LPN's Role in the ICU?

[Nurse-o-Matic]

I am an RN in a 24-bed ICU. Currently, we have 1-2 LPN's scheduled per shift. Our policy is no more than 2 patients per RN unless you have an LPN working along with you, in which case you may have 3 patients. My experience with LPN's in citical care is that they seem to want to step outside of thier role-for example, push meds or draw off picc lines. Also, when the patient is crashing and I'm starting a new drip, calling the doc, etc., they will sometimes go off on break?!? Because RN's are paid more, some they feel they shouldn't do as much work and will bring a book to read while I run around at the end of the shift getting I&O's, restocking, or boosting patients.

I have worked in other departments with LPN's where each of us did our role and got the job done. In ICU it's different because our LPN's do have additional skills and want to function at a higher level. 10 years ago our ICU had LPN's taking care of thier own patients including IV pushes, IV's, and calling docs. There are a few of these LPN's left who practiced under those conditions and are now bitter to the rules. They feel they are stepping backwards in thier profession, but don't wish to pursue the RN degree.

Does your ICU employ LPN's?

[bluesky, BSN, RN]

My (ex) SICU and current combined SICU PICU MICU (interesting, huh?) does not employ LPNs. I think that each nurse_ whether LPN or RN_ has to prove her/him-self to be a competent safe nurse in their own right. I therefore support the presence of LPNs in the ICU with their own patient assignment. I am however, not in favor of team nursing with LPNs because of a. the innevitable power struggles and differences of opinion and b. I don't want to have to sign off on someone else's work and take the ultimate legal liability for anyone but myself.

[RN34TX]

RN34TX has some good points. Here in Texas LVN's are not as limited in their practice. And an RN who knows nothing about what they are doing in an ICU setting is a scary thing. But I do say, and I practiced as an LVN for 3 years, that LVNs should not practice in an ICU setting. I don't know if things have changed in the past years but when I was in school at the LVN level they did not teach us critical drips, vents, swans, etc which are common every day things in the unit. LVNs are being phased out here in Central Texas, where I work now they don't even hire them. The last hospital I worked at in West Texas informed the few LVNs that they had working in the ICU that they had like 12 months in which to obtain their RN or they would be transfered to a non-critical area even if they had been working in the unit for years.

RN's don't come out of school being able to manage drips, vents, and swans either.

That's why they have internships and preceptorships for new grads in ICU that often last 3 months or longer. They need the additional training that goes beyond the basic RN cirriculum.

BTW, I think that hospital was being a little stingy with their timeline of 12 months for the LVN's to get their RN.

12 months is generally the minimum time frame it takes to transition LVN to RN.

And this is taking for granted that the LVN has already completed all prereq's and there is no waiting list to start their transition program.

Most likely that would not be the case of this hospital's LVN's who had not anticipated your hospital doing this to them.

[austin heart, BSN, RN]

RN's don't come out of school being able to manage drips, vents, and swans either.

That's why they have internships and preceptorships for new grads in ICU that often last 3 months or longer. They need the additional training that goes beyond the basic RN cirriculum.

But they are at least exposed to them. In my critical care rotaion (last semester of my ADN) we had extensive hemodynamic teachings as well as some major pharmacology including critical drips.

[RN34TX]

But they are at least exposed to them. In my critical care rotaion (last semester of my ADN) we had extensive hemodynamic teachings as well as some major pharmacology including critical drips.

True.

However, given the minimal amount of info that seems to be retained by most that I've worked with, I have to question whether this clinical experience really makes a big difference in the long run.

I've never oriented LVN's to ICU so I can't compare, but it seems that I'm starting from scratch when explaining the concepts of vents and drips to newbies at the same level I was taught as an LVN going to ICU.

I guess I figured that an RN grad would already have some of this down to a greater extent than I did as an LVN in learning these things but that doesn't seem to be the case in my experience.

And I'm not sure just how extensive your program was, but I have yet to run across a new grad who comes out of school able to read a strip even on a 101 level (brady vs. tachy vs. v-tach) unless they were previously paramedics or telemetry LVN's or something along those lines.

[Annor]

Ok, I'm going to get on my soap box here.....

I am an LVN, and have worked in ICU/CCU...taking my OWN patient load and doing my own IV pushes, IV meds, drips, calling docs, everything. I had no RN working with my patient's and sure never had an RN display an attitude towards me. It is VERY stereotypical to be making these comments about LVN's. Excuse me, but I know how to assess my patient's and was responsible for a full head to toe shift assessment on each patient. FYI - I'll run circles around some RN's and leave them spinning, and I'm guessing me and some other LVN's could do the same for some of you with your attitudes. Get over your BSn (b*llsh*t nurse) if you're going to have an attitude like that. RN's are technically considered Professional Nurses, but in your cases, I would have to beg to differ. Now, don't get me wrong, there are some LVN's who lack critical care skills, but HELLO - there are RN's that lack critical care skills also!

You're nursing degree does not testify to what type of a nurse you are, how good you are, how crisp your assessment skills are or anything, it just states how long you went to school. I know everyone can attest that nursing school does not define a person as what type of nurse they will be. That's my 2 cents, some of your attitudes just FLOOR me!

Well said...

I worked in ICU too.....and did my job as good as any nurse in the unit

[bluesky, BSN, RN]

True.

However, given the minimal amount of info that seems to be retained by most that I've worked with, I have to question whether this clinical experience really makes a big difference in the long run.

