Our hospital recently brought LPNs into ICU, and we are having some trouble adjusting to the change. They were brought in to our units because we have lost so many RNs recently, and have not been able to replace them. Please don't think I am putting LPNS down, I am not. I was an LPN for four years before I was an RN, and I have a great deal of respect for them. The two that have come in to the unit are sweet wonderful girls with a lot of knowledge and they work very hard. The real problem is the limitations placed on them In our state LPNs are not allowed to give IV pushes, hang blood, or hang and titrate drips. They cannot measure hemodynamics, and cannot take verbal orders from a physician. So an RN must do all of these tasks for them, as well as take on a full patient load of her own. The LPNs get very frustrated too when they need something done for their patient and the RN who is supposed to be covering her can't get away from her own patient to handle a problem. We have tried to have an LPN and an RN share four patients, with the LPN doing meds and treatments, and the RN doing assessments, drips and the like, but this has not worked out either. To make matters worse, some of the RNs are hostile to the LPNs, and give them a hard time. Most of us have been supportive of them, but a small number of the RNs have made things difficult in numerous ways. Most of it is very subtle, and is difficult to take anything specific to our unit manager. A few of the docs have also expressed discomfort with the LPNs being in a critical care area. Again, I am not complaining about the LPNs, I am just looking for some feedback and advise on ways to organize care and make this situation a little easier on everyone.
Specializes in CVOR,CNOR,NEURO,TRAUMA,TRANSPLANTS.
Well this is another one I will say good luck to,
The spectrum of care in an ICU is beyond the care and LPN can give, not because they dont want to but just that they dont have the Knowledge base to draw from as an RN does. I dont say this with any sort of resentment towards your LPNs that work in your ICU but I speak from experience . I was an LPN before I was a RN and when I realized the difference I almost wanted to be a LPN again. If they have a base in which they can work from and draw from the resources that are not hostile , then they would be an asset to the area. But if they recieve subtle as you call it actions towards them , then it will only cause a friction in that area.
One in which does not belong there. Apparently they have the will to jump into such a critical area, and I applaude them for that , but Its like having a 6th finger , its there and wants to help but just doesnt have what is needed to get the job completed on its own behalf.
Watch thier backs because they are truly the low men on the totem poll:o
If a nurse's hands are tied and are unable to perform the job that needs to be done then in my opinion those nurses should not be there. The pt standard of care comes before any other considerations.
That said... the rules need to be changed. LPNs are not LPNs because they couldn't do the work in an RN program but many times it is because of monetary or time limitations. We accept that in the way it reflects on our salaries. However it is poor utilization of resources to not allow each member of the team to function at the highest level of their competency.
I will say this one last time. No where did RNinICU state the LPNs didn't not have the ability to work in ICU! You ...ITSJUSTMEZOE, may not have had the knowledge base to draw from....but I do! I again will say, and repeat what RNinICU said so well!
RNinICU - The original inquiry was for any suggestions on how to organize care and allow the RNs and LPNs to support each other, instead of resenting each other
RNinICU - The two that have come in to the unit are sweet wonderful girls with a lot of knowledge and they work very hard. The real problem is the limitations placed on them In our state LPNs are not allowed to give IV pushes, hang blood, or hang and titrate drips. They cannot measure hemodynamics, and cannot take verbal orders from a physician
mattsmom - My state of Texas is very liberal with LPN's practice...and many facilities here only limit them in terms of charge capability, so I don't mind LPN's caring for ICU patients at all, (as long as they are competent ICU nurses.)
Please let's not make this about something it is not! It's not about LPNs having enough knowledge base. It's about the fact that the LPNs in RNinICU's unit, are restricted from doing what they're capable of doing! And because these LPNs are restricted..this places a horrific weight on the RNs in that unit! Because of the restrictions placed on those LPNs in that unit...it's makes the unit a dangerous place to be, for the pts who shouldn't have to have a nurse who is spead between possibly four different pts, because of these restrictions placed on the LPNs in that unit!
I feel that the LPNs in that unit shouldn't be there, or any other unit, where they're thus restricted. NOT because they're aren't qualified...but because of the restrictions placed on them....nothing more!
