Lpn's working ER

[Arky]

Question for all the old hands here. I'm an RN and just started working a small rural hospital that uses lpn's to work the ER. I can't understand how they get away with it. I'm not saying that the lpn's don't know how to handle emergencies but legally how can they assess a patient? I've never seen this until now and they tell me the hospital has been doing this for years because they have an RN in the building. How can they push IVP drugs where assessment needs to be made on the patient. There may be an RN in the building but they are not in the ER seeing the patients. Confused........

[leslie :-D]

this isn't about "i know lpn's who can do just as much as RN's" it is about legal scope of practice. i would love to hear from LPN's that can prove in their state that they can do primary assessments, IVPB meds and such. in illinois it doesn't happen. i worked with a lpn that lost her job for going out of her scope. we all work too hard for our licenses (LPN's and RN's) to lose it.

thank you, angel!

i think it's important that we stick to the subject matter, especially knowing where we don't want it to go.

leslie

[MikeyJ, RN]

Wow -- I am very suprised that LPN's are not allowed to assess in some states. There are some LPN's that work on my floor who do everything, with the exception of IV pushes. They are assigned their own patients, perform assessments, etc.

Interestingly, I just looked up the LPN scope of practice and it says they can "contribute to the health assessment." That suprises me, but I now understand why the charge nurse co-signs everything the LPN's do (even though the LPN's do everything themselves on my floor). Kind of dangerous now that I think of it.

[Virgo_RN, BSN, RN]

this isn't about "i know lpn's who can do just as much as RN's" it is about legal scope of practice. i would love to hear from LPN's that can prove in their state that they can do primary assessments, IVPB meds and such. in illinois it doesn't happen. i worked with a lpn that lost her job for going out of her scope. we all work too hard for our licenses (LPN's and RN's) to lose it.

I'm not going to point you to my state's BON, as I like to maintain a certain amount of anonymity on the internet. I will say, however, that as an LPN, I may collect and record data (ie perform a head to toe physical assessment and chart it), but an RN must utilize the data to form the nursing diagnoses and plan of care. As an LPN, I may modify an existing care plan under supervision of an RN. In other words, if I'm assigned to care for a patient and I determine that risk for skin breakdown is no longer applicable because the patient is ambulating, has good bed mobility, is eating and drinking, and has no sensory deficits, then I may check with an RN with my findings, and if the RN agrees, I may chart that Risk for Impaired Skin Integrity has been resolved and remove it from the plan of care. At my facility, a patient needs to have a plan of care entered into the electronic record within eight hours of admission. So, when I admit a patient, I perform a head to toe, record my findings, and let an RN know that the patient needs a POC. The RN then uses my documented findings as well as their own to identify their nursing diagnosis and enter the appropriate care plan.

As far as IVPB, IVP, etc., the BON is vague in that area. It simply states that an LPN may perform nursing care of stable patients with minimal supervision by an RN. It is my facility that outlines specifically which nursing tasks an LPN may and may not perform. For example, an LPN may perform venipuncture once competency has been verfied. An LPN may administer IV fluids and premixed meds, including IVPB antibiotics, but not vasoactive medications or anticoagulants such as heparin. An LPN may monitor these infusions, but may not initiate them nor make any rate adjustments. An LPN may not initiate blood transfusion, but may participate in the safety checks and monitor the infusion once initiated by an RN. An LPN may administer certain specific classes of medications via IVP in a peripheral line. With central lines, an LPN may perform dressing changes, routine flushes, and administer IV fluids and premixed medications. An LPN may not administer any IVP medications via central line. An LPN may not initiate TPN, but may perform bag and tubing change on an existing TPN infusion.

There is much more, but I will assure you, as an LPN, I do adhere to my scope. When I was new, I kept a copy of the LPN scope of practice on my clipboard in order to verify that any task was within my scope before I performed it. Now, I'm familiar enough with my scope that I simply go look at the electronic copy on the computer if I need to double check something.

