LPN's in CCU, a vent

lee1 · Mar 31, 2005

Not so true. I work ICU and CCU from time to time, and our LPNs are very valuable members to both areas. An LPN can give meds--PO, IM, SQ, rectal, via tubes, and IV ATBs if IV cert.. An LPN can do an assessment on a patient, as long as one has been done by an RN Q12H. An LPN can do the baths, vitals,TLC, etc.... Our LPNs do not take a team, per se; they do help out tremendously to all teams. I know it might not be like this everywhere, but I just want to let the readers know that there are some places that LPNs can help tremendously. I do think however that the original poster's situation should be looked into. That does sound unsafe and unorganized.

Maybe you work in a fairly nonacute intensive care unit. There is no way an LPN can survive in mine. Frequent Swan/ IABP/ CVVHD, etc. We do heart transplants, etc. I could possibly understand a chronic vent unit but beyond that still believe an LPN is not appropriate and only a drain on the other nurses unless there is a legitimate shortage in your area------meaning, not connived by the hospital to save money.

RN34TX · Apr 1, 2005

Maybe you work in a fairly nonacute intensive care unit. There is no way an LPN can survive in mine. Frequent Swan/ IABP/ CVVHD, etc. We do heart transplants, etc. I could possibly understand a chronic vent unit but beyond that still believe an LPN is not appropriate and only a drain on the other nurses unless there is a legitimate shortage in your area------meaning, not connived by the hospital to save money.

I sympathize with the OP but I'm a little disturbed at some of the comments by RN's and LPN's alike here.

I'll chalk it up to a lot of RN's who work ICU have little, if any, exposure to LPN/LVN's and therefore, do not completely understand their capabilities.

Then there are the LPN's who have little exposure to ICU, so they are scared of the unknown and that is where you get the previous comment about LPN's only taking care of "stable with predictable outcomes" patient. That same quote that this poster made (who didn't include this in their comment) is also followed up with "and/or assisting the RN with unstable and/or complex patients" in nurse practice act language in 2 states where I've worked as an LPN and is taught in most LPN programs.

I was floated to ICU as an LPN frequently and fortunately the staff didn't look at me as a burdon and I ended up learning a lot along the way.

Yes, I understand the reality of ICU life, and as an ICU RN now, I wouldn't always have time to "teach" non-ICU nurses who may float to my unit, I'd rather have ICU trained nurses who can jump in and help when we are swamped.

Lee1, how many new RN's have you known who were ready to take care of patients with swans and/or were on CVVHD right out of RN school, no OJT?

Or, how many RN's who have never worked in critical care areas would be able to float to your unit and take care of these types of patients independently? My guess is none.

My point is, it's not an RN/LPN thing, it's a training and skills thing.

First of all, you need to be in a state that does not restrict LPN practice so tightly, and although I'm disturbed at Mattsmom81's comments about possible new laws in TX, as an LVN in TX, I enjoyed a fairly broad scope of practice compared to other states.

If you live in a very restricted LPN practice state, then yes, I'd agree that LPN's could do more harm than good in an ICU.

But....LPN's can be trained to do a lot of these things. Just like Med/Surg RN's, it's just that the RN's get the benefit of the doubt of being able to learn these things and it's often assumed that LPN's couldn't grasp the concepts because of their limited education.

Many places hire "monitor techs" nowadays, so why is it such a strange concept to teach LPN's V-tach,V-fib, blocks, etc?

And what is so hard about titrating drips?

You can train an LPN to look at the monitor and recognize dangerous rhythms, and let's say that the patient is on a Levophed drip....well, LPN's are taught in school about what normal and abnormal pressures are, so if the order is to maintain a MAP >60, how hard would it be to teach the LPN to bump up the drip when their BP begins to drop? Or wean them off the drip?