I worked ICU from the time I qraduated from school, and have never had a single RN express any distress after working even one shift with me in an ICU. With every contract I have worked in an ICU, I have been asked to extend, and once extended at least THREE times! It was the RN's in that unit, that decided whether or not they wanted me there! Before giving me a contract, they worked me per diem, and offered the contract after having worked with me! If they hadn't thought I was competent, I wouldn't have been offered the contract. I also wouldn't have been offered $5,000 to come on board permenantly. An offer that was supported by the RNs I worked with.
Everyone has a right to their own opinion....and you're welcome to yours...:). But please...let's not start the age ole arguement, that LPNs are not knowledgeable enough to work in ICU...based on your personal knowledge of what you did or didn't know. I know many LPNs who have no where near the experience, and or knowledge base I have, and I have know just as many who far exceed my own knowledge, and or experience.
I have racked my brains for a solution to this problem, that would keep the LPNs in their positions. But I can find none! As mattsmom said...the RNs in that unit, don't need helpers. They need nurses who have the ability to perform independently. They don't need to have to monitor hemodys on four pts, and they don't need to manage four vents, or possibly calling four different MDs!! I feel it's just plain wrong, to expect these RNs to operate until this continued pressure!
The only solution I can see at all, is for this hospital to bring in competent ICU RN travelers, who can take the load off...and give this hospital time to search, and agressively recruit competent ICU RNs! Yes the hospital will say they can't afford this measure. But they also can't afford to lose anymore nurses! As I agree with mattsmom, when she wrote that this is where all of this will evidently lead.
Specializes in CVOR,CNOR,NEURO,TRAUMA,TRANSPLANTS.
I was a LPN and I can tell you that the knowledge base is limited for the spectrum of care in the ICU!, I didnt say that you werent quailified nor would I ever . Dont drag me into this cat fight!
Specializes in CVOR,CNOR,NEURO,TRAUMA,TRANSPLANTS.
The limitations placed on a LPN in the ICU restrict the type of care needed in a Critical Care Unit, its nothing against the LPNs at all its the fact that they cant do what needs to be done in the critical care setting, its spectrum of care ,not LACK of care.
Goodness, that should be the extent of my comment here. But it won't be.. haha.. I have to say that the person exudes the title for the most part. Experience does as well, but facts remain facts and regulations remain regulations, LPN's are much greater restrictred in their care of patients versus RN's PERIOD. We all have our restrictions don't get me wrong, RN versus FNP, come on I don't want the responsibility to prescribe medications and diagnose patients, I enjoy offering my expert advise which is no different from the LPN's for whom I work with and also enjoy their input in the unit, but when I am expected to supervise and be responsible for their patients I want to know the capability of that particular LPN, and believe you me I know their capabilities, and I respect them totally so for that I am comfortable 95% of the time when I am responsible for their patients. (and heck 95% is my own comfort level at times, I am never 100% comfortable on my own---just the life of the ICU) I only care about the amount of support I must provide and I try to manage my time and make it the most effective possible in taking care of the amount of patient load and acuity. The unit is a complex place in which to work, I am very fortunate that I have a wonderful team where I work. We all look out for each other, we honestly don't care about titles there we do care about the patient that is the most important here. If something bad happens we all feel responsible, yes it is a singular responsibility in most cases, but none of us feel like we are left alone in our ICU. We are all a team and the LPN's are an intricate part of that cog in the wheel, but not any LPN, RN, Critical care aide, or tech are meant to be in the ICU. It does take a special person, pure and simple. Just think of some of the family practice MD's you have seen come in to your unit now and then, and just remember how out of place that most of them seem as well. So unless you belong in the Unit, and unless you are a member of a great team, don't criticize what your neighbor or partner is doing or not doing, because if they aren't doing it right they either need more training or don't belong there. Remeber don't judge the title, judge the person.
The limitations placed on a LPN in the ICU restrict the type of care needed in a Critical Care Unit, its nothing against the LPNs at all its the fact that they cant do what needs to be done in the critical care setting, its spectrum of care ,not LACK of care.
You dragged yourself by your post. I didn't write it ....you did! I just responded to it. A little secret about posting here. You post and someone usually responds to that post! Just in case you didn't realize that fine point.
