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?

[tfunkrn]

First off, what does being ACLS and PALS have to do about being an LPN. I work tele and its required to be ACLS, I get floated to PEDS and have to have PALS.. Its just a requirement of my job. I also get floated to couple care and yes I am NRP certified.

Now I had a good laugh at the sterile dressing change.. What only an RN can do that.. Why can't an LPN do that?

ACLS and PALS has nothing to do with being an LPN, but is a requirement in most hospitals in the ICU. I did not realize, as an LPN, that you would be able to be ACLS or PALS certified, sincing pushing vasoactive meds are usually within the LPN/LVN scope of practice. So.. I want to be sure I understand this.. It is permisable for you to practice in the ICU in your state - Texas - under the LPN/LVN scope of practice without an RN needing to sign off? Believe me, I am not trying to 'widen the gap', but I do believe in practicing within our own legal scope of practice. I have also seen LPN's that are envious of the RN role and try to practice outside their legal scope of practice.. and that DOES bother me, especially when it is my patient and they are placing my patient and licence in jeopardy. I know you are going to be an RN soon, but I am asking strictly about the legal ramifications.. and if there is any title as ICU LPN. Also, in certain states, sterile dressing changes 'legally' are changed by RNs.. so if it is a laughable matter to you as an LPN, it is not laughable to me when I have a lawsuit placed against my licence for something someone else did.

[tfunkrn]

Hopefully I won't get in trouble or flamed for saying this....but I'm an LPN....couldn't afford that extra year of school at the time.

I do get floated to stepdown and have cared for ICU overflow patients. I always get my own team...I can't imagine having another nurse hovering over me like I was at clinicals. I am also ACLS certified. I have cared for vented patients in a long term care facility, although that was a long time ago.

In my state I can draw off of lines, assess my own patients, hang and titrate drips, monitor chemo and blood, call docs for orders, etc....mainly I can't spike a bag of blood (but if another nurse is in there to check it, what's the extra five seconds it'll take you, really?) or do IV pushes.

IF I could do the pushes, I would feel totally comfortable working in ICU after an orientation. IF the ICU was staffed with RN's who were willing to help out (I usually volunteer to do labs, pass po meds, etc. in exchange for pushes being done) I'd be willing to do it, and I'm sure I'd do it well. I'd be fine working stepdown regularly now, except I like the nurses I work with now too much to leave, even though the charge nurses from there try to poach me from my floor.

When I do get pulled to stepdown, I constantly get "You're just a LPN? I thought you were a RN by the way you acted!" I try to take it as a compliment but I always want to ask just what exactly that means....

What state do you live in? I think it is great as long as you are comfortable and able to do this on your own licence under your state's LPN/LVN legal scope of practice. As far as blood is concerned, we have to have 2 signatures checking the blood out of Blood Bank, and 2 signatures before spiking the bag. You sound very capable.. Are you going to go back to school to get your RN?

[Nacki, MSN, NP]

I've never worked with a LPN in the ICU and wouldnt want to. The fact of the matter is that hospitals want to cut the staff to handle more pts, paying the LPN's less and having few RN's on duty. I would not want to be in charge of 4-5 critically ill pts and doing duties for another nurse on my "team". This is a lawsuit waiting to happen.

[Magda_PatagoniaNurse]

Hi (excuse me about my english, i'm still learning)

My name´s Magdalena, I'm a chilean new grad nurse. I was reading all the comments posted here, and what can i say, here in my country we have the same troubles with our teammates...But the issue here is different because in Chile there are only two types of nurses, "professional nurses" like me, trained during 5 years only at a college, and "tech nurses", who were trained only at tech institutes during years. So, the gap in knowledge between professional and techs is giant...For me is very strange what you are commenting, about RN signing the other's job. I found it a very unsafe and unfair practice, because accountabilty or whatever yoy may call it, is absolutely personal and untransferrable (impossible to charge other with the own responsibility for the care).

In my opinion, your problem is that you have 2 nurses, doing essentially the same tasks...and paid differently. In Chile, tech nurses are capable of draw blood samples, not always, but they can do, and I as a nurse, wouldn't feel jeopardize my career because drawing blood is a techique, no critical thinking in a high grade is required for that.

