LVNs in the ICU

RN1980 · Sep 16, 2011

ive never worked in a icu here in mississippi that has lpns staffed as regular staff icu nurses. now i have heard of smaller type units in small rural parts of the state that might have a lpn II but i think they are pretty much being phased out. i figure since a lpn has thier own licsence i am not responsible unless i sign behind them on something, but i may be wrong.

TexRN08 · Sep 16, 2011

I work at a large level 1 trauma center so they are hiring the LVNs as support staff instead of CNAs (which we currently have). The duties of the CNAs/techs are primarily accuchecks and recording urine outputs, so from what i took from the discussion is that by replacing CNAs/techs with LVNs our support staff will be able to carry out a broader range of functions, thereby allowing the RNs to focus more on other tasks. In addition, as I mentioned earlier, they will also be able to take over care of the stable patients who are awaiting transport. We're guessing this is a way of freeing up an RN when a new admit comes in without having to call someone in. So far they haven't given us exact details about how it will all work, but they have started the process of hiring LVNs to one of our ICUs. I suppose they want to try it out in one unit first and work out the kinks before implementing it throughout the entire ICU. We shall see :-)

donmega818 · Oct 31, 2011

What hospital is this?

HazelLPN, LPN · Apr 27, 2013

This is an old post, but I have experience with this. I am a retired LPN and spent most of my career in various ICUs...adult ICU (later MICU when we split) and most recently in PICU and NICU. I work in a state that allows for the LPN to have a broad scope of practice. Anything that was in my scope was MY responsibility and my license, not the RNs. It is mistaken to think that the RN has to follow the LPN around to make sure that she/he does everything right. What was outside of my scope was the responsibility of my RN charge nurse, who took no patient assignment of her/his own. I titrated my own drips, drew off the line, started my own IVs, did my own sterile drsg changes, I did my own pushes, I had patients on vents, HFO, swans, ECMO, CRRT, IABPs. I was responsible for my own shift assessment but could not write the initial assessment and start the problem list on admission. I did not write the care plan and serve as the pts primary nurse, although I could make suggestions to the plan and serve as a pts associate nurse. I did not administer any IV chemo products, had to check all blood products and some IV drugs with an RN before I gave them, and did not push propofol or other anesthics. I didn't take charge or carry the code beeper and couldn't train to run the ECMO pump. RNs who work in states and hospitals where the LPN scope is limited should worry about the extra work that is placed on them. For example, I know some states where LPNs can not give any IV meds or can't draw any labs off the A line...this would be a pain in the rear for the RN to have to cover those duties. If the state and hospital has limited restrictions on the LPN, then there is little to worry about. Usually, the only thing my charge nurse would have to do for me is check blood before I gave it or change my assignment around as I didn't take admissions. Otherwise, I took care of very sick patients and managed them on my own with little help from the RN. To those who say LPN education is not enough for acute care, I say my 54 years in nursing and ability to learn and read on my own more than compensated for my formal education that quickly became obsolete...as everyone's does to some degree. When I started in nursing, there were no ICUs and if you had a patient who needed an IV, you helped the docs put it in. I shiver to think of any doc these days who would try to start an IV....

Glad to see that your hospital has still found value in LPN/LVNs instead of kicking them to the curb like yesterdays garbage like so many other hospitals have done.

Best to you,

Mrs H.

calivianya, BSN, RN · Apr 29, 2013

I've never seen LPNs in an ICU, but they do hire EMTs to work as CNAs in mine instead. There is no transfer of care over to the EMT, the EMT is strictly support personnel and doing the CNA's job. I haven't seen any actual CNAs there. The only place I've ever seen LPNs in the hospital is on inpatient rehab, and they have to have all of their work cosigned by the RN at the end of the shift and they cannot do admissions or initial assessments.

*LadyNurse* · May 9, 2013

We have one LPN in our unit and that nurse has been there for well over 30 years. There hasn't been another one hired since. I think that it can sometimes it can be difficult to manage your own critical load of patients in addition to doing things that are out of the LPN's scope (drip titrations, blood, and NGTs). Some days it is manageable and others it is a near impossibility.

HazelLPN, LPN · May 9, 2013

We have one LPN in our unit and that nurse has been there for well over 30 years. There hasn't been another one hired since. I think that it can sometimes it can be difficult to manage your own critical load of patients in addition to doing things that are out of the LPN's scope (drip titrations, blood, and NGTs). Some days it is manageable and others it is a near impossibility.

LPNs here manage all of that on our own. The LPN role in your facility certainly is more limited and I can see why the RNs would have a concern having to cover things outside of her scope. I would imagine, however, that this veteran LPN is a trusted member of the team due to her experience.

We had a role called "PIP" which stood for partners in practice. A nursing student who had passed her peds clinical rotation could obtain a position in the hospital called a nursing assistant II. She worked alongside an RN and they would take an expanded assignment (usually three of the more stable 1:2....or a 1:1 with a kiddo ready to go upstairs). The NA II could not give meds, do sterile dressing changes or assess the patient, but could write a data collection (an assessment without calling it that) and draw off the line, suction the ETT or trach and pretty much anything else under the immediate supervision of the RN. They were usually hired in the unit as GNs when they graduated and had a much shorter orientation that the usual new grads. It sounds like this might be a better role for your LPN than having her own patient assignments with RNs covering what is outside of her scope.

Hopefully, even if she can't legally titrate the drip, she knows when it needs to be bumped up or down and why and can let the RN know what needs to be done vs simply ignoring what is outside of her scope.

kellycinalli · May 9, 2013

I'm in New Jersey and can do virtually everything except drawling blood from a pic and Iv push meds. Other than that we do NG tubes and even chest tubes etc. we are responsible for our patients including new admits and care plans. No one counter signs for me. And I am hearing that r scope for Lpn is going to be broader which would allow push meds and blood drawls. I've been at my facility for 16 years.

kathconserv · May 19, 2013

I have worked in a setting where they have nursing assitants and techs do the finger sticks and urinary output and help with washing patients. This was a 12 bedded ICU with 6 to 7 nurses. I now work in at 12 bedded ICU with 6 to 7 patients and we do not have any nrusing assistants. The nurses do everything and help each other. Also, this is an amazing ICU with teriffic nurses who are more than helpful. I like being the one to do everything for my patients. Sometimes nursing assistants do not understand the imortance of accuracy with certain things like urinary output and finger sticks. Also, they will not even change a pillow case without the nurse in the room if the patient is on a ventilator.

kathconserv · May 19, 2013

I'm in New Jersey and can do virtually everything except drawling blood from a pic and Iv push meds. Other than that we do NG tubes and even chest tubes etc. we are responsible for our patients including new admits and care plans. No one counter signs for me. And I am hearing that r scope for Lpn is going to be broader which would allow push meds and blood drawls. I've been at my facility for 16 years.

I have tremendous respect for LPNs but I don't believe they should work in the hospital setting. It is not about "doing the same tasks as an RN." It is about responsibility.

Natasha A., CNA, LVN · May 26, 2016

Any new updates success stories of LVN in ICU