have a stable, predictable outcome. Patients in ICU and other critical care areas are beyond the LPN scope of practice. I was an LPN for many years and always understood and respected this. I was never once insulted that I did not hold the skill and educational level to practice in these areas. LPN's are great and valuable! I learned so much as an LPN--it really helped me make the transition. We all have our place in nursing and we all need to stay within our legal scope of practice.

Karen

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The P&V for practical/vocational mean just that...care of the patient with common conditions that have a stable, predictable outcome. Patients in ICU and other critical care areas are beyond the LPN scope of practice. I was an LPN for many years and always understood and respected this. I was never once insulted that I did not hold the skill and educational level to practice in these areas. LPN's are great and valuable! I learned so much as an LPN--it really helped me make the transition. We all have our place in nursing and we all need to stay within our legal scope of practice.

Karen

I understand what ya'll are saying and I was a LVN myself first. I just know quite a few sharp LVN's who learned ICU OJT and do very well well there; as well as I did. I myself, as a very old RN, never took a critical care course perse...I also learned ICU 'OJT'. But the times they are a changin'.

The law is the law; and Texas and other states are making it law LPN's cannot go into these areas where instability is likely (and that's why they're in ICU).

Now we shall see what transpires. Hopefully it will not be even higher nurse patient ratios and addition of UAP's to specialty areas. If there is such a 'nursing shortage' out there I fear this will occur. I hope I am wrong.

Does it not seem strange: all the 'nursing shortage' hoopla yet BNE's make laws causing further staffing problems in areas currently utilizing experienced, competent LVN's who will now be reassigned to areas they are quite overqualified for. Will these LVN's resign? I might...after working ICU for 15 yrs I may have no desire to move to medsurg.

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We titrate them kind of drugs where I am in NC.

We doesn't here.

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