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LPNs in ICUs titrating drips

Posted

Specializes in critical care: trauma/oncology/burns. Has 38 years experience.

Hello Everyone

I work in a Military medical center and we utilize LPNs in our burn unit but the rumor mill has churned out that in the near future only military LPNs will be hired.

My question is:

How many LPNs/LVNs are currently working in an ICU and - if you are, do you titrate drips such as levophed, vasopressin, dopamine, lidocaine, etc.?

If you DO titrate drips, were you certified to do so? Do you take an annual in-house certification exam that "allows" you to titrate the above mentioned drips?

[i am trying to do research and justify keeping our LPNs in the burn unit]

Thank you all for reading this and thank you for your responses.

athena

ktwlpn, LPN, RN

Specializes in Med Surg, Homecare, Hospice.

Not in the scope of practice in this state

athena55, BSN, RN

Specializes in critical care: trauma/oncology/burns. Has 38 years experience.

Thanks for responding ktwlpn :yes:

May I ask, which state?

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

Specializes in ER, TRAUMA, MED-SURG. Has 22 years experience.

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

Anne, RNC

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

SquishyRN, BSN, RN

Specializes in ER, Trauma, Med-Surg/Tele, LTC. Has 10 years experience.

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

HouTx, BSN, MSN, EdD

Specializes in Critical Care, Education. Has 35 years experience.

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

Specializes in Adult ICU/PICU/NICU. Has 54 years experience.

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.

Edited by HazelLPN
arthritic fingers

ReordonaSRN

Specializes in Emergency Medicine. Has 1 years experience.

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, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 10 years experience.

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

HazelLPN, LPN

Specializes in Adult ICU/PICU/NICU. Has 54 years experience.

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...

I never taught myself how to titrate a drip, I was trained on the job. Part of that includes in service training, reading and learning on your, asking questions, and putting the information into practice with a good understanding of the pathway of the drug and its effect on the body. That's probably how most nurses learn to maintain critical care drips.... by informal education...not in nursing school. I certainly didn't learn how to titrate a drip in school because IV therapy was still the function of the docs at that time. However, we somehow managed to do it when the time came...though informal education. In nursing, everyone's formal education becomes obsolete if you stick around long enough.

Nurses who have less formal education CAN and DO compensate for it by the informal education that we continue to receive on the job that is not from school. I'm not saying formal education isn't important. I tell all young people to get that BSN...but I'm quick to point out that it won't make you a better nurse than the veteran diploma RN or LPN who's been working since you were in diapers and who had a wealth of knowledge that isn't learned in school.

Back to the topic at hand.....LPNs who titrate drips or who work in critical care units are the exception to the rule but there are states and facilities where they are functioning within their scopes of practice and do an excellent job. I managed to do it very well, as did my LPN colleagues, despite what studies about patient outcomes may say about how LPNs or even diploma RNs should be put out to pasture because their lack of formal education is so profound that no amount of informal education can compensate for it. These studies, designed in partial fulfillment of the MSN or PhD are often plagued by poor research methods, bias and/or misuse of stats and /or coding if qualitative techniques are used. If the BSN is to be the entry into nursing, so be it...its good for the reputation of the profession and may attract better quality of nursing students, which sadly had been on the decline for many years.

I don't need luck at this stage. I had a wonderful career. You are the one who will need the luck as you have a long way to go and some lofty goals you wish to obtain.

Best to you,

Mrs H.

Nienna Celebrindal

Has 12 years experience.

In Florida I could do almost anything with I meds after getting I certified and taking an extra class (it was several weeks long and then lots of being double checked by an RN after) but there was a list of drugs I could not use.