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?

[lindarn]

Hazel--

You are absolutely right...the very best teacher is experience. I am sure with your many years critical care experience that you are a capable as well as mentor!

LPN/LVNs in ICU? Not on my watch and my license. You are not as capable or educated as an RN, and you have no place in ICU. Period. There are more appropriate areas to for you to work in, that would better utilize your education and scope of practice.

LIndarn, RN, BSN, CCRN

Spokane, Washington

[speti4]

LPN/LVNs in ICU? Not on my watch and my license. You are not as capable or educated as an RN, and you have no place in ICU. Period. There are more appropriate areas to for you to work in, that would better utilize your education and scope of practice.

LIndarn, RN, BSN, CCRN

Spokane, Washington

Wow Lindarn, You sound pretty sure of yourself.

[91CRN]

LPN/LVNs in ICU? Not on my watch and my license. You are not as capable or educated as an RN, and you have no place in ICU. Period. There are more appropriate areas to for you to work in, that would better utilize your education and scope of practice.

LIndarn, RN, BSN, CCRN

Spokane, Washington

LINDARN--I've got to say, I think you are fabulous but I think you've been a little harsh on this one. I agree that LVNs should not be in the ICU but for different reasons--more political/business reasons. I started out my career as an ICU-LVN (military trained). Like the previous poster I was very proud of my abilities/expertise and QUICKLY found myself out-nursing MOST of the RNs around me. Having said that, I think there is a large variance in training; theory as well as clinical. The talents of people getting thru LVN and RN programs also varies markedly. Here is the point: we have to have a GENERAL MARKER for making sure that the people hired to perform in critical care are up to the challenge; I agree that should mean an RN license with the appropriate certifications, ACLS etc.. I truly value the work of some talented LVNs and I think there can be a place for them in clinics etc.. I think that because an RN is responsible for the overall care that otherwise licensed people are providing, it doesn't make sense to have them provide it. So, while I really feel for the talented LVNs out there who are outraged--channel your outrage into an RN license and get paid double for the work you are already doing! Get your training any way you can and see if the hospital will pay for it. I SAY THAT WITH GREAT LOVE AND RESPECT. ALSO BECAUSE I AM THE SAME PERSON I WAS WITH THE SAME BRAIN, AND WITH VERY LITTLE ADDED EDUCATION WAS EARNING OVER TWICE WHAT I MADE AS AN LVN DOING THE SAME JOB. DON'T GET MAD---GET PAID!!!!!!!!!!!!!!!!!!

[Beth's granddaughter]

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!

Dear LVN, I am sorry to hear you sounding so unhappy about the RN/LVN issue. It truly is not a question of how good you are as a nurse (and I am sure you are very good at what you do), rather, it is a question of what your state law allows you to do and how your state defines registered nursing and vocational (or practical) nursing.

I have attached below an except from your Texas State Nurse Practice Act, which, in my mind, clearly defines the role of the RN and the role of the LVN. It does not go so far as to say who can work in an ICU, but it establishes the fact that legally, there is a difference in what an RN can do versus what an LVN can do. Individual hospitals might interpret the NPA in slightly different ways, but on the same note, they might not be aware of the legal consequences of using an LPN/LVN outside their scope of practice. I cannot account for the fact that you "had no RN working with [your] patients." And I will agree with you that some LPN's can "run circles around an RN" - but that is not the issue here. The issue is scope of practice. Your Board of Nurses are usually the official interpreters of your Nurse Practice Act. (I searched the net for "Texas Nurse Practice Act" to find this.)

(Oops - I didn't copy the initial sentence which says, in essence, that a registered nurse practices professional nursing... my mistake, sorry. I added the italics.)

2) "Professional nursing" means the performance for compensation of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or prescription of therapeutic or corrective measures. Professional nursing involves:

(A) the observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes; (B) the maintenance of health or prevention of illness; ©the administration of a medication or treatment as ordered by a physician, podiatrist, or dentist; (D) the supervision or teaching of nursing; (E) the administration, supervision, and evaluation of nursing practices, policies, and procedures; (F) the requesting, receiving, signing for, and distribution of prescription drug samples to patients at sites in which a registered nurse is authorized to sign prescription drug orders as provided by Subchapter B, Chapter 157; and

(G)the performance of an act delegated by a physician under Section 157.052, 157.053, 157.054, 157.0541, 157.0542, 157.058, or 157.059.

5) "Vocational nursing" means nursing, other than professional nursing, that generally requires experience and education in biological, physical, and social sciences sufficient to qualify as a licensed vocational nurse.

My own state NPA (Utah) says the RN assesses, evaluates, plans, implements nursing diagnoses, and implements nursing treatments while an LPN "participates" in assessment, evaluation, treatment, and planning.