SmilingBluEyes · Apr 1, 2005

Folks, "Capable" or not, law is law. If the BON does not permit LVN's to do certain things, it CAN place a HUGE burden on the RN who works with him or her. That is the crux of the matter in for the OP. Why do we always need to turn it into an LVN versus RN thing? Neither is "Better"----we can only do what the BON sanctions. LVNs' scopes *are* limited by varying degrees by state. They don't discuss "capabilities" much in their laws, just what will and will not be done as an LVN or RN. Truly, it behooves us all to know what the rules in OUR own state are and abide by them. The OPs situation is intolerable, to me. It IS a lawsuit waiting to happen.

NYERNURSE · Apr 1, 2005

Folks, "Capable" or not, law is law. If the BON does not permit LVN's to do certain things, it CAN place a HUGE burden on the RN who works with him or her. That is the crux of the matter in for the OP. Why do we always need to turn it into an LVN versus RN thing? Neither is "Better"----we can only do what the BON sanctions. LVNs' scopes *are* limited by varying degrees by state. They don't discuss "capabilities" much in their laws, just what will and will not be done as an LVN or RN. Truly, it behooves us all to know what the rules in OUR own state are and abide by them. The OPs situation is intolerable, to me. It IS a lawsuit waiting to happen.

Thank you for understanding my viewpoint. I am in no way belittling the profession of LPN but merely venting about the frustrating situation I find myself in. I am not exaggerating or whining about a miniscule irritation....it is a lawsuit waiting to happen. I did find another postion in an ICU which is RN only. Again, everyone's opinion is appreciated.

mattsmom81 · Apr 1, 2005

I certainly don't view this as a RN vs LVN thing. I AM however worried about how staffing will be managed when Texas chases 1/2 their staffs away from ICU.

RN34TX · Apr 2, 2005

Folks, "Capable" or not, law is law. If the BON does not permit LVN's to do certain things, it CAN place a HUGE burden on the RN who works with him or her. That is the crux of the matter in for the OP. Why do we always need to turn it into an LVN versus RN thing? Neither is "Better"----we can only do what the BON sanctions. LVNs' scopes *are* limited by varying degrees by state. They don't discuss "capabilities" much in their laws, just what will and will not be done as an LVN or RN. Truly, it behooves us all to know what the rules in OUR own state are and abide by them. The OPs situation is intolerable, to me. It IS a lawsuit waiting to happen.

I agree that it is definitely a lawsuit waiting to happen in the OP's particular situation and that we must abide by the state practice acts. I also agree that LVN restrictions can place a huge burden on RN's and therefore in the OP's particular situation, placing LVN's in ICU would be inappropriate and unsafe.

I was only pointing out that the comments following the OP were making blanket statements that LPN/LVN's never have a place in ICU and that all ICU's in every state should be staffed by RN's only. If any of these people are in TX, then that tells me that they do not understand the rules of their own state because I understand them quite well and have been in both roles in ICU.

I was also pointing out that having an all RN staff in ICU does not necessarily solve the problem either because I've had RN's floated to my unit out of desparation who have never seen a swan, read a rhythm strip, or even opened a crash cart in their entire careers.

Do they belong in ICU taking patients on their own just because they are RN's?

In states that allow it, if you squeeze out well-trained LVN's just so that you can have all RN's regardless of their skill level would be counter-productive and unsafe, but in short staffing situations that's what you are going to get.

lee1 · Apr 2, 2005

In the ICUs at my hospital we regularly take new RNs just out of school. The last few have been from various programs. Their training takes about 3 months intense 1:1 preceptorship with classes being taught by our CNS. They do not float for approx 6 months and in some cases longer.

Personally I think the responsiblity of having an LPN working in an ICU is too great. At all times the RNs would be responsible for their care. Critical thinking skills take time to learn. Assessments that provide proactive care immediately are the hallmark of prevention of complications. It is hard enough with inexperienced nurses/new nurses/floated nurses/traveler nurses in the mix.

HazelLPN, LPN · Apr 8, 2005

I have been an LPN for nearly 50 years, and most of that time has been spend in critical care. Fortunately, in the state and hospital I work in, LPNs have few restrictions. I can titrate my pressers, I give blood products, I draw gases, I can give pretty much any medication except chemo...and only a few of our RNs who have been hem/onc nurses can give that. I do not take new admissions, I do not take charge, and I can not serve as a patients primary nurse and write the care plan....though I can assist with it.

