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.
now i sense you're feeling a bit angry because brownie is confronting some of the things you are saying...i have to say i question some of your comments as well. perhaps you aren't realizing it, but some of your comments have come off like "what's the big deal here?" you've done this in other threads too...like the one about the cna calling herself "nurse judy" ...maybe you have not intended this attitude, as the written word doesn't always translate well...
whether an er nurse, lpn or rn is sent to be my 'helper' on a short icu shift, there comes a time when 'helpers' in lieau of competent practitioners will create an unsafe environment...critical care nurses can only be stretched so far in providing supervision to helpers. most of the critical care nurses in this forum have felt 4:1 carries an unacceptable liability and safety risk, and we are concerned for rninicu.
we need both competent icu nurses, and safe icu nurse-patient (2:1 core) ratios to provide today's level of icu care!
now...no more fightin', chilluns, can we talk????:kiss
i'm actually laughing hysterically. "no more fightin' chilluns" is hillarious.
ok....i really don't know any other way to say that my original intentions was to offer a quickly posted "idea" to rninicu. did i think long and hard about it? no, probably because i didn't get the impression that each and every noun and verb would be analyzed and scruntinized, which is kinda the way i felt at one point here. brownms didn't really make me angry as much as annoyed me with the tone of "i'll make this simple for you...", "did you read", (i'm thinkin' did she ask me can i read?...ha!) and other comments. i did feel a little bull-doged. and for what....an idea? come on....an idea!!!!....???
but never did i feel "what's the big deal here?" because rnin icu's situation is a big deal, and i think i expressed that in the post yesturday and the original post. you say "you've done this on other threads". i was and am concerned. but lets say i wasn't. wouldn't i have the right just as anyone else to post my opinion? i can't see how my first response on this thread would bare an uncaring tone? (the nurse judy thing isn't a big deal to me. sorry, that's the way i feel!).
i think what hasn't come across loud and clear is that i agree with everyone here. it's bad the position rninicu is in. but i didn't want to continually cry "shot em all" without offering some suggestions, whether they be good, bad, un-do-able, basic, stupid or not worked out to a tee. i thought maybe i could spark an idea with an idea and rninicu could take it from there. after awhile of going back and fourth, rninicu posted a reply that my idea was a wash, so the extra time spent on explaining it didn't and doesn't seem important. i'd rather move on to the next idea?
your point above says:
we need both competent icu nurses, and safe icu nurse-patient (2:1 core) ratios to provide today's level of icu care!
i totally agree! how do we get there? i stated it will take some time, but education will kick in eventually with those newer rn's brave enough to hang in icu. yes, i know rninicu's problem is right here and now. i suggested she possibly recruit trusted networks. bad idea? what's another idea? i have a three part form letter that we turn in to our union whenever we feel acuity versus nurse ratios is unfair. these forms are tracked, and are pretty extensive in verbage. even if the hospital is non-union, turning in one of these puppies to the manager on a regular basis and encouraging others in the unit to do likewise might be worth a try. would you like a copy?
if i didn't care, i sure wouldn't have taken the time to post. i guess i thought rninicu had enough "sisters" to drink with and call the man a dirty dog (smile.). i thought a different approach would be to "see if this will work"....nothing magical to erase the injustice....just another approach/idea.
i want to know where an er nurse would gain the knowledge about complications of iabps,(especially in certain pts), and have the experience of understanding timing, weaning, without being icu trained??
:chuckle...i'm playing nice mattsmom...(hiding my typing fingers)...see..:kiss:
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.
i have a clear understanding you are frustrated. that's what i started with in my first response to your post. i don't know everything nor do i have all the answers, just suggestions and ideas. take what you can...toss the rest...
originally posted by rninicu
you also seem to take a lot of what is posted here personally.
only when i find myself walking wounded after reading responses personally to me!
originally posted by rninicu
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...
"ayyyyy"....sighhhhhh....i give up. its hopeless and nothing will get better...
It seems I'm not the only one, who thinks you need to re-examine your posts, and your ideas. I didn't write "did you read"...to state that you couldn't read. I wrote it because it seems to "me", that you couldn't have read the entire post....when I read your post...if you thought that an ER LPN was in anyway a solution to RNinICUs problem! I didn't state for a fact you didn't read it...I asked you a question...period! Also your statement of
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???.
Now where in RNinICU post...was there any mention this was a CCU?? Where in that post did RNinICU state the LPNs in the unit were lost??? When did RNinICU ever post any problems with having the LPNs in that unit... except for their restrictions??? It would seem to me...that you didn't read the entire post!! "IF" you did read the post...how did you come up with the suggestion you gave???
