LPNs and RNs---does your hospital see a difference?

[Riseupandnurse]

In our hospital there is very little distinction between RNs and LPNs. The RNs have to do the IVPs, change the care plans, give blood, do an initial assessment on a new admit. Otherwise, each carries the same load, makes the same decisions, does the same work. The LPNs will place patients, assign staff, take "charge" with whatever is going on with their patients without telling the RNs, etc. Most get upset when an RN, even the charge RN, even inquires about what is going on with a patient because they feel the RN has no right to interfere with an LPN's patient. Reports are done person to person so no-one, not even the designated charge, has much of an idea what is going on with the other patients on the floor. It is hard because the RN is technically legally responsible and because it is hard to have the same number of patients and have to step in to do the IVPs and blood while still having the same patient load. Oh, and the "charge RN' has the same load as everyone else. I would like to see more of a team approach but the LPNs have ruled this out over the years. Is your facility like this?

[Nurse Lulu]

My hospital does not hire LPN's to acute care. I am sorry to hear about the lack of teamwork CAT

[APRN., DNP, RN, APRN, NP]

My hospital, and the three closest surrounding hospitals are RN only in my area. They do not hire LPN's/LVN's for acute care.

[lpnflorida]

One of the units in our hospital approaches the team concept in the following way.

The Rn has a team of 10-12 patients. They do all the assessments obtain any orders needed. The Lpn on the team does all of the medications and treatments for these same patients, then there is a Cna who does the personal cares. It is my least favorite floor to be pulled to. While I like all of the staff I dislike this type of nursing. It so becomes the left hand does not know what the right hand is doing. This is the only unit which runs like this.

All the other units in the hosp which have Lpn each has their own assignment most often with a Cna. Our working primary with smaller number of patients and no aide. We still let the Rn charge or team leader know what is going on with our patient when it is something out of the ordinary. We still help each other out with what ever is needed. I do for them as they do for me.

As an Lpn we can not initiate the care plan, however we are able to update the careplans.

I believe as far as attitude to having an Rn ask about a patient, I do not have a problem with it, nor if I ask an Rn about one of their patient do they have a problem. In that regard we are a team and bounce ideas off of each other.

[arlel58]

The hospital where i worked appreciates a lot of LVN who are very knowledgeable and do a lot of critical thinking. The frustrations lies on the fact that LVN's cannot pushed meds when our patient's are in severe pain. As if you are really asking a big favor. It's really a big deal for some of this RN's wwhen you ask them for IV pushes. I don't know why. I am in the nursing program to be an RN. I know I won't be like them when I graduate on May 2010. So for all the LVN's out there, go to RN school to finish your degree so that you don't get frustrated. OK

[arlel58]

That's horrible when you do team nursing without an aide. i have experienced working in a hospital when we do team nursing and i like it because the work load is distributed fairly. RN,LVN,CNA team work. We never work without a CNA that's why it is called team nursing eh. Without CNA that's torture team nursing not fun and I know it. It is difficult to work like that pass meds and total care that ridiculous.

[RNperdiem, RN]

No LPNs work at my hospital. I haven't met one in years.

[blondy2061h, MSN, RN]

My hospital (or at the very least my unit) is RN only. Being a BMT unit, most of what we do is outside of an LPN's scope of practice. Tons of IV pushes, tons of hanging chemo, and I've had shifts where I've hung 5 blood products on my shift. We also titrate a lot of drips, ranging from pressors to opiates to insulin. Further, we do a lot of telemetry, and conscious sedation on our floor.

Regardless, all of us work well together, and it's not uncommon for someone to help with someone else's assignment and we're all always asking how "so and so" is doing since we get to know our patients so well.

The environment you describe would be very upsetting to me.

[CathyLew]

Most get upset when an RN, even the charge RN, even inquires about what is going on with a patient because they feel the RN has no right to interfere with an LPN's patient.

I would have a problem with this. If I were the RN, and "technically legally responsible" I would want to know what was going on with the patients. or if an LPN asked me to give IV pain med to her patient, I would have to assess the patient myself. Not just take someone's word for it. It is my licence.

[S.N. Visit, BSN, RN]

We have 1 LPN. She was hired as an aide but graduated from Nursing school and passed her NCLEX, otherwise we don't hire LPN's. She will pass some meds, but generally continues to work in the aid role on nursing wages.

[pagandeva2000, LPN]

My hospital still uses LPNs. What you are describing, well, it depends on the floor. Most areas have the LPN as the medication nurse, while the RN does the rest, but it used to be different...LPNs would have their own patients; the more stable ones, but had their own assignment. We hang IVPBs, can initiate a peripheral line, can even hang potassium and magnesium sulfate, but are not allowed to push meds, or administer meds to central lines.

In the clinic I work in, the differences are more subtle...we do not triage walk ins, flu and pneumococcal vaccinations cannot be administered without an RN screening and I discovered just 4 days ago when I cross trained in the OB/GYN clinic that we cannot administer Rhogam because it equates to administrating a blood product. We can sign with an RN that it was received, but we can't give it.

[Riseupandnurse]

Please don't misunderstand my concerns. I have a HUGE amount of respect for the LPNs I work with. Many have lots of experience, very creative, lots of help in a crisis. I just think it would be a lot better for the patients if one person on the floor actually had an idea what was going on with ALL the patients, and it makes me nervous when as an RN I have to give a push or hang blood (we hang a lot) without knowing anything about that patient. I also know that the charge RN will be called to task if errors are made and we all make them. I have even been in a position where a patient was having a bad cardiac rhythm, the cardiologist showed up on the floor, I couldn't find the LPN who had the patient, and when I tried to help as I was charge and had more cardiac experience than she does, she suddenly appeared and lectured me about staying away from her patient as it wasn't any of my business. I don't think this is the best thing for the patient, let alone for her and me.