LTC/rehab facility: ?'s --LPN Scope of Practice

pagandeva2000, LPN · Jun 25, 2009

As others have said, each state has a different scope of practice. You'll fair better contacting the Board of Nursing to see what is required in yours. Nursing homes usually give a wider girth to LPNs because we predominate there...sometimes, there is only one RN in the entire building or even by telephone, from what I am hearing. Now, I would not place food in my medication cart, but sure, I have kept a power bar or a small bag of nuts in my pocket when I work the floors per diem because there are times that you will not get a break no matter what you do. In fact, sometimes, there isn't even another LPN to relieve you for lunch because there may just be one nurse per floor at night.

ktwlpn, LPN · Jun 25, 2009

As others have stated the LPN's scope of practice varies from state to state.Go to your state's web site and educate yourself. It seems that this kind of behavior is common among many healthcare workers.I worked with an RN and she was always eating and drinking coffee off of her med cart.

AllSmiles225 · Jun 25, 2009

Absolutely 100% agree. I'm an LPN in a LTC facility and if ANYONE said ANYTHING to me about carrying a bottle of water and my sandwich while I'm doing my med pass I would look the other way and keep eating. Obviously if the state was there I wouldn't do it, but on a typical day I start at 3 and end at 11 and there is NO time to eat. A break? Hah, maybe in my dreams. I assess my patients and chart/document. The RN cosigns the assessment. I do the admissions and have the RN cosign them. Insulin double checks? I have NEVER had ANYONE double check my insulin and quite frankly if someone tried to I would be offended. I went to school too and am quite capable of checking a blood sugar and administering an insulin injection as per sliding scale coverage. I always count my narcotics with the oncoming shift. Your additional education gives you the initials RN but there are many LPNs who may be just as educated as you are in LTC. Most of them have worked there 10+ years and know exactly what there doing and know those patients better than you do regardless of the initials behind your name. You should start looking for qualities in your coworkers that make you unified not segregated.

summerrose_10 · Jun 25, 2009

It's true the scope of practise varies state to state. Also in our LTC CNA's can still use the glucometers and take BS for us. So you do have to read up on your state laws.

I have to agree with many of the other nurses that posted, LPN's are awesome. The LPN's where I work are great. :bowingpur Many of them should be grandfathered in as RN's. Other than IV therapeutics, I believe they had all the training the ADN RN's had.

As for double checking insulin, well, that is just being a good/safe nurse.

In the previous post

" The RN cosigns the assessment. I do the admissions and have the RN cosign them. Insulin double checks? I have NEVER had ANYONE double check my insulin and quite frankly if someone tried to I would be offended. I went to school too and am quite capable of checking a blood sugar and administering an insulin injection as per sliding scale coverage."

Just remember if you(RN) cosign the assessment , you are documenting you agree with the admission assessment. If some unexpected outcome should occur, it could be your license on the line. So... know your LPN, and do the initial physical assessment yourself. I do believe an RN has to do that anyway.

It is too bad the previous poster would be offended if someone where to double check her insulin. In our facility we store our humalog and lantus in the same drawer seperated only by a divider. To prevent errors I normally ask another nurse to verify that I pulled the correct bottle, and drew up the correct amount. There was one time I didn't ask for this double check (in a hurry, and it isn't, unfortunately, required in our facility) Lo and behold, I gave 35 units humalog instead of lantus. It was an unnecessary mistake, I knew it was GOOD practice to ask for a double check on insulin, but...since it wasn't "policy" to get that double check, I made the error. :cry:

As for eating on the run at the med carts, well...unless your the charge nurse and you want to micro manage, I would stay focused on what is important; good patient care. :twocents:

We're all nurses and I believe we should support each other regardless of the initials behind our name:redbeathe

kkluczynski · Jun 25, 2009

yea im an lpn at a LTC/skilled unit and im quite capable of listening to lung sounds and bowel sounds. i take orders from docs over the phone and in person. we don't double check insulin but we always count narcs at the begining and end of our shift. just because were not RNs doesn't make us incompetent.

Raefabian4 · Jun 25, 2009

I wish that they did checks on the insulin or did their narcotics checks. You wouldn't believe the other stuff I witnessed today: One LPN was eating her whole shift (candy and snacks on her med cart)--not washing hands (ever!)--even after taking blood sugars and administering insulin (w/out gloves). Other LPN's had snacks in the pockets of their scrubs and were munching their entire shift. All I could think was "Wow." I know they thought I was weird because I contacted supply and made them bring up 4 bottles of hand sanitizer, and I kept asking where the gloves were, so I could keep myself and my patients safe. :banghead:

Their bad behavior and poor hygiene isn't because they are an LPN, it is WHO they are as a person. As the RN in charge, talk to them nicely and in private and make them aware of the issues at hand. Also, make sure you bring up the fact that one of the pt's. lungs were not clear and to make sure that they are doing it properly. Sounds to me like you have some nurses with no initiative. Good Luck.

