LPN's Role in the ICU?

fran313 · Apr 17, 2012

smiles at all of the comments.............I am an ICU Rn, here in Florida Lpn cannot assess, push iv meds, titrate gtts, etc.............and although I know several long time Lpn's that probably have forgotten more than many Rn's will every know..........it is because of thier yearssss of experience and learning and seeing it all on the job, kinda likethe old way nurses were trained, on the job, not college degrees. Yes it does depend onthe individual and how interested they truely are, but Lpn do not have the same education here in Florida as Rn, Lpn is a technical trade, not a college degree, they dont have anatomy, physiology, pharmacy, chem, micro, etc .................we should all strive to the highest level we can, that we enjoy are comfortable with, it takes all kinds of nurses to get the job done....

NCRNMDM, ASN, RN · Apr 19, 2012

I live in NC, and LPNs are rarely hired at hospitals around here anymore, and they certainly aren't hired in the critical care setting. I'm a nursing student with 11 months left until I graduate, and I want to be an ICU nurse after graduation. I understand the rationales behind not hiring LPNs in the critical care setting (such as not being able to administer blood, not being able to titrate drips, etc), but I don't think that RNs should disparage the skills and knowledge of LPNs simply because they, the RNs, hold a higher degree. If I get a critical care residency as a new grad, I don't care what my preceptor's qualifications are as long as they are a good, compassionate nurse who is enthusiastic about teaching a young nurse the ins and outs of ICU nursing.

In the end, LPN and RN are both letters behind someone's name. LPN doesn't make you a lesser nurse, and RN doesn't make you a more superior nurse. I've always heard nurses say, "I would take an older, experienced LPN over a young, inexperienced new grad any day." I can see why this would hold true, and I think that some RNs need to remember that. Just because you have your RN doesn't mean that you are suddenly more skilled, or better at nursing.

lindarn · Apr 19, 2012

I beg to differ with you. "LPN and RN:are just letters after someone's name". Those, "letters", indicate and educational difference and legal title. The education of an LPN is similar, but lacking in the education that increases the scope of practice between them.

RNs are educationally more prepared for the larger scope of practice. Are, "just letters after someones name", the same mentality between a PA and an MD? Are PAs and MDs the same, just differences in the letters after someones name?

I have all the respect for LPNs but they are just not educationally prepared to work in ICU, ER, etc.

A long time ago, I worked with an RN who was an LPN, who went back to school to be an RN. She had this dream of working in ICU.

She washed out of one ICU training program, and decided to work at the hospital I was working at, in the Stepdown unit, which had monitored patients, limited drips, etc. After a year or two, she applied for and got accepted for a position in the ICU.

She struggled in orientation, but was eventually passed. She struggled just as much when she was on her own, but no one noticed it, and she did not ask for help.

Her lack of critical thinking skills eventually was instrumental in killing a patient. She just did not understand that it was her responsibility to question a doctor's order, to critically re- assess the order that had been written, realize that if, "ABC was not happening" ,that you call the doctor and inform him/her, to request a change in the order.

The doctorordered a large dose of IV lasix, she gave it, the doctor, or course, expecting the patient to diurese, patient did not diurese. But she continued to administer potassium boluses over one hour x 4, not noticing/having it compute, that if the patient was not diurese, after one or two doses, stop giving them and call the doctor. The patient became severely hyperkalemic, coded, adn died. She was finally fired after that incident.

There were other incidents that had happened previously, that should have made the nurs manager question her ability to continue to work in ICU. That, of couse was not her fault, but she did not want to admit that she was not cut out to work in ICU.

I have has other incidents with LPNs that affirm my belief that LPNs have no business working in ICU. That is not prejudice, it is a fact that their education is not cut out for ICU, ER, etc.

JMHO and my NY $0.02

Lindarn, RN ,BSN,CCRN

Somewhere in the PACNW

HazelLPN, LPN · Apr 20, 2012

I beg to differ with you. "LPN and RN:are just letters after someone's name". Those, "letters", indicate and educational difference and legal title. The education of an LPN is similar, but lacking in the education that increases the scope of practice between them.
RNs are educationally more prepared for the larger scope of practice. Are, "just letters after someones name", the same mentality between a PA and an MD? Are PAs and MDs the same, just differences in the letters after someones name?
I have all the respect for LPNs but they are just not educationally prepared to work in ICU, ER, etc.
A long time ago, I worked with an RN who was an LPN, who went back to school to be an RN. She had this dream of working in ICU.
She washed out of one ICU training program, and decided to work at the hospital I was working at, in the Stepdown unit, which had monitored patients, limited drips, etc. After a year or two, she applied for and got accepted for a position in the ICU.
She struggled in orientation, but was eventually passed. She struggled just as much when she was on her own, but no one noticed it, and she did not ask for help.
Her lack of critical thinking skills eventually was instrumental in killing a patient. She just did not understand that it was her responsibility to question a doctor's order, to critically re- assess the order that had been written, realize that if, "ABC was not happening" ,that you call the doctor and inform him/her, to request a change in the order.
The doctorordered a large dose of IV lasix, she gave it, the doctor, or course, expecting the patient to diurese, patient did not diurese. But she continued to administer potassium boluses over one hour x 4, not noticing/having it compute, that if the patient was not diurese, after one or two doses, stop giving them and call the doctor. The patient became severely hyperkalemic, coded, adn died. She was finally fired after that incident.
There were other incidents that had happened previously, that should have made the nurs manager question her ability to continue to work in ICU. That, of couse was not her fault, but she did not want to admit that she was not cut out to work in ICU.
I have has other incidents with LPNs that affirm my belief that LPNs have no business working in ICU. That is not prejudice, it is a fact that their education is not cut out for ICU, ER, etc.
JMHO and my NY $0.02
Lindarn, RN ,BSN,CCRN
Somewhere in the PACNW

Lindarn, old girl, I think that much of what you said is correct, HOWEVER, as a retired critical care LPN, I must also add my midwestern two cents.