This was never a cat fight! But maybe you're trying to make it one! ALL LPNs are not restricted in all states, and or facilities! Many places allow LPNs to do just as many skills as RNs...even being in Charge! But do I wish to be in charge?? NO! I have even been offered a head nurse position...by the head of an OB dept. But I turned it down...because one... I didn't have the knowledge base to do so, and I believe that position belong with an RN. Not that I didn't have the knowledge base to work in Ob...because I obviously did. And because the RN supervisor who was present when the position was offered....was so pissed he couldn't speak!!! But it was fun watching him stew ..:chuckle!
brownms...doesn't it seem a little "enlightenning" to you, that your responses to posts, myself included, are toned a little (lot) harsh?. i'm really not trying to pick on you. i do appreciate that you are thinking out of the box and really trying to understand the complexity of it all. i'm impressed you've got us all thinking. you'd be great in battling policies and procedures. but some of your responses, to me and others are equivelent to a bull-dog attack with a smiley face at the end. calm down a little...you can attract more bees with honey than vinegar.
i really hope you take this into consideration.
take care.
s_bsn
ps...don't go there! i'm not trying to be sarcastic, mean, rude or otherwise
I have always been a very point blank in your face kind of person... ...just my style. Believe me...no harm intended. That is the reason I place the smiley faces at the end...so others will realize that also. I have been posting a long time here, and most here already know that. You don't see any other regular posters and myself disagreeing here. If I put a smiley face at the end of the post..it means I'm not going for the throat...just trying to make my point. But many of us on this BB, have long realized that it is difficult just by reading post to discern a person's feelings.
So if I come off (lot) harsh...I will be glad to tone it down...but please do the same...K?? Starting with statements like
really trying to understand the complexity of it all.
. I understood the complexity of it all...from my first post. I have not changed my thinking since then. I hope I said that nice enough...I truly do..
i had to think about this a while before i responded. i am also not sure what you are suggesting. i don't see how floating er lpns to icu would help. they would be working under the same restrictions as the lpns currently working in our unit, and would be further hampered by the lack of icu training.. the problem right now is that our acuity has been so high, that there are no patients the lpns can handle without a lot of help from the rns, which just increases our workload.
"your lead or charge would determine day-to-day acuity's based on your manager's direction (she'll need to make guidelines) and determine if staffing an er lpn to pick up patients that need less rn specific care is appropriate. or, if a rn is more suited for your census acutity."
i understand lvn's have restrictions. but does this stop them from anticipating a need? sure, you still have to carry out the duty. but it helps that everything is set up ready to go once you get to carrying out that order (task). i'm not confussed to think this simple suggestion solves everything. yeah..i know...being responsible covering those extra patients is trying to say the least. but you are on the right track solving small problems and saving the big overwhelming hurdles for later!
i was not aware that your hospital does not have staff for a float pool. is there a referral program intact that you could refer a rn for possible employment? i know it sucks, but if recruiting/hr is not hiring fast enough or just plan ole "enough", maybe you can pull some of your trusted networks aboard. again, i realize time is a factor...and waiting it out is a bummer. if the situation is unbearable....move on.
our er staff, even the rns could not handle a lot of our patients. the er staff stabilizes patients, and sends them to us. they do not manage iabps, vents, or dialysis. when they have a vent patient waiting for transfer to us, there is an rt there with the patient at all times. and our rn staffing is so low throughout the house that there is no one else to float into icu.
i didn't understand your staffing is so low that no float pool could be created. management needs to do some recuiting! i do still believe:
"the med-surg and er rn's won't be "new" forever...and it will take time to become familiar with ccu care. my suggestion for er lpn's was becuase it was mentioned the ccu manager wasn't willing to remove them completely. if i had to work with an lvn, i'd rather work with one that can "anticipate" what might come next after any given emergent procedure or treatment, as opposed to being ???lost???. they can grab treatment equipment and set it up without me having to do it myself. one less step i have to do." the lpn's that are currently in your ccu may already be doing this. if so, great! they are doing at max waht they can do
i disagree that er rn's can't transition to ccu. don't we start the care that you finish? we may not "manage" day-to-day nursing care interventions, but we know how to. we may appear like we don't know much about ccu, but in fact...we do.
the original inquiry was for any suggestions on how to organize care and allow the rns and lpns to support each other, instead of resenting each other. i appreciate your very thoughtful response, but i don't think it can be applied in our unit.
good luck to you...i hope things get better and eventually work out! please let us all know how this mammouth was tackled!
