LPN's in CCU, a vent

[NYERNURSE]

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:

[dorimar, BSN, RN]

In defense of the OP, she was not knocking LPNs, but the added responsibility their scope of practice places on the RN when they are working in the ICU. I whole heartedly agree with her, and I have to say that I absolutely would not be responsible for someone else's assessment no matter how much i trusted them ,without going in and assessing the patient myself (especially in the ICU). Everything she described sounds extremely unsafe, and not because the LPN's aren't competent, but because the RN has so much more responsibility that her patients aren't getting the attention they need. Because the LPN with a limited scope of practice is given patient assignments in the ICU, the RN's patient ratio is increased (as the LPN cannot admit) , her patient acuity is increased, and she is still ultimately responsible for the LPN's assignment as well (i mean in a liabilty sense). I know many of you will say the RN is not responsible for the LPN's patient, but if there is a deposition for any reason on an LPN's patient you better believe the RN will be deposed. Now in the case of RN's going to work in the ICU right after nursing school, I have some opinions about that as well, but it is an apples & oranges issue here. Once a new RN finishes her orientation, she is not working under another RN's license. Also she can admit patients, titrate her own drugs, and is responsible for her own assessments etc. If she screws up it is terrible, but I am not responsible -she & her employer are.

Doris

[suebella]

I have 10 years ICU experience and have taken and passed all of the same test the RN's have to take in order to work here. I was the first nurse in our facility to complete the ECCO class required here to work in either ICU or PCU. I take all patients except the one's with a swan ganz catheter. They prefer that the RN's take these patients. We are also not allowed to hang blood in my facility. We can monitor it, but can't spike the bag. I do agree that all LPN's can't work in the units but if they have proven themselves capable then I don't see a problem.

[ZASHAGALKA, RN]

I've worked in several CCUs in TX and everyone of them had converted to RN only staffing years ago, although a few grandfathered the LVNs that were working there at the time of the change.

So, I've worked w/ LVNs in CCU, but only ones that had been critical care nurses for a long period of time.

In my experience, they were given the same level of pts and did everything for those pts, titrating gtts, hanging blood etc.

I didn't pay enough attn to see if some of the more complex stuff, like CABGs and Swans were assigned, but I also know that they didn't just get 'stable vents'.

And I also know that a critical care nurse with several years experience is, surprise, a critical care nurse.

But, and I want to point this out: nursing school, RN or otherwise, didn't teach a single CCU nurse how to be a CCU nurse. We all learned that in critical care courses and/or OJT. I'm not by any means saying that there isn't a difference between LVN and RN school. I've been to both, and the difference is large. But, experience is a fairly decent leveler - and lots of experience is even more so.

I would trust an LVN with multi-year critical care experience over a new RN in CCU with my family members in a heartbeat.

~faith,

Timothy.

[RN34TX]

I do agree that all LPN's can't work in the units but if they have proven themselves capable then I don't see a problem.

And all RN's can't (or rather shouldn't) be working in the units either.

Unfortunately, the RN license has afforded them far less questioning of their abilities as opposed to an LPN working in ICU.

This is unfortunate, because, as someone else pointed out earlier, most of critical care is learned on the job, not in basic pre-licensure programs.

Thus, RN's who really don't have the motivation and/or ability to learn to work in critical care, can continue to do so because no one seems to question anyone with an RN title as to whether or not they should really be working there.

[dorimar, BSN, RN]

Again, the problem the poster brought up was not the competence of the LPN, but their limited scope of practice (AS SET FORTH

BY THE STATE BOARD). This limited scope of practice, makes the RN responsible for so much more. It increases the acuity of her patients ( as LPN's at her facility cannot take certain types of patients in her facility), It increases her nurse patient ratio ( as LPN's cannot admit patients, thereby causing her to admit a 3rd patient), and she is still responsible for the LPN's drips etc. Also she is probably responsible for the LPN's assessments as well, and in the ICU that is a huge deal. I would not be responsible for the best nurse in the world's assessment without assessing my self. So the RN has MORE & SICKER patients and MORE RESPOSIBLITLY outside her own direct patient assignment to boot. Sorry, but no thanks (and that's not to say many of the LPN's don't know more than many RN's out there). It is just that many of those green RN's aren't increasing my ratio's & accuities & responsibilities, and also they are not working under my license. Honestly, despite the understandable subjective emotional ties many of you have to this topic, if you re-read the original poster's thread objectively, you must understand her frustation.

[lindarn]

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

Sorry, LPN/LVNs have no place working in any critical care environment, by virtue of education, (or lack thereof), and nurse practice act. If you need to validate you self worth and self importance by thinking that you (and are allowed to), provide the professsional care that a critical care patient requires, you are very mistaken, I have never, and would not, under any circumstances, take the responsiblity of having to cover an LPN in an ICU. But of course you work in North Carolina, a "right to work", state, with no contract, and RNs have no job protection. My guess is the RNs, who you work with, (and who cover your butt), would tell another story, if they were not scared of losing their jobs by complaining about unsafe staffing situations.

Lindarn, RN, BSN, CCRN

Spokane, Washington

[provostkelly]

Wow, what state are you an LPN in? That is great!

[General E. Speaking, RN, RN]

Wow, what state are you an LPN in? That is great!

FYI: This is an old old thread.