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.
Welcome to the "Resurrect Old Threads Week" on Allnurses! Good grief, this is the second thread I've read that dates back two years or more. (Of course that probably means I need to go do something else.)
I'm on my first ICU job, and what happens to only be my second job as a nurse. My unit, actually my whole hospital, uses LPN's extensively. They by far outnumber the RN's and I believe it is due to several factors: the hospital is small, close to an LPN program and it saves them money.
So what does my facility do to differentiate the two. Well it's team nursing on paper in ICU, and primary nursing in practice. That takes some clarifying. Six beds, most of the time not full, two nurses on the schedule, one has to be an RN. I prefer to work with LPN's that are oriented to ICU AND are ACLS/PALS certified AND have enough ICU experience to know what to do and how to do it. Meaning there are people I'm used to working with, that make life good. That's also a widely-seen generalization, however; we all work hard to build work relationships and have some that we prefer.
So you got an RN and an LPN team, on paper. The RN does admit assessments, the care plan in the computer, and countersigns the LPN's flowsheets. Also if the LPN happens to drop the ball on something and the powers that be get uppity about it, the RN is suddenly reminded that he/she is responsible for the unit. We sign for each other on the cardiac drugs, insulin, and we witness each other's narcotic wastes. We check each other on blood administration. It may be that they require an RN on the checking of blood but I didn't think of it since there's always one in my unit. The LPN's push whatever drugs are called for, if they normally work ICU. We have no secretary so we each do our own paperwork and chart checks.
The practice of having one or two more things to do does affect the way the unit runs. The RN doesn't "make assignments" on paper, it depends on who's working and how they feel about acting as though they are in charge. I don't generally like to act like a charge nurse but if there's a situation that requires it, I can rise to the occasion. Most of the time that is a bad idea if I haven't had my coffee! We take group verbal report and decide afterwards who's gonna do what. Since we're all used to each other, sometimes we just go on nonverbal cues, I know Nurse Nancy (not her name) loves this type case and I like this other type patient, or we go with the patients we had the night prior, etc.
If we're in the department, not floated in, we are all ACLS/PALS certified. They require the RN to be, and if a new RN isn't, she has another RN working with her until she is, so I guess it's really imperative for the RN to have those certs. It may or may not be as critical for the LPN to have it but boy I sure do prefer it, and since the LPN's are certified, the question hasn't come up. Normally we all have the idea that avoiding codes is the optimal thing to do, so regardless of licensure or certification, we talk through problems and work on stuff as a team.
When we get in the situation of using LPN's that are not oriented as ICU nurses, the RN reads tele, (normally we split that up or alternate who does it) and does the chart checks if their float is not used to it, and structures the assignments according to who's best suited to take which patients. A non-ICU LPN doesn't get the cardiac drips or the vents. Add to that the lack of a secretary and it can get pretty interesting if the unit's busy and you work with two floor LPN's... I've done that once, and holy cowabunga, we had an emergent intubation at the end of the shift and three very frazzled nurses ready to run screaming out of the building. I love to teach, but I like doing it under more controlled circumstances. And teaching is expected (not written but definitely necessary) of any ICU nurse, not just the RN, who wants help with the workload.
I'm trying to not put out an opinion per se on whether LPN's belong in ICU, because I haven't worked in an ICU where there was RN only staff. We don't even have techs most of the time, when we do they look at me funny because I help with baths. I can tell you it's tense when I'm reminded that I'm responsible for the legal scope of practice, if the person doing the reminding is not happy with something. It's also workable and fun, and I've met some amazing nurses. The LPN's I work with have taught me a lot about critical care, how to work as a team, and they're still working on my pitiful coffee-making skills.
My boss says there is some noise coming down the grapevine about CMS and JCAHO wanting to require the RN to do ALL of the assessments. (like for each shift instead of just admission...) I think that would shake up our workload groove and on principle that means I don't approve, plus I have a sneaking suspicion that rearranging my carefully crafted work habits would not come with a raise.
Regarding the disrhythmia course, I wish it could be that easy to just take one of those courses, but since I HAVE to take ACLS (its a job requirement) the disrhythmia course wont cut it. So please drop this stuff that a LPN shouldn't be taking these advance courses.. It must be very lonely in your ivory tower...
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.
Why should someone in TX and or FL get thier RN/BSN if the LPN can push meds. Its very simple, the LPN can not push all medications, I know that in TX they can not push vasopressors, and a couple of other class of meds. They can not start a blood transfusion, but once its started the LPN can titrate the drip.
As far as Belitting you, most (90%) of RN in this threat (on how they write) look down to LPNs...
