LPNs in ICUs titrating drips

ktwlpn, LPN · Jul 28, 2014

Not in the scope of practice in this state

athena55, BSN, RN · Jul 29, 2014

Thanks for responding ktwlpn :yes:

May I ask, which state?

Dante75067 · Aug 26, 2014

I work in an ICU and have for 20yrs in Okla and now in Texas. I have always titrated my own gtts. It depends on hospital policies. I have taken many courses and that does help to demonstrates competence.

sissiesmama, ASN, RN · Aug 26, 2014

Our hospitals in north Louisiana don't allow LPNs to work in ICU at all.

Anne, RNC

kbenning0003 · Aug 26, 2014

In Alabama it is out of our scope of practice to titrated medication.

SquishyRN, BSN, RN · Aug 26, 2014

In California, LVNs cannot administer IV medications at all, only fluids and blood if IV certified.

jadelpn, LPN, EMT-B · Aug 26, 2014

If you look at the scope of practice in your state, it will tell you what LPNS can not do--otherwise, there's many states that allow an LPN to do whatever it is that a facility allows them to.

Texas Board of Nursing - Nursing Practice FAQ

Here's a link that could be helpful to you.

HouTx, BSN, MSN, EdD · Aug 26, 2014

By definition, titration involves adjusting rates as dictated by the patients response... which can only be ascertained by assessing the patient. This is beyond the LVN scope of practice in Texas because it requires the application of advanced physiology / hemodynamics and this is not part of LVN education. IF you have "titrations" set up like sliding scale insulin... as a protocol ( if -then) rather than one that requires independent judgement, ... you may be able to scoot it through NPA-wise, but that would be very iffy. Chances are, any patient that requires a titrated drip is unstable in the first place... so there should be an RN managing the care.

Bigger question - if something bad happened, how would you explain this to the plaintiff's attorney or the patient's family? What was so important for you to do at the time that you delegated this to an LVN? If you could explain and justify your decision in a way that is congruent with your Nurse Practice Act and overall professional responsibility -- without getting red in the face -- go for it. For me? There's no way I would pass the red face test.

HazelLPN, LPN · Aug 26, 2014

It was in my scope of practice in the state and facility where I worked to titrate my own drips and to do my own pushes. Nowhere in my state scope of practice does it mention that LPNs can only take care of stable patients with predictable outcomes. I was responsible for my own shift assessments but did not do the initial assessment on admission. I also didn't serve as charge nurse, push propofol or other anesthetics, train to run the ECMO pump or serve as a patient's primary nurse. Otherwise, I managed my own patients and did so very well for over 50 years before knee replacement surgery forced my retirement from critical care nursing. Having to use a cane pretty much tells you its time to retire....

At my hospital, any nurse, RN or LPN, who works in the units takes a critical care class before they can give any critical care drug. It was taught by the pharmacists and our clinical nurse specialist. They would also take their ACLS, PALS or NRP around the same time. If we got a nurse floated from the floor, they were never assigned to a patient who was on any drip that required titration unless they were paired with an ICU nurse and functioned more as an extra pair of hands vs having her/his own assignment. In that case, we took care of the drips and usually the suctioning.

Back in the 80s I found myself in school for my BSN as management determined that all LPNs would need to get their RN in order to keep working in the ICU. I finished 3/4 of my schooling and only had one semester left, but life got in the way and I never finished my BSN and remain an LPN to this day. Thankfully, our nurse manager and head intensivist fought to keep the veteran LPNs in the unit and won because you can't replace all of that experience. However, the only LPNs that would be hired in the unit would be those working on their RN.

Did my RN training help me in critical care nursing? No. Honestly I learned my critical care on the job and I learned the science behind it on my own. The only science that gave more insight into how the body worked was when I took the pre medical level chemistry courses which is beyond what nursing students take. Even then, understanding how buffers work to maintain pH didn't change the way I did critical care, but I did have a better appreciation about what the values really mean when you get your gas results.

The LPN in the ICU is the exception to the rule. It is only when if they have a broad scope of practice where it is appropriate to work in a critical care setting. Usually, they are veteran nurses within a few years of retirement and are replaced with an RN when they retire. I'm fine with that, but we must remember that education does not end in nursing school. It continues throughout one's life. I would let the LPNs that I worked with take care of me or my loved ones any day as they were truly excellent critical care nurses who proved themselves worthy of working above and beyond. I can't say the same of all of the RNs that I worked with.

I'm now working as a substitute assistant school nurse and find myself happy to clear up misconceptions about LPNs from the student nurses who are working on their community rotation. They are surprised when I say that I worked in critical care and one even said "but you were never taught critical reasoning skills like we were!". I nearly dropped him with my cane but refrained because I still need my license for a couple more years. He'll never make that mistake again...especially when addressing an old school LPN who still wears her whites and her cap.

Best to you,

Mrs H.

ReordonaSRN · Aug 26, 2014

Practicing without formal education is both good and bad... Good for you to have learned a skill that many RN's have problems understanding... But on the other hand nursing itself is evidence based practice and had been for a long time... It's what brought nursing to what it is today... When you teach yourself a skill you really don't know if your skill is being taught the best way possible to provide the best patient outcomes... I encourage everyone to go to school and actually learn and study theory behind what you are practicing... I work ICU and ED and obtaining my Doctor of Nursing Practice from University of San Francisco... I have to say school has given me a better understanding of what nursing was and how nursing came to be where it's at now... Plus studies have showed that formal education plays a big part of creating better patient outcomes... When I graduate with my DNP I would have had over 9 years of being in school while learning and studying my profession as a nurse... Working for years can't replace education... That's why it's not practiced here... No one can work in the hospital for a long period of time and call themselves a nurse or a doctor just because of work experience... Education never stops because one can continue to learn in school... But there is only so much you can learn on the job... Because unfortunately jobs do require a person to have so much education first then they look at experience... Because 30 years of being a LPN will never equal to an RN... But I do agree with you... There are RN's that are really bad but they are outliers and do not represent the majority... Here is an interesting fact 10% of all nurses hold a graduate degree and less than 1% hold a doctorate... Education has given opportunities for nurses to practice independently and evolve a nurse to open their own clinics and become primary care providers... And that could never happen without education... Well good luck to you and thank you for your years of dedication in helping and caring for others...

JustBeachyNurse, LPN · Aug 26, 2014

Out of the scope for NY, NJ and I believe PA