I would strongly disagree with the posters who say than an LPN lacks the assessment or critical reasoning skills to work in ICU simply become one is an LPN. Sorry folks, we learn the most from experience on the job....not in nursing school. I went to school back in the 1950's....essentially nothing is the same these days. If there are not a lot of state restrictions on the LPN scope of practice and if she/he is bright and willing to learn....then why not? It depends on the individual...plain and simple. When one speaks in generalities....one usually gets themselves into trouble.

RN34TX · Apr 8, 2005

I have been an LPN for nearly 50 years, and most of that time has been spend in critical care. Fortunately, in the state and hospital I work in, LPNs have few restrictions. I can titrate my pressers, I give blood products, I draw gases, I can give pretty much any medication except chemo...and only a few of our RNs who have been hem/onc nurses can give that. I do not take new admissions, I do not take charge, and I can not serve as a patients primary nurse and write the care plan....though I can assist with it.
I would strongly disagree with the posters who say than an LPN lacks the assessment or critical reasoning skills to work in ICU simply become one is an LPN. Sorry folks, we learn the most from experience on the job....not in nursing school. I went to school back in the 1950's....essentially nothing is the same these days. If there are not a lot of state restrictions on the LPN scope of practice and if she/he is bright and willing to learn....then why not? It depends on the individual...plain and simple. When one speaks in generalities....one usually gets themselves into trouble.

Thank you HazelLPN!

It's about time this discussion gets some input from LPN's who work in critical care.

They are out there, and in states without too many practice restrictions, it works.

My hospital only hires LPN's to work in outpatient settings, not even in Med/Surg which is where I spent most of my time as an LPN.

Meanwhile, we are working on new RN grad #3 to be to be moved to another area after 6-9 months and still just not "getting it" in the ICU setting.

mattsmom81 · Apr 8, 2005

. If any of these people are in TX, then that tells me that they do not understand the rules of their own state because I understand them quite well and have been in both roles in ICU. QUOTE]
I worked in Texas ICU's with LVN's for 25 yrs and always thought LPN's could work wherever they are deemed competent. As I read the statement below, I cannot help but feel facilities have been taking a surprising risk and need to rethink this practice.
ftp://www.bne.state.tx.us/lvn-guide.pdf
This applies only to Texas of course, and the document appeared to be formed last fall, (october 2004) so maybe not every nurse has seen this...I don't know.
Just goes to show how important it is to read the NPA and be aware of updates, IMO.
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Nicki_RN · Mar 29, 2006

Well where I work as an LPN, being IV certified is a requirement for the job, which is why I am currently taking the course. I can't wait to be cert. because I hate having to go to another Nurse to shut the darn pump off if it's going off for some reason, and then getting them to give my meds. I can do initial assessments as long as another nurse signs off that I correctly did the assessment. And, I usually do something else for the RN that is doing my IV stuff, so that she isn't behind in her work. Although, remember most LPNs are getting their RN, so don't scare em off!!

RNforLongTime · Mar 29, 2006

Although, remember most LPNs are getting their RN, so don't scare em off!!

Really? I know a lot of LPN's that are perfectly happen as an LPN.

That said, the ICU that I used to work in did not utilize LPN's. In PA, LPN's are NOT allowed to give IVP meds except abx, they aren't allowed to titrate pressors, hang blood, hang TPN, perform admission assessments or initiate nursing care plans.

The ICU that I now work in has an LPN that's worked in the unit for 15 yrs and believe me, she's a darn good one and is better than some of the RN's in this particular unit. She's pursuing her RN through Excelsior College. I LOVE working with this lady! She's wonderful. We work in a low key ICU. But an ICU none-the-less. Not too many pressors to be titrated here.

----Kelly RN, CCRN (as of 3/28/06)!!!!!!!!!!!!!!!!