So, i think you (RN) feel jeopardize your jobs because the RN aren't capable to differenciate of a LVN.

Saludos

Magdalena

[tfunkrn]

Hi (excuse me about my english, i'm still learning)

My name´s Magdalena, I'm a chilean new grad nurse. I was reading all the comments posted here, and what can i say, here in my country we have the same troubles with our teammates...But the issue here is different because in Chile there are only two types of nurses, "professional nurses" like me, trained during 5 years only at a college, and "tech nurses", who were trained only at tech institutes during years. So, the gap in knowledge between professional and techs is giant...For me is very strange what you are commenting, about RN signing the other's job. I found it a very unsafe and unfair practice, because accountabilty or whatever yoy may call it, is absolutely personal and untransferrable (impossible to charge other with the own responsibility for the care).

In my opinion, your problem is that you have 2 nurses, doing essentially the same tasks...and paid differently. In Chile, tech nurses are capable of draw blood samples, not always, but they can do, and I as a nurse, wouldn't feel jeopardize my career because drawing blood is a techique, no critical thinking in a high grade is required for that.

So, i think you (RN) feel jeopardize your jobs because the RN aren't capable to differenciate of a LVN.

Saludos

Magdalena

Hi Magda,

The difference is there are many states here in the US that have their own statutes for scopes of practice. The pay is not the same, but neither are the content of knowledge, years of schooling, responsibilities, or the testing for licensure the same.

We have CNAs, CMAs, LPNs, and RNs.. and each have certain people who are licensed as one, yet appear to have classification envy and attempt to practice outside their scope of practice... or make up titles I had not heard of before, such as ICU LVN. I restarted this thread, out of curiosity after hearing a title I never had heard before, and have since determined my initial insticts were correct about someone who said they were ICU LVN in California.. this person is a person with 'classification envy', since she is retired. But most of all, I am curious as to what the different states allow the LPN to do in their scope of practice on their own license.

I am not stating that either is smarter than the other, but RNs have more training than LVNs because they went the extra mile to acquire the extra knowledge. If LVNs want to practice as an RN, they need to go back to school and pass the licensure test. It has nothing to do with intelligence, and all to do with motivation. I will say this in all honesty, I refuse to be responsible for an LVN practicing under my license. If they want to be an RN, instead of exerting energy into complaining, they need to channel their energy into going back to school to do it! It is not any RN's fault that they are not allowed to practice outside your scope of paractice.. only they can make the change by persuing a degree.

[love-d-OR]

In the hospital I work, LVN's are rarely used on the floor and are not employed in the ICU. The couple of LPN's that I have seen working in the ICU work in the capacity of a nurse assistant, basic nursing care.

I think this thread is very interesting, as I read through, I could not help but wonder why even bother becoming an RN (granted I would not change my degree and hope to move on to a masters some day)? I still can't help but wonder what some of the LVN's that have posted hear hope to have RN's do? I pose this question because many LVN's have stated they are fully capable of taking MD orders, pushing drugs, titrating drips and the like. Things I was thaught to believe were outside their scope of practice. If you do exactly what an RN does, then why even bother with the title distinction? If your job function falls under the definition of a 'professional nurse (assess, etc)', then whats the difference between an LVN and an RN (other than pay obviously)? If an LVN can take a two day class to be IV certified, then why even bother spend all those years in ADN/BSN school?

I certainly don't have a problem with LVN's, but let's give credit were it's owed! If LVN's could do the same job as RN's, and in some cases could "run circles around an RN" then why would hospitals even bother hiring RN's? Why not just hire LVN's, afterall they are payed less?

Just my

TfunkRN, to answer your question, I live in California, and I am yet to see an LVN work in an ICU. My hospital will only use them as nurse assistants.

[tferdaise]

First off to have your ACLS, PALS, NPR, and AMLS one does not have to be able to push medications. Second, when you have a team of PROFESSIONALS who are on the same page when a code happens, makes things go much smoother. Working Tele it very important to know what to look for on your strips, or is it only the RN who can do that. I am hopeing ONE day RN's with your attitude will be gone and work with other PROFESSIONALS in a professional manner.

