LVN scope with ventilators?

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Hi guys! So I work at a small group home, kind of like a SNF but it’s just 6 patients and they all have muscular dystrophy. So everyone is on a vent. We just got some mail from the BVNPT and Respiratory Care Board clarifying the LVN scope as opposed to an RT scope. They basically say we can’t do anything with the vent, not even administer a nebulizer through it or change a cannula, or transfer with the client if they need to go somewhere. Does anyone know more about this? Trying to find the exact scope of practice on the BVNPT website is difficult, but this just seems incorrect so I wonder if I’m reading it incorrectly or missing something? Thanks! This is in California btw.

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It sounds like you've already answered your own question. If the California board of nursing (BVNPT) says so in their mail, then you have to adhere to what they say. It seems like they want respiratory therapists to do the vents & neb's. It's possible that the policies stated by the BVNPT are specifically for your type of health care facility... as opposed to, say, home health, where a nurse does trach & vent care in the patient's home.

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It also specifies home health as an area that an RT would have to do all vent care. That’s why it’s so confusing, it just completely goes against what I know our scope to be. And I learned trach care and vent stuff in school, state has been to our facility and not said a thing. It’s just weird.

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This is interesting. I wonder what prompted the letter from the board?

I'm in CA and worked in a facility with vents. Our policy was that LVNs could change the trach as long as an RN or RT disconnected the vent tubing from the trach. RTs did the vast majority of the neb treatments for pts on vent, but the LVN would do it if RT was busy in an emergency. Both RN/LVN/RT suctioned. Only the RTs could manipulate vent settings. We were surveyed every year by the state and never had issues with this.

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This ruling is absolutely ridiculous! As a Clinical Supervisor for Home Care, I have seen LVN's caring for ventilator dependent clients for the past 24 years. Most of my clients have not had a RT make a home visit in many months. The RT companies here in San Diego state they have a 24 hour response time. However, tracheostomy ties must be changed daily, suctioning may be hourly, inner cannulas are changed daily, circuits on some clients are changed daily but are at least done weekly, patient's are transferred from the bed to the wheel chair requiring disconnect from bedside vent, nebulizer treatments are both routine and as needed for wheezing and ventilator alarms happen often; what will our clients do? Call the RT? What a joke! Will California pay for RNs in the home? If they do where will those RNs come from? We have clients who live on their own, dependent on their LVNs. This decision may force clients in to facilities, if facilities have available sub-acute MediCal beds. What about the "least restrictive" rule. What is the true reason for this decision? One has to wonder. Please review the ruling. California Association for Health Services (CAHSAH) is holding meetings in a variety of settings to address this issue. Please look at their site and try to attend the meetings and voice your concerns. Let your clients know about this and how it may impact their lives.

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Specializes in LTC.

Why on earth is the respiratory board trying to suggest things to the nursing board?! From what I hear, respiratory therapy is a dying field https://www.cheatsheet.com/money-career/these-are-the-15-fastest-disappearing-jobs-in-america.html/

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On 4/9/2019 at 8:46 AM, Golden_RN said:

This is interesting. I wonder what prompted the letter from the board?

I'm in CA and worked in a facility with vents. Our policy was that LVNs could change the trach as long as an RN or RT disconnected the vent tubing from the trach. RTs did the vast majority of the neb treatments for pts on vent, but the LVN would do it if RT was busy in an emergency. Both RN/LVN/RT suctioned. Only the RTs could manipulate vent settings. We were surveyed every year by the state and never had issues with this.

That’s what I’d like to know too! What happened to make this sudden shift?? I’ve been a ventilator LVN for seven years!! My home agency works with a majority of ventilator patients. We have a hard enough time getting LVNs because of less than stellar pay!! If it was an scope of practice issue my RN case manager wouldn’t let me do it!!??

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I thought this was addressed in a previous thread. Any time one has a question about scope of practice, one may write the Board and they should receive a written reply which explains the issue. If this is so, why is it not common knowledge and commonly discussed amongst home health agencies? Where I am, I still see ads for LVN's to do vent care. No mention anywhere about any restrictions. If this is implemented, there will be a heck of a lot of LVN's out of work and a large number of vent dependent patients looking for non-existent RN's to do their home care. This type of ruling was needed on Day One when somebody decided they could go the cheap route by utilizing LVN's to provide vent care in the home or in facilities. Stupid to walk it back now, decades later.

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I think both the LVN board and the Respiratory Therapist board made this decision without input from any of the stakeholders. Where does the RN board stand. How about the physicians who see the clients and sign our Plans of Care. What about those most directly affected: the clients. And since most everything is about the $$$$ how about the payers especially the STATE OF CALIFORNIA!

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On 5/30/2019 at 5:35 PM, Cherry Aims said:

This ruling is absolutely ridiculous! As a Clinical Supervisor for Home Care, I have seen LVN's caring for ventilator dependent clients for the past 24 years. Most of my clients have not had a RT make a home visit in many months. The RT companies here in San Diego state they have a 24 hour response time. However, tracheostomy ties must be changed daily, suctioning may be hourly, inner cannulas are changed daily, circuits on some clients are changed daily but are at least done weekly, patient's are transferred from the bed to the wheel chair requiring disconnect from bedside vent, nebulizer treatments are both routine and as needed for wheezing and ventilator alarms happen often; what will our clients do? Call the RT? What a joke! Will California pay for RNs in the home? If they do where will those RNs come from? We have clients who live on their own, dependent on their LVNs. This decision may force clients in to facilities, if facilities have available sub-acute MediCal beds. What about the "least restrictive" rule. What is the true reason for this decision? One has to wonder. Please review the ruling. California Association for Health Services (CAHSAH) is holding meetings in a variety of settings to address this issue. Please look at their site and try to attend the meetings and voice your concerns. Let your clients know about this and how it may impact their lives.

Yes!! If it was a problem, then WHY are LVNs continually being hired and why isn’t the Board making sweeping license inquiries?? If the Board declares that I can’t work on vents because of “scope of practice” , fine. But it’s throwing the baby out with the bath water at this point.

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3 hours ago, Cherry Aims said:

I think both the LVN board and the Respiratory Therapist board made this decision without input from any of the stakeholders. Where does the RN board stand. How about the physicians who see the clients and sign our Plans of Care. What about those most directly affected: the clients. And since most everything is about the $$$$ how about the payers especially the STATE OF CALIFORNIA!

Yes!! I’m just waiting for that too! I don’t think RNs are going to flood home health agencies, do you? Patients on ventilators have been cared for by LVNs for decades. What’s going to happen to them now that someone suddenly decides this is an issue? If anything, make it mandatory for a licensed person only to care for a vent patient. Families are hiring caregivers (for lack of LVNs already)!!??

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On 4/9/2019 at 4:23 AM, Floor_Nurse said:

It sounds like you've already answered your own question. If the California board of nursing (BVNPT) says so in their mail, then you have to adhere to what they say. It seems like they want respiratory therapists to do the vents & neb's. It's possible that the policies stated by the BVNPT are specifically for your type of health care facility... as opposed to, say, home health, where a nurse does trach & vent care in the patient's home.

It seems they (CA Respiratory Board) just made a proposal saying LVNs shouldn’t be doing ventilators in home health now, either. I’m going to a meeting June 7.

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