I've never oriented LVN's to ICU so I can't compare, but it seems that I'm starting from scratch when explaining the concepts of vents and drips to newbies at the same level I was taught as an LVN going to ICU.

I guess I figured that an RN grad would already have some of this down to a greater extent than I did as an LVN in learning these things but that doesn't seem to be the case in my experience.

And I'm not sure just how extensive your program was, but I have yet to run across a new grad who comes out of school able to read a strip even on a 101 level (brady vs. tachy vs. v-tach) unless they were previously paramedics or telemetry LVN's or something along those lines.

Well by the time I graduated, I had already read Dubin and knew how to interpret 12 leads. Maybe we could stop making generalizations and take each nurse on a case by case basis.

[RN34TX]

Well by the time I graduated, I had already read Dubin and knew how to interpret 12 leads. Maybe we could stop making generalizations and take each nurse on a case by case basis.

Well that's great that you could do that as a new grad but it's hardly the norm so you should be proud. Many experienced RN's can't read 12 leads.

But that's not what this is about.

The bottom line is this:

In states and facilities where LPN/LVN's are utilized to their fullest potential and capacity, it works.

But if the state and/or facility is going to reduce LPN practice to little more than being a glorified aide who can pass pills and put in foleys, then, no, it won't work.

All of this nonesense of having RN's signing off LVN's charts and having to give all of their patients IV pushes and manage drips will do nothing more than disrupt the unit and frustrate both RN and LPN/LVN and compromise care. In that situation, you might as well just put a CNA on the unit to help out the RN's.

I've also been floated to ICU as an LPN in a state with a very restrictive LPN practice and they might as well have just paid a CNA to come help out instead because all I did was bathe, change linens, empty foleys, and check blood sugars. I did it because it was fairly easy money, but what sense does that make?

[icugirl33]

Oh boy..Another LPN vs RN thread. Run all the circles you want, the RN is still getting paid more. If your so sure about your LPN skills, petition the employers to start paying you equal pay. I guarantee you this will never happen. If I owned a healthcare facility, of course I would hire tons of LPN's and save a load of money (if legally allowed by the state).

[organichombre, ADN, BSN, MSN, LPN, RN]

Bravo CVN! I worked as an LPN in a Veterans Hospital for 5 years prior to going back for my degree. True there is a movement to remove them from ICU which is probably the right thing to do. Lpn school does not prepare a person for that environment and only with extensive ojt was I able to function there. I was covered by an RN for everything I did and there were distinct parameters on what I could and couldn't do. But, shame on that CCRN for her attitude. AACN does advocate that only RN's are employed in ICU's but that does not mean that they are incompetent. I'm currently working on my MSN ED and hope that the image of competent NURSES will improve for both Lpn's and Rn's.

Rick Davies RN BSN CCRN

[nsg]

Some of you RNs sound very unwelcoming, threatened and resentful. It concerns me that any LPN would have to tolerate such intolerant and discriminatory attitudes. My sympathy rests with any poor LPN who would have to endure a shift with such unprofessional nurses.One would expect from nurses with higher education less stereotypical remarks. Your lack of professionalism reflected in your remarks makes the point that some RN's can also be professionally inadequate in variety of areas.Perhaps you are overdue in updating yourself on the current role of LPNs. I've met incompetent Rn's and incompetent LVN's. And I've met RN's who are very threatened by LVN's who possess the same skill level or higher than RNs.

Some LPNs don't pursue professional development and others do, just like RNs...some advance themselves and some don't. You can't assume everyone if fuctioning on the same level. This is a very simplistic view. Everyone brings to nursing different levels of education, experiences and abilities. I would not look down on a RN who knows nothing about methadone maintenance or maintaining IVs...I would do my best to be understanding and supportive.

This a more an issue of supportiveness. I thought nurse were supposed to be supportive and caring.

You don't need to feel so threatened. It would be helpful if we could support and help each other. As an aside, some LVNs have higher education that RNs...they may possess a BSc or other degrees. So please don't stereotype and please don't feel so threatened and resentful as its not very professional and simply not nice. There are professional Rns and LVNs and unprofessional Rns and LVNs.

Remember each nurse is an individual and should be taken on there own merit. Discrimination is ignorance and should not be tolerated.

[Darlene K.]

Quote

OK, I'm going to get on my soap box here.....

I am an LVN, and have worked in ICU/CCU...taking my OWN patient load and doing my own IV pushes, IV meds, drips, calling docs, everything. I had no RN working with my patient's and sure never had an RN display an attitude towards me. It is VERY stereotypical to be making these comments about LVN's. Excuse me, but I know how to assess my patient's and was responsible for a full head to toe shift assessment on each patient. FYI - I'll run circles around some RN's and leave them spinning, and I'm guessing me and some other LVN's could do the same for some of you with your attitudes. Get over your BSN (b*llsh*t nurse) if you're going to have an attitude like that. RN's are technically considered Professional Nurses, but in your cases, I would have to beg to differ. Now, don't get me wrong, there are some LVN's who lack critical care skills, but HELLO - there are RN's that lack critical care skills also!

You're nursing degree does not testify to what type of a nurse you are, how good you are, how crisp your assessment skills are or anything, it just states how long you went to school. I know everyone can attest that nursing school does not define a person as what type of nurse they will be. That's my 2 cents, some of your attitudes just FLOOR me!

Here in FL - I take full responsibility for MY patients, call the MD, take the order, give the med!

[AlexCCRN]

Our hospital employees LPNs but NOT in the ICU. Too many cooks in the kitchen. I find LPNs mostly distracting on the floors.