LVN's in Observation Units or Magnet Hospitals?

[happy.persimmon, BSN, RN]

Greetings fellow nurses, pray this finds you well.

I work at a California Magnet hospital, and we are considering hiring LVN's for our new outpatient observation unit. This is a first for our institution and wanted to pick your brains.

- Do you work inpatient or outpatient?

- If given the opportunity to practice to the fullness of your license and skillset, what would that look like? 

- Are there any LVN's that work at a Magnet hospital, and if so, what work/team model do you use?

 

Generally, can LVN's in CA do the following:

- IV medication administration

- Central Line medication administration

- Draw Labs

- Run Codes (what is the role there?)

- Wound Care

- Patient Education 

 

Thank you for the help with this. I'm having a hard time seeing consistencies in the literature, looks like many times the scope that is allotted LVN's is based by hospital. 

 

Appreciate the feedback ? 

[Jean Ivy, BSN, LVN, RN]

Hey there,

 

according to California board of nursing LVNs are not allows to administer IV meds with the exception of vitamins etc. they’re not allowed to mess with central catheters, or do the initial teaching. They can however do the reinforce teaching, draw blood or labs, start an IV, hang and connect fluids etc. I feel the RN board limits the scope of practice for LVNs which hinders their skill set. In other states they’re allowed to do all that you mentioned which I find odd California doesn’t allow them. I was once an LVN

[happy.persimmon, BSN, RN]

Thank you Jean Ivy! That is truly helpful, I appreciate it.

I agree, it's odd that the nurse roles are not standardized... California is an incredibly strict state with what nurses of all types can do, it makes onboarding so much more complicated. Plus, with LVN's, they're allowed an IV cert, so I don't get why they can't do much with it apart from start an IV... Anyways, thank you very much again!

[PoodleBreath]

I hope that you can make this model work. I worked in an LTAC with RN/LPN/CNA teams, RNs doing care management, assessments, delegation of tasks, LPNs carrying out a lot of the direct bedside nursing tasks and reporting to the RNs, bridging the gap between RN/CNAs.

Problem was that the hospital decided to cut staffing because of this and so patient loads went through the roof. But I was able to get my ACLS, can't run a code, but still did help when working with telemetry patients. Worked with a lot of patients on ventilators and any kind of drips, tubes, drains, wounds under the sun. RNs did the assessments, set the protocols, and care plans, LPNs carried out tasks and reported to RNs. The scope in every state is different.

Nursing tasks allowed revolve around whether an assessment is needed - at least in my state. LPNs can collect information and report back to RN, who determines course of care. With good teams it's very seamless, with trust built up between RNs and LPNs, and LPNs can have a lot of autonomy.

I work in hospice now and we use the RN/LPN/CNA team model and it's fantastic.

Because so many LPNs work in SNFs/LTC, they have really solid wound care skills and there are wound care certification courses for LPNs and so they can manage wound care, although in some places not allowed to stage - although we are required to know how to -- or independently set up wound care plans.

Good time management skills, and LPNs really do need to run the floors, with sometimes only 1-2 RNs in the building. Like any profession there are people that rise to the challenge and others that sink, and some that just don't care.

Patient education we are required to do, we can draw blood, cannot give blood, can follow up on labs, request labs, do anti-coag follow up, in-house INRs, etc. LPNs can be IV certified and in some facilities allowed to manage IVs but not push IV meds.

The most important way to make this work is to focus on building strong teams, and cultivating a positive, respectful environment. Sadly, I'm not sure our healthcare system can do that...