LPNs in hospice?

[4boysmama]

I work for a pretty small hospice office, and we just hired an LPN to work part time. Mgrs hyped it up like it was going to be such a big help to those of us with full caseloads and aking lots of extra weekends on call. But, my understanding is that in my state (PA) she's not able to do admissions, death visits, initial teaching, nor emergency visits on any issue that hasn't already been assessed by an RN. So....for the weekends that she is on call, well still have to have one of us RNs on backup to go out for any of the above issues. so...please tell me about your experience with LPNs at your hospice? I really like this nurse as a person, she's very sweet and eager to learn....I'm just not feeling like it was a very helpful hire for us overworked RNs.

[pfeliks]

At the Hospice at which I work, LPN's are not allowed to take call fro the exact reasons you state. I'm in Massachusetts.

[jdub6]

Not in your state but mine is very similar in relations and our hospice uses both rns and lpns on call. At this point there is almost always an lpn working each on call shift (with an rn). The rn triages all "emergency" calls. The lpns have been found very helpful for things like routine dressing changes, delivering supplies, handling after hours calls where the caregiver doesn't know how to draw up liquid meds or other basic pt care teaching, giving enemas, disimpactions, post death visits at nursing homes where the pt has been pronounced by the facility rn but the hospice likes to send someone for support and chaplain or sw isn't available, making calls on weekends if the pt had med or condition changes late in the week to ask the pt or family if they are working or need a visit or have questions (if there is a simple question like "can I take this pill with food?" The lpn can answer by phone; if the pt/family says anything other than "I'm/he's all better" then the rn goes to assess but many times the pt is fine and lots of times the rn saves lots of time).

On weekends, the lpns are scheduled for the basic tasks like dressing changes and also for some routine pt visits, usually established, stable pts. The way they cover themselves having the lpn fill out the visit paperwork including the pt assessment is either send them to facilities with rns so they can write "in consultation with facilty rn sally" or they write a note at the end saying "assessment and plan of care discussed with [hospice rn] jane per protocol."

The lpns do not take orders; if the pt requires a new med the rn must either see the pt or at times will just consult with lpn and maybe pt/fam by phone and call the doc. The lpns are able to process routine renewals of established meds from the pharmacy which is another thing they help out with on their visits (they can also take those lovely midnight calls "I just gave him his very last haldol pill and he will need one in 3hours, I thought I should let you know").

This is just the experience of our hospice. We generally have a census of I would say at least 450? Over a VERY large area (IMO)(5500miles or so). Perhaps the large distance is part of why having lpns to cover the routine tasks is so helpful. Your mileage may vary, particularly for smaller hospices. I also feel that our hospice is fairly disorganized and our case mgrs totally overloaded meaning there is a lot more need for after hours dressing changes and basic teaching, things that probably could be accomplished during regular hours if better staffed. Don't know what your situation is.

Thus far, I have not seen or heard of any negative legal or regulatory action due to using lpns for on call. Some of the lpns have not liked it, didn't feel confident but some had no problem. The rns generally love it. Apparently the agency feels it has helped the bottom line because they are increasing their hours constantly. Good luck!