Where in ALL of my post on these formus have I EVER written I work in ICU? BTW, I'm in Phoenix, AZ, not TX.

Why not educate yourself before writting on these boards and inserting your foot in your mouth, go to the TX state board of nursing and read whats the scope of practice is for a LPN in TX as well as FL. You might learn something.

ACLS and PALS has nothing to do with being an LPN, but is a requirement in most hospitals in the ICU. I did not realize, as an LPN, that you would be able to be ACLS or PALS certified, sincing pushing vasoactive meds are usually within the LPN/LVN scope of practice. So.. I want to be sure I understand this.. It is permisable for you to practice in the ICU in your state - Texas - under the LPN/LVN scope of practice without an RN needing to sign off? Believe me, I am not trying to 'widen the gap', but I do believe in practicing within our own legal scope of practice. I have also seen LPN's that are envious of the RN role and try to practice outside their legal scope of practice.. and that DOES bother me, especially when it is my patient and they are placing my patient and licence in jeopardy. I know you are going to be an RN soon, but I am asking strictly about the legal ramifications.. and if there is any title as ICU LPN. Also, in certain states, sterile dressing changes 'legally' are changed by RNs.. so if it is a laughable matter to you as an LPN, it is not laughable to me when I have a lawsuit placed against my licence for something someone else did.

[tferdaise]

One of the biggest issues I see on these boards are most nurses when they post, they post in a debate with THIER state board of nursing rules, and not releaizing that there are 50 state boards of nursing out there. That is why I would like to see there ONE standard for all 50 states so this confusion doesn't happen.

As for LPNs working in ICU, its not a good thing, why not? I keep hearing from all of you RN's saying "LPNs shouldnt be able to work in ICU" but I never hear a concret reason why... I know a many of an LPN that could run circles around some of you ICU RN's on medications, strips and handling extereme emergencies. Just because you have RN behind yours name doesn't make you wonder nurse...

In the hospital I work, LVN's are rarely used on the floor and are not employed in the ICU. The couple of LPN's that I have seen working in the ICU work in the capacity of a nurse assistant, basic nursing care.

I think this thread is very interesting, as I read through, I could not help but wonder why even bother becoming an RN (granted I would not change my degree and hope to move on to a masters some day)? I still can't help but wonder what some of the LVN's that have posted hear hope to have RN's do? I pose this question because many LVN's have stated they are fully capable of taking MD orders, pushing drugs, titrating drips and the like. Things I was thaught to believe were outside their scope of practice. If you do exactly what an RN does, then why even bother with the title distinction? If your job function falls under the definition of a 'professional nurse (assess, etc)', then whats the difference between an LVN and an RN (other than pay obviously)? If an LVN can take a two day class to be IV certified, then why even bother spend all those years in ADN/BSN school?

I certainly don't have a problem with LVN's, but let's give credit were it's owed! If LVN's could do the same job as RN's, and in some cases could "run circles around an RN" then why would hospitals even bother hiring RN's? Why not just hire LVN's, afterall they are payed less?

Just my

TfunkRN, to answer your question, I live in California, and I am yet to see an LVN work in an ICU. My hospital will only use them as nurse assistants.

[tfunkrn]

First off to have your ACLS, PALS, NPR, and AMLS one does not have to be able to push medications. Second, when you have a team of PROFESSIONALS who are on the same page when a code happens, makes things go much smoother. Working Tele it very important to know what to look for on your strips, or is it only the RN who can do that. I am hopeing ONE day RN's with your attitude will be gone and work with other PROFESSIONALS in a professional manner.

Where in ALL of my post on these formus have I EVER written I work in ICU? BTW, I'm in Phoenix, AZ, not TX.

Why not educate yourself before writting on these boards and inserting your foot in your mouth, go to the TX state board of nursing and read whats the scope of practice is for a LPN in TX as well as FL. You might learn something.