There are still some LPNs around who have been doing critical care nursing for many years who live in states where the LPN has a broad scope of practice who do have the critical reasoning skills. There are also plenty of RNs that I have worked with who lack the critical reasoning skills to be ICU nurses...and I too have watched these girls fail miserably and cause substantial harm to their patients because they didn't have the natural talent to do the job. If I may be so bold, I've saved the license of more than one inexperienced BSN who simply lacked the experience and/or talent to truly understand what she was doing and why.

At the time of my retirement from critical care nursing (three years ago after fifty four years on the job), we had only a few LPNs left in the units. They were replaced by an RN when they retired. All but one were veteran nurses with 15+ years of experience in critical care and the youngest LPN was simply an exceptionally intelligent young woman with a thirst for knowledge and an inborn talent for nursing. She had worked as a unit clerk in the PICU and was hired as long after the hospital stopped hired LPNs in critical care. I would happily let any of these LPNs care for my great grandchildren if God forbid they ever needed it.

I can't say the same for all of the RNs that I worked with.

As you know, I'm with you that the BSN should be the standard entry into nursing practice. However, lets respect nurses from an earlier generation who don't have the formal education but who compensate for this by years of experience, natural talent, and a drive to learn new things. An LPNs formal education does not prepare her/him for critical care. I will add that most RNs formal education does not either. One must go above and beyond their formal education. One must read and research and question and seek to understand why and how on a much higher level of learning. This is informal education and informal education can be a very powerful thing indeed. It was due to my informal education and years of experience that made me a good critical care nurse...not my long obsolete practical nursing diploma from 1955....

That's my own two cents. I enjoy and admire your passion for nursing and your comittment to improving the profession from your other posts. I think if you would have had a chance to work with me in the unit, you would have been happy to have this old LPN work the shift with you. Not just because I was a good nurse, but because I am also a very skilled home bartender and home cook (informal education again) and was known to help friends from work after work unwind with my legendary ability to titrate ETOH and chocolate desserts with my friends' stress levels.

Cheers (clink!)

Hazel H.

rgroyer1RNBSN, BSN, RN · Apr 21, 2012

Lindarn lay off the Lpns, I was an Lpn before getting my bulls**t bsn, but now that I have worked as a nursing sup. and nm in both er and sicu, I have a few lpns that work for me and believe me when I say that a properly trained lpn can give wonderful care to a critical care pt. under an Rn, and that I would prefer one of them taking care of me then a new grad or some very incompetent Rns I know.Go LPNs! Rod RN, Bsn

rgroyer1RNBSN, BSN, RN · Apr 21, 2012

Another thing Lindarn have u ever worked er, because if u have u would know that we have a heck of alot of things an lpn can do in er, as in I mean we do alot of wound care, splints, im inj, hanging fluids etc. I will admit I have had a great vetran lpns that have saved my butt before, so yes I will go to bat for them anyday, and not to be offensive or mean but save the superiorty complex attitude for someone else or the best thing would be to lose it, let me tell you I have had high and mighty Bsns who have killed someone, I had a chf pt who the bsn on duty before me turned her fluids on the pump to 999ml, and the poor women had to be tubed and have laxis out the wazoo. So I will always take one down a notch when they are feeling high and mighty because I have learned that is generally when they make their big mistakes. Rod Rn, Bsn

HazelLPN, LPN · Apr 21, 2012

Another thing Lindarn have u ever worked er, because if u have u would know that we have a heck of alot of things an lpn can do in er, as in I mean we do alot of wound care, splints, im inj, hanging fluids etc. I will admit I have had a great vetran lpns that have saved my butt before, so yes I will go to bat for them anyday, and not to be offensive or mean but save the superiorty complex attitude for someone else or the best thing would be to lose it, let me tell you I have had high and mighty Bsns who have killed someone, I had a chf pt who the bsn on duty before me turned her fluids on the pump to 999ml, and the poor women had to be tubed and have laxis out the wazoo. So I will always take one down a notch when they are feeling high and mighty because I have learned that is generally when they make their big mistakes. Rod Rn, Bsn

Thank you for your support of veteran LPNs Rod, but I have a lot of respect for Lindarn. She is a strong advocate for nursing as a profession. Where she lives, LPNs have a limited scope of practice and it would place additional work on the RNs who would have to cover what is outside of the scope of the LPNs. She's also had a negative experience with a very untalented individual who used to be an LPN. She's allowed to feel the way she does because these are her experiences. If she worked with me, her experiences would be much different.

In states where LPNs are allowed a broad scope of practice, LPNs work well in critical care. They do so based on their experiences, natural talent and work ethic, not their formal education. I would add that no RN can simply go to work in an ICU either based solely on her/his formal education. One must take the initiative to learn far beyond what one was taught in school in order to be a successful critical care nurse.....RN or LPN.

Best to you,

Mrs H.

rgroyer1RNBSN, BSN, RN · Apr 21, 2012

I had bad experiences as well, Mrs.H, and I feel for lindarn and have respect for her, but all I am trying to say is why dont we all just get along respect each other for who we are not just the letters behind our names be it lpn or bsn, and believe me here in missouri lpns are pretty limited but I would still take a veteran Lpn over a new grad bsn in my sicu, and er anyday.Rod Rn, Bsn, Cen, Cfrn, Ccrn.