LVN/LPNs in acute care

lsyorke, RN · Dec 16, 2003

I was an LPN for 15 years before going back for my RN and the role has changed drastically over the years. When I started(1984) we functioned as primary nurse with the only restriction being IV push meds and telephone orders. We did admission assessments(observations!!) hung piggyback meds etc... Now jump to 2003 and our LPN's function as nursing assistants. No meds, no charting etc... Its really a shame since the level of education for an LPN is higher that the NA. Their skills are not used to the fullest extent and in this nursing shortage you would think that someone could come up with a better division of duties.

AimersTriageRN · Dec 16, 2003

In my hospital, LPNs still do almost everything....including IV piggybacks, starting IVs, telephone orders and all assessments for their patients. They cannot do pushes or blood is all. They do it all!

marshalbc77 · Dec 16, 2003

i work in a busy med-surg floor full time and ER fastrack Per diem. In Med-Surg floor its basically primary nursing.I will have my own patients. I do everything such as assesments, p.o. meds, dr.'s orders including telephone orders, may hang some electrolytes depending on how much meq's it has, hang blood products,anticoags,start IV's. only thing i can't do IVP & IV ABX and draw blood from a central line. I like how my unit utilize LVN's

I have learned so much. It will be an easier transition when I become an RN. A lot of our LVN's turn RN's. One of our LVN just turned RN and found the NCLEX-RN to be easier than the NCLEX-PN she stated questions on the NCLEX-RN are what we do here at work. I have experience a more limited scope of practice for LVN's when I did registry, this one particular hospital all the LVN's scope of practice where to pass meds for the 13 patients. I did not like that at all, no challenge, i felt like i did not know the patients at all. In ER same I do everything but IVP and IV ABX.

nursemouse · Dec 16, 2003

Thanks! We're trying to look for the best way to utilize these excellent practitioners without exploiting them or exceeding their scope of practice. Your feedback is really helpful!:kiss

mattsmom81 · Dec 17, 2003

Here in Texas there are few restrictions on the LVN from the state. Facilities vary in their policies, and in my hospital different units have unit specific policies about what the LVN can do.

For instance, in my ICU the competent, qualified LVN can do whatever I as a RN can do ( except be in charge. )

In my medsurg area, LVNs cannot spike blood or do an admission asessment, and a RN must do a 24 hr asessment on the LVN's patients. LVNs in my area do not learn IV skills in school consistently, but if they take my hospital's IV competency course they may then start IV's, do pushes and fluids.

Other hospitals in my area further limit the LVN...at one they cannot do IV's at all...cannot start them, can't hang fluids or give pushes. In this facility, they manage by teamwork: the LVN's do the RN's fingersticks for her if she will cover her IV's, etc....tradeoff. It is hard for many LVN's to be deskilled in this way and I can sure empathize with that.

BRANDY LPN · Dec 17, 2003

I work in OB and I can do everything that the RNs do except push versed.

The RNs must do an assessment on all pts Q shift and they have to chart when the babies are born ie(viable fe del.....)

I, however will not take pts that I do not feel comfortable with or have not had training to do care ie( MgSO4, transfusions, ect.) because I feel that these pts need a nurse with higher skills than mine, not that I wouldnt want to learn but Im not comfortable "praticing on the pt" without some theory to back it.

bjblpn · Dec 17, 2003

I have been an LPN for 24 years. In the facility I presently work the LPN can do daily assessments but not the initial admission assessment, the hospital has an IV team that consists of RN's and LPN's, mostly LPN's. (LPN's start IV's but do not give IV medications).

The LPN's are currently being reassigned from the units d/t the RN's not wanting to cover their IV's. We pass medications except the study medications.

We generally carry a heavier patient load, being assigned to the most acute patients d/t RN's claims of having to give our IV medications.

There has been a trend with the newer RN's of objecting to what the LPN's should be allowed to do. But not really wanting to take on the heavy assignment themselves:confused:

KaroSnowQueen, RN · Dec 17, 2003

I am an LPN. I am licensed in two states. In one state, I do just about everything including iv pushes and initial assessments. In the other, I can do just about everything except iv pushes and initial assessments. Call the md, write orders, hang ivs, change drsgs,draw blood, start ivs, etc. The whole nine yards. The day they make me a glorified aide is the day I quit and go to Walmart.:p

shawng007 · Dec 18, 2003

Hello, I am an LPN in a local hospital, as a float, I work primarily in med/surg, occasionally pediatrics and mental health and physical rehab. The type of nursing depends day to day on which unit and who is working, whether we do primary or team. either way, I get an assignment, usually five pts, and I have an RN to cover me. Usually it's not too bad, unless there are a lot of PICC lines or TLC's, which we cannot access. we also cannot hang blood, although NY allows LPN's to become certified for blood, the hospital does not recognize it. according to written policy we can take telephone orders, but everyone there tells me we can't, so there is some discrepancy there, which i find out because many LPN's dont want the responsibility, and the RN's want to have the control apparently. We pass meds, except IV push and heparin drips, epidurals, and pca's. Other than that, it is usually just a madhouse and the stress level is out of this world. I usually dont even want to go to work, but once i am there and see my patients I wouldn't have it any other way, helping them is the most rewarding thing i could do. :roll

austin heart, BSN, RN · Dec 18, 2003

The hospital that I work in now does not use LVN's. The last hospital I was at did not use LVN's in the Critical Care areas (ICU, CVICU, L&D and ED), but did have them workin on the medical units. They could do everything an RN can except spike blood (they could monitor the patient after the RN spiked it) and do addmission assesments. An RN did have to do an assessment on the pt. every 24 hrs. It just varies from hospital to hospital, because when I was an LVN the place I worked used LVN's ever where and they could do anything an RN could do except an addmission assessment.