For telemetry, if you do not need knowledge about the drugs, then a disrhythmia course should suffice. Do not try to turn the tables on me, sir. I am not insulting you, and your insulting me is unprofessional. I just asked some questions, and there is no reason to attack me personally.

In your post, you mentioned Texas and Florida.. I am sorry I placed you in the wrong state. Initially, the scope of practice for LPN/LVN was the same in all states except 2, and then more states followed implementing their own variations. I did some homework before asking my questions. I may take up traveling again, and Phoenix is where I will go, since I have connections there already in place.

Now, I am sure some LPNs do know how to do what an RN can do from observation, and maybe there are a few LPNs who can run circles around some RNs.. and vice versa. But, if they are wanting to practice nursing outside their scope of practice in whatever state they are in, they need to go back to school and pass the same boards I had to pass. After all, it is MY license, which makes it MY decision.

[OncologyRN23, BSN, RN]

Hi Magda,

The difference is there are many states here in the US that have their own statutes for scopes of practice. The pay is not the same, but neither are the content of knowledge, years of schooling, responsibilities, or the testing for licensure the same.

We have CNAs, CMAs, LPNs, and RNs.. and each have certain people who are licensed as one, yet appear to have classification envy and attempt to practice outside their scope of practice... or make up titles I had not heard of before, such as ICU LVN. I restarted this thread, out of curiosity after hearing a title I never had heard before, and have since determined my initial insticts were correct about someone who said they were ICU LVN in California.. this person is a person with 'classification envy', since she is retired. But most of all, I am curious as to what the different states allow the LPN to do in their scope of practice on their own license.

I am not stating that either is smarter than the other, but RNs have more training than LVNs because they went the extra mile to acquire the extra knowledge. If LVNs want to practice as an RN, they need to go back to school and pass the licensure test. It has nothing to do with intelligence, and all to do with motivation. I will say this in all honesty, I refuse to be responsible for an LVN practicing under my license. If they want to be an RN, instead of exerting energy into complaining, they need to channel their energy into going back to school to do it! It is not any RN's fault that they are not allowed to practice outside your scope of paractice.. only they can make the change by persuing a degree.

You could not have typed a better response!!! It bothers me greatly when I hear LPN's complaining about the things they can not do and the fact that they want to be able to do ALL the things that an RN can do, yet they themselves do not want to pursue the RN licensure.

This is like another thread I've been on about LPN's wanting to challenge the NCLEX-RN simply because they have worked as an LPN for x amount of years. RIDICULOUS!!! I, as have many many others, have worked hard for my degree and anyone else who wants to become an RN should have to go through the same process!

[mama_d, BSN, RN]

Tfunkrn...

Thanks! I'm in Missouri, there are only a handful of things that distinguish my scope of practice during my shifts from that of an RN's:

Can't hang chemo (but I can monitor)

Can't spike a bag of blood (but I can monitor it, even for the crucial first 15 minutes...makes no sense to me. I can imagine in the past an evil LPN purposefully misspiking blood and causing disastrous messes that they then made the poor housekeepers clean up, leading to a lobbying campaign to keep us from doing so.)

Can't access a port-a-cath or place a PICC, although I can draw blood from one, do the dressing changes, deaccess/discontine, etc.

Can't initiate care plans (again, no sense here...)

Can't do IV pushes, except in life-threatening situations

Have to have an RN sign off on initial assessment for new admits (per our hospital policy)

Have to have an RN assess patient q24hr (honestly, I'm not sure if this is a state issue or a hospital policy)

I'm not sure about what LPN's can and can't do in OB, since I haven't had that since school.

I am back in school again for my ADN, and plan on not stopping again until I get my MSN, now that I'm done having babies to interrupt the flow of things! It is interesting to do homework again with a two year old "helping" me out, I gotta say.

[love-d-OR]

Tferdaise,

I see you have my post quoted on your last post, but you do not address the questions I raised. So, I wonder why you even bothered to quote my post. Anyway you are right in stating that the scope of practice from state to state is different, and people should acknowledge that when posting.

Finally, RN behind my name does not make me wonder nurse, but it sure does not give you or anyone else the right to belittle it!