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........

[pagandeva2000, LPN]

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.

That is true; how many RNs are working in this particular ER? Is it a small emergency room, is it a trauma hospital?

I think that if the LPNs are there, but working within their scope of practice according to the BON, and policy/procedure, it may not be a problem. Our ER has LPNs, and as far as I know, they are not working of of their scope. They do not do triage or IV push. They are trained to hang blood, but only with an RN present and I don't think that they monitor them in the first 15 minutes after the initiation of blood products.

[angel337, MSN, RN]

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.

i think its great that LPN's in some states can do so much, its just that as long as i have been in health care i have never heard of LPN's being able to do exactly what the RN does. i would not feel comfortable having an LPN hang blood on my patient unless i knew that if something went wrong i would not be held liable for it. i think hospitals would definitely benefit if we could use LPN's more. thanks for the info about michigan.

[luckylucyrn]

My ER has one LPN that works in Pediatrics. He is awesome, and has 10 more years experience than I do. He works as the "second nurse" in Peds and we share the 5-bed assignment. (You RNs that do Peds know that lots of procedures take 2 people, sometimes more!). We each kind of stick to our own scope of practice. I have to triage the patients or at least co-sign his triages. He can put in the IV's but I have to give the IV meds. Recently Tennessee updated their scope of practice to state that LPNs can give IVP meds but not to pediatrics. Other than that, we pretty much do the same job. I have learned a LOT from him, and when I am not there and other nurses with less experience do Peds, they only want to work there if he is going to be there to help them!

[nkochrn, RN]

I also work in a small rural hospital where LPN's go to the ER. We have 2 RN's and 1 LPN working every shift and that's to cover the WHOLE hospital. The RN has to do the triage assessment. All of our LPN's are IV certified, but there is still drugs they can't push and they can't hang blood. I believe there is supposed to be an RN in the ER at all times.

[Irish Nurse 89]

Speaking as an LPN who has been working in an ER for 2 years at my current hospital, as well as 7 years in a Trauma ER before this , I absolutely feel that we SHOULD be allowed to work in the ER, within our scope of practice....That being said, an LPN should NOT be working in any ER "alone", without the direct guidance of an RN.

[pagandeva2000, LPN]

I keep saying that there is enough at the table for everyone to partake. I can see if an LPN is working independently in an area where patients are acute and need initial assessments-that should not happen because the LPN and RN roles are NOT interchangable. But, we can work there together.

[mscsrjhm]

OP indicated "rural" small hospital. This type of facility is a world of difference from a larger hospital.

Easier to staff LPNs than try to staff with non-existant RNs. Many smaller areas don't have RN resources to hire from.

[BinkieRN, BSN, RN]

In my state LPN's can and do give IVP medications, hang blood, certainly can do assessments.

I don't think we have any LPN's in the ER but we do have LPN's in ICU and CCU and they do a better job than I could, that's for sure.