LPNs in the ER

[amandab13]

I am a LPN and I work in a busy ER in Alberta, Canada.

I am looking to write a paper about LPNs in the ER and would love any feed back!

Do LPNs work in the ER where you're from? Do they require any extra courses (ACLS, TNCC, etc...)?

And what are your thoughts about LPNs in the ER??

Any feed back would be greatly appreciated!

Thank you!!

[PeakRN]

We do not have LPNs in our ED.

LPNs can not test for TNCC or ENPC and therefore cannot be certified per the ENA, but may audit the course. We don't have LPNs in any of our critical care environments so I can't attest to if we would want them to have ACLS or PALS.

I've only known one LPN who worked in a large ER in my state, and he was grandfathered in. Currently all of the EDs that have twenty or more beds in the state don't hire LPNs, those that do are often critical access hospitals. Most EDs hire RNs for nursing care and either EMTs or Paramedics to work as techs. Depending on the system and their certification level may be able to hang medications, start IVs, perform reassessments, discharge, or assume care of patients under the provider's license (I've only seen this in fast track/vertical triage/'urgent care' sides of EDs) among other tasks.

With the large number of EDs in the US that use EMTs and Paramedics I'm not sure how much of a role is left for LPNs. I have a friend who is Canadian but is a RN in the US (she worked in EMS in Canada), and she told me that EMTs and Paramedics don't work in the EDs there; I'm not sure if this is still true or even a regional thing but in this case I could very much understand having LPNs in the EDs. In my current system I don't see a need for LPNs in the ED and lean towards the idea that these roles are probably better filled by EMTs/Paramedics, but I don't have anything against LPNs working in a similar role in the ED.

[amandab13]

In your state, do you happen to know the scope of practice for LPNs? Are they able to start IVs, do IVP medications, etc?

I have both TNCC and ENPC. True, I don't hold a typical certificate, but I have audit the course. That being said, there is no difference between what I have and a RN has. We both paid the same, tested the same. My current manager doesn't see any difference when it comes to a certificate or audit; I did the course, did the test and scenario and passed both. Our understanding is that I, as an LPN, cannot be certified is because its an American course, and in the USA, LPNs aren't viewed the same as in Canada.

Also, in Alberta anyways, the scope of practice for EMTs is very small, they can only administer a handful of drugs for example.

I find it so interesting how everywhere is so different!

Thank you very much for your reply!

[PeakRN]

LPNs can start IVs and give piggy back meds or infusions but cannot give high risk IV medications (heparin, chemo, pressors, narcotics...).

In an inpatient or long term care environment the initial assessment must be performed or directly supervised by an RN but then care can be assumed by an LPN in the patient is not critical or predicted to deteriorate, the LPN would still have their care 'supervised' by an RN who is on the unit. In the ED this means that the triage and any initial assessment would need to be performed by a RN and then the patient care could be assumed by an LPN however there would still need to be an RN who is responsible for the patient. Because we often cannot truly predict how sick an ED patient is most who are not in a fast track type area would not be eligible to be have their care assumed by an LPN.

Our EMTs are very limited in the medications that they can administer, and in my ED we have decided that we would rather have them support the unit in other ways rather than be able to administer the dozen or so medications they would be allowed to give in the ED (in the field they can 2-3 times that amount). Our paramedics can give far more medications including most IV push meds, but this is still a smaller scope than when they work in the field.

LPNs make substantially less than RNs regardless of care area here. In our system they are payed slightly more than our EMTs but less than our ED paramedics. Their scope of practice is very different but I would lean towards saying that our paramedics have a large scope of practice than our LPNs, at least in regards to they type of care and assessments that we provide in the ED.

[amandab13]

Thank you for all that!

Very interesting.

Where I work, I am responsible for up to 6 ER patients. We have a charge RN for the whole unit, but I work independently. I can take verbal and phone orders, draw blood, relay information to the physicians, initial and continuous assessments. The only main things I can't do is spike a blood bag prior to a transfusion and bladder scan (thats a whole huge issue right now here).

I can triage and do initial assessments as well. I used to work in a small rural hospital and I did everything. Had to when there is only one RN on! :)

Thank you again!

[Lunah, MSN, RN]

I have both TNCC and ENPC. True, I don't hold a typical certificate, but I have audit the course. That being said, there is no difference between what I have and a RN has. We both paid the same, tested the same. My current manager doesn't see any difference when it comes to a certificate or audit; I did the course, did the test and scenario and passed both. Our understanding is that I, as an LPN, cannot be certified is because its an American course, and in the USA, LPNs aren't viewed the same as in Canada.

What an RN has after these courses is different. RNs hold verified provider status after those courses. You earn continuing education hours but you really should not say that you "have" TNCC and ENPC, because only verified providers can claim that. I am an instructor and course director for TNCC and an instructor for ENPC, and this is spelled out in the administration manual - non-RNs are not given a verification card or verification status (p. 9 of the manual). With that being said, I have seen some discussion about allowing LPNs and Paramedics who take the course to actually be given a provider card, but I am not sure where that will go. It makes sense to me because LPNs and Paramedics are part of the team in many places; why not grant verification status to anyone with licensure or certification who can take the course and pass the test?

I worked with some great LPNs in the ED in the past, but my current facility has phased LPNs out of the ED and most other units as well. I think many of those LPNs thought the day would never come, because we've all heard it for so long - that the LPN role in the hospital was going away. But then it happened. Very sad for them, there were some fabulous LPNs.

[Meriwhen, ASN, BSN, MSN, RN]

We have LVNs working in our ED. They have to have ACLS (and I believe also PALS) and be IV certified.

I don't work in the ED, I just visit to do psychiatric consults. So I don't have an opinion one way or the other about LVNs working there. I do think LVNs can be a valuable asset to any nursing team though, even with the limitations on their scope of practice.

[HarleyGrandma, RN, EMT-B]

No LPN's in our ED. We do have EMT's and Paramedics, and a really good working relationship between all of us (Dr, RN, tech, etc) In Virginia