In my experience, LPNs in Utah do not do IV pushes, access central lines, change sterile dressings, hang blood, titrate drugs, call physicians or take physician orders, note charts or orders, admit patients, assess immediate post-ops, or implement care plans. Because of these "do nots" it would be very inappropriate to have an LPN in a fast-paced critical area like ICU. LPN's are great, however, at ongoing bedside nursing. They can easily be a part of the team caring for stable med/surg and post-partum patients, as well as long term care patients. As a former Med Surg charge nurse, I enjoyed working with LPN's as team members, but honestly, and I don't say this in a mean way, if I carried a patient load, and the LPN carried a patient load, legally, both of the loads were my ultimate responsibility. I NEVER left the floor at the end of the shift before my LPN's did, because I had to countersign all their charting (in the hospitals where I have worked, every patient's chart needed an RN signature every shift to prove that "professional" nursing care was given), note all their orders, call the doc for them when their patient needed something, do all their 24 hour chart checks, assess any admission before I turned it over to them, and all this in addition to my own patient cares and documentation. That's not true team nursing, but then again, that is not the LPN's fault, it is management's fault for not understanding the legal scope of practice of an RN and an LPN, and for hiring an LPN to do what an RN is legally bound to do.

Take a careful look at your nurse practice act. Aim your dissatisfaction toward the law, not toward the people who understand the law and its consequences, and who abide by the law. If you still disagree with how you are allowed to practice nursing, call your Board of Nursing and voice your opinion. See what they have to say about the way you feel you are being treated. If you feel so strongly about being a good nurse, then become active in your state nurses' association and in the political process that creates the laws that govern nursing. I wish you the best and a long and successful career in nursing!

Out of curiosity - are there any other Texas nurses out there who have comments on this? Is it a normal practice in Texas to have LVN's pushing IV meds, titrating drips, calling docs, etc?

[RN34TX]

Out of curiosity - are there any other Texas nurses out there who have comments on this? Is it a normal practice in Texas to have LVN's pushing IV meds, titrating drips, calling docs, etc?

Normal?

I'm not completely sure, I can only go by my own experiences.

But as a former LVN in TX, yes, my jobs have routinely included pushing IV meds and calling docs. When I floated to ICU, I titrated drips as well.

A few of the DFW hospitals I worked at placed limits on which meds I was allowed to push such as some saying no narcs or cardiac meds, but I absolutely never, ever, had any RN call docs or handle much of anything else outside of hanging a bag of blood for any of my patients on med/surg units.

ICU was a different story, but in med/surg, I functioned independently, not much different than a med/surg RN.

[RN34TX]

Now, get off the RN vs LPN/LVN thing. None of us want to hear it!!

I respectfully disagree.

Obviously, many do, in fact, want to hear it as it is an extremely popular topic on this forum and it comes up fairly often.

But if someone really doesn't want to hear about it, it needs to be kept in mind that no one is forcing anyone to read and/or participate in RN vs. LPN type threads.

Discussing the issue doesn't necessarily merit the "bad attitude" or "high horse" labels.

[TopherSRN]

Quite simply, I work in a state that limits LPN's scope (no IVP,tritration, assessments etc. So why would I want double the load (4 acute patients) with only 50% (LPN's scope) more help? A PCT would be just as helpful in a unit setting since IV is the most common drug route. I would be in fear of my license mainly from having to depend on someone else.

While I'm not a fan of LPNs and wouldn't want to work with them on a floor either, they do serve an invaluable purpose in that setting. But not in a unit. I work with an LPN in the ER and because people let her she has taken on the role of an RN. She does her job well but she is a huge liability due to working outside her scope of practice.

Whether you want to see it or not there is a marked difference in each educational preparation, therein lies the reason why many RNs wouldn't want to be responsible for someone else. They would rather do it theirself and know it was done/done right.

[RN34TX]

Quite simply, I work in a state that limits LPN's scope (no IVP,tritration, assessments etc. So why would I want double the load (4 acute patients) with only 50% (LPN's scope) more help? A PCT would be just as helpful in a unit setting since IV is the most common drug route. I would be in fear of my license mainly from having to depend on someone else.

While I'm not a fan of LPNs and wouldn't want to work with them on a floor either, they do serve an invaluable purpose in that setting. But not in a unit. I work with an LPN in the ER and because people let her she has taken on the role of an RN. She does her job well but she is a huge liability due to working outside her scope of practice.

Whether you want to see it or not there is a marked difference in each educational preparation, therein lies the reason why many RNs wouldn't want to be responsible for someone else. They would rather do it theirself and know it was done/done right.

In states that place significant limitations on LPN scope of practice, it wouldn't make sense to have them working in ICU. I agree.