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!
I work in massachusetts and honestly the few times I worked with an LPN on a cardiac floor was rather burdensome. She could only give po meds, she could not push meds, she was not allowed to interpret tele strips, and I ended up having to co-sign her assessments. Honestly it was like having a glorified aide (no offense to the other LPNs but that's how it felt at the end of the day when i have to basically recheck everything that was done to help me out because it all goes under my license).
I never like hearing about lpns talking about how much better they are than an RN because they do the same job etc... comparing an 18month training program to 4 years of education isn't exactly fair. and no amount of in-services will replace the level of education in a BsN program.
The other posters were a lot more eloquent in getting their points across haha but they were right. If you have no desire to continue your education, then stay within your scope of practice. But don't try doing things an RN can do without the RN degree. I'm more than capable of doing some procedures only a physician is allowed to do at my hospital, but it doesn't mean i'd do it.
Thanks for responding to my post. From other LVN posts I was under the impression that some LVN's could do everything an RN could do (legally), hence I posed that question.
Anyway, regarding the wonder nurse comment, I did not say anything rude about you or any other LVN. So, when you quoted my post and made that statement on the same post, I thought you were referring to me.
Going back to the topic at hand, it seems to me that the education leading to nursing (any kind) may be adding to this issue. Take for instance California, where a CNA can challenge the LVN boards. A CNA with x number of years of experience as a CNA, is allowed to sit for the LVN boards. All she or he needs to do is take a 54 hour pharmacology class, they need to prove that they have spent x number of hours working in peds, ob, med-surg as a CNA, then they are eligible to sit for the LVN boards! Yes, you heard right!!
Tell me what part of CNA work exposes them to any kind of nursing work (except the obvious basic care)? Do you really expect the nurses in an ICU to welcome this person with open arms as an LVN, while she hangs abx pushes meds, does a neuro assessment and runs a code? At this point its not a matter of being a newbie, its a matter of safety!
Hm. Okay I do agree that the nurse who challenged boards based on a pharmacy course plus CNA experience would make me very nervous. I wonder if other states' boards of nursing would give such a nurse a license by endorsement.
Well first off before a LPN gets hired, we go through the same hiring proccess as the RN, so I would hope the Manager of the ICU unit would look at someone resume and notice the lack of formal training as a LPN before they get hired into a Acute setting, so please lets not focue it all on the shoulders of the LPN...
Going back to the topic at hand, it seems to me that the education leading to nursing (any kind) may be adding to this issue. Take for instance California, where a CNA can challenge the LVN boards. A CNA with x number of years of experience as a CNA, is allowed to sit for the LVN boards. All she or he needs to do is take a 54 hour pharmacology class, they need to prove that they have spent x number of hours working in peds, ob, med-surg as a CNA, then they are eligible to sit for the LVN boards! Yes, you heard right!!
Tell me what part of CNA work exposes them to any kind of nursing work (except the obvious basic care)? Do you really expect the nurses in an ICU to welcome this person with open arms as an LVN, while she hangs abx pushes meds, does a neuro assessment and runs a code? At this point its not a matter of being a newbie, its a matter of safety!
Regarding the disrhythmia course, I wish it could be that easy to just take one of those courses, but since I HAVE to take ACLS (its a job requirement) the disrhythmia course wont cut it. So please drop this stuff that a LPN shouldn't be taking these advance courses.. It must be very lonely in your ivory tower...
I never said they should not take the courses, I said I did not know they offered it to LPNs. And.. I have plenty of company in my 'Ivory tower'.. Thanks for your concern.
While I have no problems what-so-ever working with LPN's, I find them very capable and knowledgeable and they carry their own full workload I do not believe they should be able to challenge the NCLEX-RN no matter how long they've been a nurse or no matter how much experience they have.
Anyone can study and pass a test. The requirement of having a minimum of an ASN should remain the requirement to be able to take the NCLEX-RN
In my state and hospital, LPNs have a broad scope of practice with few restrictions. The charge nurse, who takes no assignment, covers what is outside of the LPNs scope. I certainly keep my charge nurse informed about my patients, but honestly, there is little that she/he needs to do that I am unable to do myself. I do not take new admissions, I don't give IV chemo products, I must check several IVP meds and all blood products with an RN. I don't write care plans or serve as a patient's primary nurse. I don't take charge or train to be an ECMO tech. Everything else, I manage on my own. There are at most two LPNs per shift, and that is rare. Usually there is one or none. Most of the LPNs who work in the units have 25+ years of experience and are very competent nurses. There are not many left, and when they leave they are often replaced with RNs.
