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?

[Smokey9283]

As an LPN I know that I take my direction from the RN. Regarding not knowing what is going on with a patient, it is the opposite in our hospital. The LPN's float the floor and do various tasks for each RN ie, hand IVPB, dressing change, insert IV, parts of an admission..... The difficult thing about that is that we aren't getting any report on patient's. We are expected to blindly do these tasks. What's even more frustrating to me is when a patient is c/o pain and i don't know what the patient has been getting, and what the plan is. I would be able to simply give a percocet, but it takes 20 minutes because I have to locate the RN then get the med.

In your situation it sounds like the LPN's are afraid of loosing their title. If they are having to be accountable to someone other than their patients, then they will feel like less of a nurse. In our hospital LPN's are not referred to as nurses, but support staff. It's a nasty hurtful term. I get fired up just thinking about it. Just food for thought.

[shodobe]

My facility hasn't used LVNs for almost 8 years. On the other hand as the charge I do want to know what is going on with all patients. If the LPN doesn't like this, to bad. I have the responsibility in the long run. I wasn't sure what state the OP was but in CA the RN is the ultimate responsible person.

[Katie82, RN]

The role of the LPN in a hospital setting is mandated and restricted by the State BON, so this accounts for the fact that hospitals do not hire LPNs in states with more restrictions. In the states that allow LPNs to perform more duties, it is actually more economical to hire LPNs - lower pay scale. In a lot of these states, they use the team approach for every 12-15 patients, one RN, 2 LPNs and 2 CNAs. A LPN who has total control of a group of patients should expect to report to a RN, that is the scope of her job. I'm not saying they should be micro-managed, but occasional report is a reasonable expectation. THey need to check their state Nurses Practice Act, then your Unit Manager needs to lay down a few rules.

[eriksoln, BSN, RN]

I guess so, since I got hired and an LPN wouldnt.

[linzz]

I think that it is reasonable to expect to update the charge nurse. It is not something I would have a problem with. It seems to be that it might be pretty challenging for a charge nurse to take on a full load of patients and do charge but I am only guessing here.

[Jules A, MSN]

I'd absolutely agree with updating the charge nurse but it is my understanding that if the LPN is practicing within their scope the other staff RNs on the unit are not responsible for what the LPN is doing. I don't know but it seems like "they are working under my license" has taken on a life of its own and I'm not comfortable with that blanket interpretation.

[Faeriewand, ASN, RN]

To answer you question, the big difference between RN and LVN at my hospital is PAY. But we are offered the same jobs except in L&D.

The Team approach is used on our Telemetry floor. One Rn to one LVN. Telemetry is 4:1 so they have 8 patients between them with the LVN passing all oral meds and the RN doing all IV stuff. Not sure how they divide up the assessments. Here in CA LVN's can hang blood. I get an RN to be the other nurse signing off on the bag.

On med/surg I get my own 5 patients. (Califjornia ratios) A different RN covers each pt for IV meds. Sometimes there are no IV meds to be given. But I do my own assessments and I like that a lot. For a few weeks there the policy was changed that the RN's had to do the assessments. No one liked it. I didn't feel like a real nurse if I wasn't doing assessments. And the RN had more to do if she was assessing my patient instead of me. So they changed it back. We are all much happier. There is an LVN who has been working there for 28 years so can you imagine how she felt?

I just am flabbergasted that the LPN's mentioned would give an RN flack for helping out or checking on their patient. What's the big deal? We are all in the struggle together. And I thought that the Charge nurse carrying her own pt load was a no-no.

I can understand why some hospitals will only hire RN's. But to save money some are hiring LVN's on the floor now.

[stressgal, RN]

My hospital did away with LPN's in acute care. It is kind of sad actually, we had two LPN's who worked the Gen Med floor for years. As of January 1 of this year their positions were dissolved. They have been unable to place them in a physician's office, the only place they are now able to work, so they are currently working as techs on the same floor they once nursed. One cannot leave the organization due to preexistent health issues that would likely not be covered under another employers insurance plan. I am not sure what happened with their pay as it is none of my business. I hope the facility treated them ok in that matter at least. But somehow I doubt it.

[loriangel14, RN]

Where I work the RNs and PNs get their own assignments and are responsible for their own practice.I do my own assessments, even initial ones. If I get a pt that has an IVP or blood transfusion then one of the RNs does it for me. We have no aides or techs and the charge has an assignment all shifts except mon-fri days.

[Melinurse]

When I was a LPN last year we worked as a team. The team took 9 - 10 pts depending on acuity. The RN took unstable and fresh DOS post-ops, I took everything else, did my own assessment, charted, gave report, hung IVPBs, inserted IVs , basically everything the RN could do except hang blood, no IV push meds, could not call MD ( which I thought was stupid ) no NGs ( which was awesome ). We had 1 CNA who worked with us too. We all worked very well together and did not consider any patient as mine or hers, etc. They were all our patients. Sometimes I would go into the " RNs " assigned room and give a med or check something and she did the same with mine. We had amazing communication. Hospital was impressed and started talking about bringing LPNs back and going with team nursing. Sorry to hear your facility is not doing team nursing. Maybe someday.

We were responsible for our own practice but they did hold the RN as accountable, which is why open good communication is vital to teamwork and a deep trust and respect for each other.

[pagandeva2000, LPN]

While each state differs on the scope of the LPN, all of them state that the LPN works under the auspice of the RN, which means that this is supposed to be a collaborated effort. It is absurd to me that an LPN would believe otherwise.

It doesn't mean, however, that the role and contribution of the LPN should be dismissed. I always believed that an LPN can take on the basic nursing care for patients, while the RN does assessments and picks up on the skills that their LPNs are unable to practice. What happens is that the facilities are limiting the LPN roles out of fear, and the policies and procedures are more antagonistic for the two roles than helpful.

What I have observed is that the roles of CNAs have increased, changing their titles to Patient Care Technicians/Associates, expanding their skills to include catherization, dressings, sometimes as medication aides, etc...and some RNs are grateful for that, even though they incur the ultimate responsibility, while the roles of LPNs, who have licenses of our own are diminished and are made to feel as though they are 'in the way', 'too much trouble', doing 'double work', etc... I feel "make up your mind"...you cannot have both. It is also true that we are listed as 'supportive staff' or 'allied health' more than nurses, which, can be insulting, depending on how the individual takes it.

It amazes me how the same governing bodies that created the scope of practice for RNs and LPNs act out of ignorance of a title that they, themselves, created and now, don't seem to know what to do with them.

[MAISY, RN-ER, BSN, RN]

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

The problem lies in the fact that Iv push meds (narcs) require vitals then 15 minute vitals with inital assessements and reassessments. It is a very big deal when you have your own work, and then must go to another assignment to do this for patients. That is why LPNs are not usually found on critical care or oncology units in unless grandfathered in NJ, and not hired by any hospitals (that I have heard of) in NJ at this time. As far as your graduation and working on the floor, you will be so busy learning, doing, and practicing time management. It will be a very big deal!

I am not a mean nurse, and I truly believe we should help our fellows; but you can't understand until you are actually working and doing! Being a student nurse is like a holiday compared to being a nurse. I wouldn't even call it apples and oranges, more like apples and broccoli!