"your lead or charge would determine day-to-day acuity's based on your manager's direction (she'll need to make guidelines) and determine if staffing an er lpn to pick up patients that need less rn specific care is appropriate. or, if a rn is more suited for your census acutity."
i understand lvn's have restrictions. but does this stop them from anticipating a need? sure, you still have to carry out the duty. but it helps that everything is set up ready to go once you get to carrying out that order (task). i'm not confussed to think this simple suggestion solves everything. yeah..i know...being responsible covering those extra patients is trying to say the least. but you are on the right track solving small problems and saving the big overwhelming hurdles for later!
i was not aware that your hospital does not have staff for a float pool. is there a referral program intact that you could refer a rn for possible employment? i know it sucks, but if recruiting/hr is not hiring fast enough or just plan ole "enough", maybe you can pull some of your trusted networks aboard. again, i realize time is a factor...and waiting it out is a bummer. if the situation is unbearable....move on.
[/b]
i didn't understand your staffing is so low that no float pool could be created. management needs to do some recuiting! i do still believe:
"the med-surg and er rn's won't be "new" forever...and it will take time to become familiar with ccu care. my suggestion for er lpn's was becuase it was mentioned the ccu manager wasn't willing to remove them completely. if i had to work with an lvn, i'd rather work with one that can "anticipate" what might come next after any given emergent procedure or treatment, as opposed to being ???lost???. they can grab treatment equipment and set it up without me having to do it myself. one less step i have to do." the lpn's that are currently in your ccu may already be doing this. if so, great! they are doing at max waht they can do
i disagree that er rn's can't transition to ccu. don't we start the care that you finish? we may not "manage" day-to-day nursing care interventions, but we know how to. we may appear like we don't know much about ccu, but in fact...we do.
good luck to you...i hope things get better and eventually work out! please let us all know how this mammouth was tackled!
s_bsn
[/b]
i don't mean to be sarcastic, but you admit you don't understand the situation, yet you seem to have all of the answers. my hospital, like so many others is making a major effort to recruit rns, but we are still very short staffed. but there is a major teaching hospital 20 minutes from us, and six other small community hospitals within a hundred mile radius. competition for rns is fierce. up until a few years ago, our hospital was considered one of the best to work at, but since we have become part of a larger health system, staff is not as happy here. retention is a real problem.
you also seem to take a lot of what is posted here personally. i am not saying that lpns cannot function in icu, just that they are not allowed to in my state and facility. i do however believe that staff from other units, including the er cannot function independently in an icu. our staff goes through a one on one orientation, as well as critical care and dysrhythmia courses. have you ever managed a swan catheter or a balloon pump in the er? could you handle them if you are pulled to icu? without training in how to work with them, how could you "anticipate" what i need for these patients if you do not know anything about the equipment?
we have been told that the lpns are in our unit to stay. two of our rns have left within the past three months because they do not want the responsibility of four high acuity patients. i have been employed here for 25 years, and i am seriously thinking about leaving also. i don't want to give up the benefits i have now and the time i have accrued, but i don't want to be a part of this situation.
DIPLOMATICRN4HIRE, MSN, RN
501 Posts
Well this is another one I will say good luck to,
The spectrum of care in an ICU is beyond the care and LPN can give, not because they dont want to but just that they dont have the Knowledge base to draw from as an RN does. I dont say this with any sort of resentment towards your LPNs that work in your ICU but I speak from experience . I was an LPN before I was a RN and when I realized the difference I almost wanted to be a LPN again. If they have a base in which they can work from and draw from the resources that are not hostile , then they would be an asset to the area. But if they recieve subtle as you call it actions towards them , then it will only cause a friction in that area.
One in which does not belong there. Apparently they have the will to jump into such a critical area, and I applaude them for that , but Its like having a 6th finger , its there and wants to help but just doesnt have what is needed to get the job completed on its own behalf.
Watch thier backs because they are truly the low men on the totem poll:o