But not all states are like yours.

[MistyDreamer]

As a former LPN, now an RN in a critical care setting, I have been on both sides of this issue. As an LPN I was often pulled into CCU and did my best to help the RN's so that having to push my IV meds or initiate some of my drips did not cause alot of problems. I stayed organized and handled what I could within the scope of my license. As a result, I was transferred into the CCU by request of the RN's in that unit. I was only the 2nd LPN utilized in a unit as a staff nurse. My exposure there gave me the incentive to return to school and obtain my RN degree. I was hired as a new grad RN straight into an MICU because of my previous experience. Not all LPN's are capable of handling critical care nursing, neither are some RN's. It comes down to the type of nurse that person is and also the state and facility limitations of practise. Would I work with an LPN in my unit today? Yes, and I do. She only practises within her license scope and is quick to spot trends and changes. I do not feel that my license is in jeopardy working with her. There is an RN however that I have formally refused to work with because of her unsafe practises. Just another viewpoint from someone who has been on both sides.

[91CRN]

As a former LPN, now an RN in a critical care setting, I have been on both sides of this issue. As an LPN I was often pulled into CCU and did my best to help the RN's so that having to push my IV meds or initiate some of my drips did not cause alot of problems. I stayed organized and handled what I could within the scope of my license. As a result, I was transferred into the CCU by request of the RN's in that unit. I was only the 2nd LPN utilized in a unit as a staff nurse. My exposure there gave me the incentive to return to school and obtain my RN degree. I was hired as a new grad RN straight into an MICU because of my previous experience. Not all LPN's are capable of handling critical care nursing, neither are some RN's. It comes down to the type of nurse that person is and also the state and facility limitations of practise. Would I work with an LPN in my unit today? Yes, and I do. She only practises within her license scope and is quick to spot trends and changes. I do not feel that my license is in jeopardy working with her. There is an RN however that I have formally refused to work with because of her unsafe practises. Just another viewpoint from someone who has been on both sides.

Dreamer,

My history is very similar to yours. You were hired because you were talented and your talent was known based on your colleagues exposure to you. Most RN's are hired strictly by virtue of our licensure. This is quite a dilemma for a lot of units/admin. It seems we work in a volume BUSINESS, everything has to be streamlined and that includes hiring practices; therefore protocols are put into place to reduce liability all the way around. This is good and bad. We wind up hiring a lot of people that look good on paper; but you can miss out on the actual talent. Having said that, I have come around to be one of those that doesn't believe an LVN should be in the unit. In CA the scope of the LVN is limited--making it difficult for an RN to "oversee" the LVNs work; I believe that this makes the LVN obsolete in the ICU here. Furthermore, I have become a proponent of the idea that RNs should be BSN trained. I am not yet a BSN; but I am becoming active in the politics, basically to try and help turn around our embattled profession. Because professions are valued (in part) based on the level of education that is needed to qualify for licensure. I believe it is essential for our professional image; which in turn would help us gain the professional foothold we so richly deserve. I want to stress the point that in my experience I haven't found that BSNs are any better than diploma RNs. I have seen a wide variety of good and bad in both cases and would agree that BSN programs need to become for clinically focused so that graduates can actual perform the job and not just write a paper about it;) Nursing today is facing some big challenges none the least of which is POLITICAL. If we want to go forward and help the public to fully actualize the value of our profession. I believe the BSN is a necessary step.

[Keepstanding, ASN, RN]

LPNs have no place in critical care. They make for very unsafe conditions for the patients and the RN's who are ultimately responsible for their work. I have never worked in an ICU that employed LPN's nad I would refuse to have the respoNsibility for their work. They are a liability, not a heLping hand in ICU. Period. The hospital that I worked in here in Spokane, laid off ALL OF THEIR LPNS ABOUT TWO YEARS AGO. The writing is on the wall, all of you LPNs out there. Go back for your RN degree if yu want to work in ICU, and the nurses who are stuck having to work with LPNs in ICU should get together with administration, and yOur union, if you have one, and change the policy. I would refuse to work with an LPN in ICU. Period. And you should too. I was under the impression that it was decided years ago to go with an all RN staff in the ICUs. What happened? It is very definately AACN policy for an all RN staff in the ICU. JMHO. and $0.02.

Lindarn RN, BSN, CCRN

Spokane, Washington

:uhoh21: A little touchy now are we ????

LPN 90 and proud of it !

[flasandy42]

>>>

i'm curious about what you study and learn in a bsn program the extra two years. is a lot of it clinical? i've worked with a lot of rns who never even put in a catheter or an ng tube and many other bedside procedures. in lpn school we had to be checked off on three of most procedures to graduate. i personally think the best rns are those that were lpns first, as they get more clinical time than a two-year rn.