[nursebabygirl 08]

Hi everyone.

A good friend of mine who is in school to become a LPN told me that our two local hospitals are no longer hiring LPN's. (I knew that one of the hospitals had made that move because they are a level one trauma/magnet hospital). She is currently doing her clinicals in a hospice facilty. She told me that her nursing instructor informed her class that their best bet for employment is a LTC facilty or the hospice home. I feel bad for her because she is a sweet person and she will make a great nurse.

I don't know about the E.R., but when i was in school and my last clinical rotation was in the T.I.C.U. (or transitional ICU ), there were many LPN's in that dept. THEY WERE GREAT, i learned alot from them and quite frankly you could not tell the difference between them and the RNs. (they did initial assessments, flushed I.V.'s, and gave I.V. push meds).

[RN1982]

LPN scope of practice is different in every state. I don't know what you mean when you say "I would love to hear from LPNs that can prove in their state..." All you have to do is look up their board of nursing and they should have a nurse practice act or public health code. In Michigan, LPNs can assess patients, delegate to UAPs, and push IV drugs (after receiving certification). Michigan is very general about an LPN's scope of practice. I've seen LPNs hang blood and IVPBs.

[kmoonshine, RN]

Now, this isn't a personal statement on what I think LPN's should/shouldn't do -this is just from a legal standpoint.

But don't most states require an RN to be triaging patients?

This could be a huge problem should a lawsuit ever arise. Triage can be a dangerous place to be at times (decision-wise), and lawyers would pounce on an LPN's back should there ever be a legal lawsuit stemming from an adverse outcome.

I've never worked with an LPN, but I do value all my coworkers (docs, techs, etc.) I see LPN's as an important part of the team, which is why I am posting these questions regarding triage. Seems to me that facilities are gambling with their licence by not having a safe mix of staff and skill levels.

No LPN bashing from me! :loveya:

[Dalzac, LPN, LVN, RN]

In oklahoma LPN's can't hang blood and iniate care plans. If you have been trained you can give IVP's I had to take a 3 day class from the hospital I worked to give ivp's and there are a couple I can't. I worked in ICU/CCU for over 25 yrs and then ER for 5 yrs. And I am just an ignorant lowly LPN.

[pagandeva2000, LPN]

We have LPNs that work in the ER in my hospital. They can hang IVPBs, initiate a peripheral IV line, read telemetry monitors, obtain labs, and such. They have plenty of RNs available for guidance. I am hearing that they may reduce the jobs to monitoring telemetry monitors and starting IVs, but not sure if it is true, or how soon it may happen. I wouldn't want to have 'an RN available by telephone or somewhere in the building' if I worked in the ER; I would want a few right there with me, because it would be my license on the line if something happened.

To me, this doesn't have to initiate another LPN to RN war, unless someone wants it to be. It is a legitimate question and I would wonder myself.

[MassED, BSN, RN]

i haven't the slightest idea.

it certainly wouldn't fly in these parts.

look forward to reading other responses.

leslie

I worked in a small ER in NC and two LPN's were hired, but they could work in Fast Track or float - not take primary nursing responsibility because of the assessment issue.

[nerdtonurse?, BSN, RN]

In ours, a small rural hospital, we have a couple of RNs and a couple or 3 LPNs per shift. The RNs do the initial assessments, the LPNs do everything else possible within their scope. I don't look at LPN vs. RN, I look at experience and if the person's a good nurse.

[pagandeva2000, LPN]

I worked in a small ER in NC and two LPN's were hired, but they could work in Fast Track or float - not take primary nursing responsibility because of the assessment issue.

I forgot, yes, we also have LPNs in fast track!

[Jules A, MSN]

Well my first thought is that since the OP is a RN and sounds like working in this ED obviously its not just LPNs running around all by themselves. So in the instances where there are things that require a RN there is one on the unit, right? It does vary from state to state so all the OP needs to do is check the Nurse Practice Act and talk to her supervisor if there are things they feel aren't being done legally.