The ICU came into being in the early 1960s and I signed on to work there several months after it opened. Before that, very sick patients were called "constant cares". That patient was 1:1 care with the nurse AND the doctor constantly at the bedside. Nobody can tell me I don't belong in the ICU, because I've been doing critical care since critical care was invented..and its been my life's work and passion ever since. My "instructors" if you will were some of the best specialists, doctors, nurses, and therapists of the past fifty years. My mentors were truly pioneers in critical care and I have been blessed to have worked with such talented people.
That said, the LPN is the ICU is an exception to the rule, but exceptions exist and one size fits none. I've said it before, experience is the best teacher.
Indy, LPN, LVN
1,444 Posts
Welcome to the "Resurrect Old Threads Week" on Allnurses! Good grief, this is the second thread I've read that dates back two years or more. (Of course that probably means I need to go do something else.)
I'm on my first ICU job, and what happens to only be my second job as a nurse. My unit, actually my whole hospital, uses LPN's extensively. They by far outnumber the RN's and I believe it is due to several factors: the hospital is small, close to an LPN program and it saves them money.
So what does my facility do to differentiate the two. Well it's team nursing on paper in ICU, and primary nursing in practice. That takes some clarifying. Six beds, most of the time not full, two nurses on the schedule, one has to be an RN. I prefer to work with LPN's that are oriented to ICU AND are ACLS/PALS certified AND have enough ICU experience to know what to do and how to do it. Meaning there are people I'm used to working with, that make life good. That's also a widely-seen generalization, however; we all work hard to build work relationships and have some that we prefer.
So you got an RN and an LPN team, on paper. The RN does admit assessments, the care plan in the computer, and countersigns the LPN's flowsheets. Also if the LPN happens to drop the ball on something and the powers that be get uppity about it, the RN is suddenly reminded that he/she is responsible for the unit. We sign for each other on the cardiac drugs, insulin, and we witness each other's narcotic wastes. We check each other on blood administration. It may be that they require an RN on the checking of blood but I didn't think of it since there's always one in my unit. The LPN's push whatever drugs are called for, if they normally work ICU. We have no secretary so we each do our own paperwork and chart checks.
The practice of having one or two more things to do does affect the way the unit runs. The RN doesn't "make assignments" on paper, it depends on who's working and how they feel about acting as though they are in charge. I don't generally like to act like a charge nurse but if there's a situation that requires it, I can rise to the occasion. Most of the time that is a bad idea if I haven't had my coffee! We take group verbal report and decide afterwards who's gonna do what. Since we're all used to each other, sometimes we just go on nonverbal cues, I know Nurse Nancy (not her name) loves this type case and I like this other type patient, or we go with the patients we had the night prior, etc.
If we're in the department, not floated in, we are all ACLS/PALS certified. They require the RN to be, and if a new RN isn't, she has another RN working with her until she is, so I guess it's really imperative for the RN to have those certs. It may or may not be as critical for the LPN to have it but boy I sure do prefer it, and since the LPN's are certified, the question hasn't come up. Normally we all have the idea that avoiding codes is the optimal thing to do, so regardless of licensure or certification, we talk through problems and work on stuff as a team.
When we get in the situation of using LPN's that are not oriented as ICU nurses, the RN reads tele, (normally we split that up or alternate who does it) and does the chart checks if their float is not used to it, and structures the assignments according to who's best suited to take which patients. A non-ICU LPN doesn't get the cardiac drips or the vents. Add to that the lack of a secretary and it can get pretty interesting if the unit's busy and you work with two floor LPN's... I've done that once, and holy cowabunga, we had an emergent intubation at the end of the shift and three very frazzled nurses ready to run screaming out of the building. I love to teach, but I like doing it under more controlled circumstances. And teaching is expected (not written but definitely necessary) of any ICU nurse, not just the RN, who wants help with the workload.
I'm trying to not put out an opinion per se on whether LPN's belong in ICU, because I haven't worked in an ICU where there was RN only staff. We don't even have techs most of the time, when we do they look at me funny because I help with baths. I can tell you it's tense when I'm reminded that I'm responsible for the legal scope of practice, if the person doing the reminding is not happy with something. It's also workable and fun, and I've met some amazing nurses. The LPN's I work with have taught me a lot about critical care, how to work as a team, and they're still working on my pitiful coffee-making skills.
My boss says there is some noise coming down the grapevine about CMS and JCAHO wanting to require the RN to do ALL of the assessments. (like for each shift instead of just admission...) I think that would shake up our workload groove and on principle that means I don't approve, plus I have a sneaking suspicion that rearranging my carefully crafted work habits would not come with a raise.