Also I was "trying" to be helpful in providing the link...not condesending! I wanted to save you the time in looking for the passage, that pertained to your statement about LPNs. Nothing more! I felt your suggestion for me to read the very link I had posted for you...to be very condesending, and offensive! And the statement
get back to "us"
....made me think...who the heck is us??? And this statement..
let us know what you've learned and are no longer confussed about.
I was totally NOT confused about what the vocational nurse practice act had stated. I asked you to "help me understand" why you felt the BVN had stated anywhere, that LVNs couldn't give ABX...but could give blood. Which made no sense...since I had already read the section..prior to giving the link to you! So it appeared where I didn't intentionally try to insult you...you did!
But in your post to me....your were not only condesending...but you preceeded to try and put words in my mouth...or text!
Your statements towards my suggestion remind me of an inflexible person sitting at a meeting waiting for the chance to say "No...This is BS...It won't work!!! Bah-humbug!!!! I hope I've simply read your posts wrong. The nursing field does not need more "Nothing will work" attitudes.
!!!
I stated I was "confused" by your posts! I also asked you to state...how an med-surg Rn with ACLS would be able to be anymore assist than the LPNS there! I gave you examples of critical care knowledge that would be needed in order for that med-surg RN to be of more assistance than the LPNs there already, who probably did have that knowledge. If you couldn't explain your position without becoming offensive...why bother to present it???
I challenged your "idea"..and your statements about what the board said! I didn't "attack" you! I didn't go on to make deragortory remarks about you or your education, as you did in this statement
If you are to become a RN, please be more open to mere suggestions
.
What has my becoming an RN have to do with anything....who the heck said I wanted to?? I have been an LPN for 22yrs...and I have been on this board for over a year...no one has ever heard me say I wanted or desired to be an RN! I'm proud of what, and who I am..period! A GREAT nurse...with an awesome resume!
And your statement...
What you are refering to has nothing to do with this BB. Again, let's talk offline
. Who made you boss to tell me to take anything offline, or to decide what does or doesn't have anything to do with this BB???
I also realized...you were trying to be helpful...but your idea....didn't make much sense to me. So rather than saying exactly that...I stated I was confused by your post...and was hoping you would provide me with a better understanding...via a well thought out explanation...not an attack!
Where is it written that RN's know the why's and what-for's and LVN's do not? Where is there documentation that RN's have all the rights and LVN's don't. Where is substantiation that they know and we have difficulty knowing?
Sorry to say that I have worked with PCA's who were more knowledgeable, had greater common sense, and deeper concern then some RN"S or LVN's. Some licensed, degreed persons have been seen bounding down stairs or hiding to avoid a crisis.
If you read your practice act, understand it, implement it, and tie that together with hospital protocol there should never be any questionable doubt. At no time should there be a controversy over abilities, demeaning overtures, or a lack of working together towards the good of the patient.
It seems to me that the more biased we become, the more negative the issues addressed seem to be the less time we have to perform our duties.
If in fact the old joke of what BSN means is true then I'd rather stay an LVN.
Okay everyone sit back breathe slowly in, exhale do it again and again until everyone agrees that wk sucks because deep down this is the power that be(managment)way of getting us all riled up and at each others throats so that we cant be the happy go lucky folks we are. If the breathing thing doesnt wk dont worry you will soon pass out be rushed into the nearest ICU and lo and behold there is going to be this person leaning over you with what is that ,could it be LPN on the badge, an RN ready to IVP some powerful narcotic to calm your protest and once again you slip into sweet deep narcotic induced sleep. love to all kelli
I said I wouldn't post here again, but I gotta say this....
This is riiiiiii-diculous. RNinICU has started another post elswhere and only a few people remain here fighting back and fourth for no reason - I guess test of wills. I gotta say it again, this would never EVER want me to be affiliated with nursing! I'm embarrassed! Are you guys considering you are talking to another human being? What if the opinions expressed here one day has the face of your patient...Would you rip them to shreds? Does it matter to you?
I think I'll report this thread to the moderators. It has lead to nothing good.
i tried promise I did, I did sleep for about an hour or two, weeellll maybe a little less, wk called me in for a while. now I am on call all night dont worry as long as I dont see the little green men coming for me I'll be okay, SO is home tonight so I should be able to sleep a little more PROMISE haha
StrawberryBSN, BSN, RN
57 Posts