BTW, when I worked in LTC, I ausculated lungs, did assessments, took MD orders, gave insulin and counted narcs with other LPN's and I am in PA. It's been a couple years though.

SaraO'Hara · Jun 25, 2009

I am an LPN & I work in a LTC facility. I assess lung & bowel sounds. I take MD orders over the phone & in person. We do not double check insulin & you ALWAYS count off narcs @ the end of your shift. As far as lung sounds go perhaps the LPN you followed has some hearing loss, or uses the facility stethoscope(which we know is the least expensive). LPN stands for Licensed Practical Nurse.

Yeah, that. As far as care plans, we use pre-printed ones. The admission "data collection" is co-signed by the DON. I was taught ad infinitum how to properly auscultate lung, bowel, and heart sounds, and you bet your bippy we count narcs! I may be an LVN, but I am the NURSE responsible for my group of patients.

SlightlyMental_RN · Jun 25, 2009

Oh, believe me, I have great respect:bow: for the LPN's out there....especially the ones that have been doing this for years. I agree that the ones that have been doing this for X number of years should have the opportunity to take the boards to be an RN, even w/out the extra education. I truly never meant to insult any of the LPN's out there...I was just concerned over how I could protect MYSELF and MY license. Understand? Thanks for all of you took the time to try to point me in the right direction. I truly appreciate it!:)

AllSmiles225 · Jun 25, 2009

"As for double checking insulin, well, that is just being a good/safe nurse"

The school I went to never practiced this and either have any of the facilities that I have worked for. That is why I would be offended--because it was never taught as something that needed double checking. Of course I understand why a double check would be "safer" nursing practice but when you have 20 diabetics on a 60 patient floor not to mention that you just may be the only nurse on the floor..double checking insulin is impossible. In my own world..I've never seen that. Sorry if it sounded naive.

southernbeegirl, BSN, RN · Jun 26, 2009

the original admission assessment must be done and or cosigned by the RN. after that the LPNs are quite qualified to perform the assessments. i consider myself to just be the resource person for my LPNs. they come get me if they have a patient going south or hear something hinky. but believe me, you will learn to really, really rely on their assessment skills. they are with the patient so much more than you or I ever will be unless we work the floor as well. so they know immediately if something is different with their patient. even if they dont know what, they know when something isnt right. it's those things that we learn to lissn to as the RN in LTC.

in my state, all licensed nurses can take MD orders over the phone.

any nurse working the floor, RN or LPN, BETTER be counting those narcs coming and going off shift or their butts will be in a sling with the BON one day!

double checking insulin in LTC is practically impossible with the staffing available. by the time you get all the chemsticks done and give the insulin half your day is done.

when you first go into LTC it is like a major culture shock. DONT FREAK! it's not bad...it's just different. you go from being on a hospital floor with many RNs to being the only RN on the shift most times. it's a lot to absorb.

take a deep breath and let the nurses you work with guide you until you figger it all out. they won't steer you wrong!

and hopefully you will learn to love LTC like many of us do.

Moogie · Jun 26, 2009

not many rns who want to work in ltc so the floor nurses/charge nurses are usually lpns with the don available and at least one rn on in the building per shift. i honestly think we need to be grandfathered in as rns after so many years' experience.

i hope your suggestion is tongue and cheek. i think that would be a huge disservice to rns and lpns alike.

thirty years ago, it was possible in some states to become an lpn without ever taking one day of classwork. i worked with a nursing assistant (these were the days before certification became necessary) who worked for several years, passed practical nurse boards and was licensed as an lpn. the other nurses were all a bit suspect about her clinical judgment and critical thinking skills. as i recall, she was assigned to night shift so she could do "the least amount of harm."

to the op, please check your state nurse practice act if you have questions about the scope of practice for lpns. as others have said, the scope varies tremendously from state to state---and you will likely find that lpns are utilized differently in ltc facilities than in hospitals.

southernbeegirl, BSN, RN · Jun 26, 2009

"As for double checking insulin, well, that is just being a good/safe nurse"
The school I went to never practiced this and either have any of the facilities that I have worked for. That is why I would be offended--because it was never taught as something that needed double checking. Of course I understand why a double check would be "safer" nursing practice but when you have 20 diabetics on a 60 patient floor not to mention that you just may be the only nurse on the floor..double checking insulin is impossible. In my own world..I've never seen that. Sorry if it sounded naive.

dont be offended. double checking insulin is a common practice in nursing. unfortunately, it's impractical in a LTC many times mostly due to staffing.