What are the duties and responsibilities of RNs, LP/VNs, and techs or other patient care personnel in you unit?
What is safe?
http://www.calnurse.org/
For Immediate Release February 20, 2003
Contact: Charles Idelson, 510-273-2246, or Vicki Bermudez, RN 916-802-3543
CNA Sues, as Threat to Patient Safety, to Block New Rule Allowing
LVNs to Administer IV Medications
RNs Charge LVN Board Covertly Aided Dialysis Industry
The California Nurses Association will file a lawsuit in Sacramento this afternoon to stop a new
regulation that substantially expands the clinical role of licensed vocational nurses displacing RNs
and putting patients at risk.
In late January, California's Office of Administrative Law (OAL) approved a proposal authorizing LVNs
to administer intravenous medications to patients in dialysis, blood banks, and other settings. It is
scheduled to go into effect February 28.
The regulation was proposed by the Board of Vocational Nurses and Psychiatric Technicians
(BVNPT) at the request of major dialysis companies and blood banks, and backed by the Service
Employees International Union (SEIU) which represents LVNs.
The ruling was seen by many in the health care industry as a foot in the door to extending the LVN
scope of practice - the legal authority that governs what a health professional can and can not do - to
other essential medical services now provided by RNs.
'Dangerous and unwarranted expansion'
CNA is seeking a temporary restraining order against the BVNPT to block the decision which CNA
President Kay McVay, RN called a "dangerous and unwarranted expansion of role of LVNs
regardless of the harm to patient safety."
Last April, the OAL threw out a similar BVNPT proposal ruling that the board exceeded its authority
to enlarge the scope of LVN practice, the proposal was "inconsistent" with California law, and that
patients would be jeopardized.
None of those concerns were addressed when the BVNPT resubmitted its proposal with only
perfunctory changes, says CNA. Two factors probably influenced the abrupt U-turn by the OAL,
according to CNA:
* Intense political pressure by the health care industry and SEIU. Three major multinational dialysis
companies that operate in California, for example, Fresenius Medical Care, Gambro Healthcare, and
DaVita, Inc. combined for $17.3 billion in sales and $373 million in profits in 2000-2001.
* Back door assistance provided to the dialysis industry by the BVNPT staff.
In its 2002 Legislative Highlights, the California Dialysis Council, the industry trade association,
described how "we worked throughout the year" with the "BVN staff (which) suggested the adoption
of a new set of regulations." Then, "we worked closely with staff at the BVN in an attempt to get a
favorable position from the Department of Consumer Affairs (the consumer protection agency over
the BVNPT) and the Office of Administrative Law."
After the initial proposal was rejected by the OAL, noted the Council report, "We then worked
closely with the staff at BVN to provide additional information to consider and use in connection with
the resubmitting of the regulations."
Dialysis Council: 'We worked closely with the BVN staff'
"We sent out a request that all CDC members provide information to the BVN," the CDC reported.
"We have been working closely with the BVN staff in an effort to be sure they have sufficient
information and support to maximize our potential for success on this important issue."
"It is scandalous and outrageous," said McVay, "that an agency created to protect consumers, the
BVN, would be in open collusion with large corporate health care corporations that make greater
profits by employing lesser skilled staff."
Notably, in its first ruling last April, the OAL had held that "consumer protection is an issue of the
utmost importance when administering intravenous therapy. Hemodialysis medications are
circulated rapidly through the patient's system and may cause potentially lethal reactions."
Yet nothing had changed in the BVNPT proposal to address that concern, says McVay.
Growing numbers of patients receive medication through IVs, "which requires a substantial amount
of clinical skill and pharmacological knowledge and the continual monitoring of its effect on the
patient."
"Dialysis patients are seriously compromised, often with complications of diabetes, severe cardiac
disease and other serious ailments. The administration of medications through an IV involves
pumping them directly into the vein or through a catheter in the neck directly into the heart - and
mistakes are irreversible," McVay said.
McVay noted that RNs are only permitted to administer medications under an order from a physician
and only after conducting a direct physical assessment of the patient.
An LVN, who has far less scientific knowledge and clinical expertise than an RN and in all other
settings can only work under the direct supervision of an RN, will be permitted to administer
medications as long as an RN is in the "immediate vicinity." The regulation does not define
"immediate vicinity" leaving it to the company to determine. "An RN may never see the patient before
the medication is given by the LVN," said McVay.
"Again, a consumer agency, the BVNPT, with the approval of the DCA and the OAL, are allowing the
health care corporations to set all the parameters for a crucial patient care decision - and they are
doing so through a regulation rather than the public legislative process," McVay said.
In minutes of its meetings, the Dialysis Council noted that it sought to carry out the change through
the regulatory process rather than the legislature due to the vocal opposition of CNA. "Our best
chance for success is via this route as Michael (Arnold, the CNC Legislative Advocate) feels we will
have little chance if we face off with the CNA in the legislature," state the June 21, 2002 CDC
minutes.
Most 'egregious example of regulatory abuse'
"Sweeping changes in scope of practice that have such a significant effect on the quality of patient
care should only occur through the legislature, the arena where the public can directly participate in
hearings and hold their legislators accountable," said McVay.
That is also one of the points raised in the CNA lawsuit. CNA charges the BVNPT lacks legal
authority to promote the regulation which violates all existing laws and repudiates the legislative
history of statutes governing LVN practice in California. "There couldn't be a more egregious example
of regulatory abuse," McVay said.
SEIU: 'the proposed regulation is necessary'
While CNA fought the proposal, SEIU campaigned for the ruling in testimony by the SEIU Nurse
Alliance and a legal analysis by the SEIU attorney who wrote that since the duties of LVNs in those
settings were "not covered by any other statute or regulation ...the proposed regulation is
necessary."
In its October 18 minutes, the CDC, the industry council, also noted the contrast. "The California
BRN (Board of Registered Nursing) and CNA both still oppose the concept. However, the Service
Employees International Union, which is trying to organize LVNs, may be supportive."
"Eroding RN scope of practice has long been a major goal of the health care industry," said McVay.
"Now, regrettably, they have the assistance of a major union and a state agency whose mission is
to protect public safety."
The lawsuit will be filed in State Superior Court in Sacramento.
(Copies of the CDC minutes and the letter from the SEIU attorney to the BVNPT in support of the
proposed regulation are available to the media by calling 510-273-2251.)
jnette, ASN, EMT-I
4,388 Posts
Interesting, how each facility differs. Even as a tech, I accessed the caths, did the cathcare and dressings, gave the hep bolus, saline boluses, etc. Our one remaining tech still does the same. Our saline boluses do not have to be co-signed at that time, but rather the charge nurse co-signs the flowsheet at the bottom after txs. are completed. Our LPNs give all the same meds as the RNs, and redo the meds after labs have come back, following the algorythms provided by our nephrologist. Techs do not assess the pt. or give meds of course. But they do prepare the baths..unless K+ has to be added to the acid bath to increase it to a K+3 bath. LPNs and RNs do this.
Again, our LPNs are invaluable to us.