I had my first shift last night on a Med-Surg Oncology floor. I was shocked to find out that I was being oriented to the unit by a LVN. Now I realize that we do a lot of the same tasks as RNs but there are other things that I would be doing that they don't...
Has any RN out there been trained by a LVN? I am a new graduate, and I know I have A LOT TO LEARN but this particular LVN was engaging in unsafe behavior consistently--she seriously only used gloves twice the entire shift.
I was thinking about meeting with the nurse manager because I told the charge nurse and she didn't seem too concerned. Everyone seems very lax on this floor and I did have a great time but I know that is not what is important. Do you think it would be too ballsy for a new grad RN employee to meet with the nurse manager this soon?? The LVN was extremely nice and was trying to be helpful but she gave me incorrect information multiple occasions as well.
First to comment on the OP list of concerns, it would seem to me that the LPN orienting you could use some education on things.
Having said that As an LPN I have oriented many RN's, and am surprised at the procedural things that new grads have only ever done on dummies in a clinical lab. As an LPN student we were required to perform just about every procedure a minimum of 3 times in the clinical setting before being allowed to pass that portion of our clinicals. Our instuctors would purposly find us patients on the floor that needed things like catheter changes etc. So again from the new grads I have oriented I've been very surprised how little they knew about how to perform most procedures.
I live in Ohio and LPN's are not allowed to admin. TPN or blood products or IV push meds. But many new grads are unsure of how to even work an IV pump or how to mix TPN ect. and come and ask me. They ask me things lke how much saline should they flush before and after giving IV push meds or how to admin. certain IV push meds. LPN's in can hange fluids and antibiotics through a peripheral line only. We were allowed to hang them through a PICC until very recently when the laws changed.
So again I'm surprised on how much procedural knowlege many RN grads don't have. After talking with a lot of new grad and LPN's that became RN's I feel this is because the focus of an LPN education is more patient based and and RN education seems to focus a lot on delegation. Now I know not all RN schools are the same just as no two LPN schools are.
The other issue I feel is ( and someone else said it in an earlier post) RN's have NO CLUE what the LPN scope of practice is. I had a DON try to write me up a few times for doing things she said was out of my scope of practice, only for her to feel pretty stupid when I told her I wouldn't sign it because she was wrong and sure enough she was.
So I think the biggest problem is many RN's come out of school with a preconceived notion that an LPN is basically an over glorified STNA/CNA that can pass meds. I actually had an RN tell me that LPN's are not taught critical thinking in school and I wasn't a "typical" LPN to be so knowlegable lol.
The fact of the matter is that while some acceptions are out there LPN's are the redheaded step children among nurse and we get screwed CONSTANTLY. I see it all the time, inexperienced RN's are given charge of patients they wouldn't have the first clue of what to do if something happened and the pt. started to crash over an experienced LPN simply because they have RN next to thier name. I;ve seen SOOOOO many horrible and even life threatening decisions made by RN's that get over looked and the RN's gets babied and "it's ok mistaked happen" and then an LPN's that make a mistake 1/10th as sever and the LPN either gets written up or fired.
Bottom line is that while I know several RN's that have a great deal of respect for LPN's, most do not and that I'm sorry to say will never change. That's why I'm back to school in Jan to get my RN's because I"m tired of most RN's treating me like I'm less before they even know my capabilities I have LPN after my name. But believe you me I suddenly because very capable when they need someone to work and there is no RN available lol.
Just wanted to elaborate on this topic! I feel there is nothing wrong with a LPN training a RN. The reason for this conclusion is because I am a new graduate LPN who works in the OR at a Metro-Detroit hospital. And I have had the opportunity to work with 2 excellent LPN's who has been working in the OR for more than 25 years. And I can say they know there jobs. Actually one of the LPN's is a Team Leader in the OR and both of them train and precept RN's. No one knows Cystology like these two NURSES. The surgeons trust and respect there judgement and opinions when it comes to the procedures, instruments, and equipment. The entire staff in the OR ask these two nurses questions in regards to cystology and Urodynamics.
These LPN's have worked in the ICU, ER, OR, and med-surg. They have been in charge, gave IV-push medications, assessments, admissions and whatever else. You name they have done it! These LPNs has more knowledge than majority of the nurses in the OR currently. So as a new nurse I suggest you look at each particular situation and learn from it and know you are not going to be that type of nurse. Because it does not matter whether you are a LPN or RN. If the work ethics is not there it's just not there. But there are others LPN out there who are just as knowledge as a RN, who are excellent nurses and know there jobs and been a nurse probably before you were even born. So show respect and learn from nurses whether they are a LPN or a RN. Know your job before being so critical of someone else. It's not the amount of school and years of school you attended but the experience and the knowledge in a clinical setting. As a nurse if you were so concern about her wearing gloves why didn't you tell her your concerns. As a nurse part of your responsiblity is being a patient advocate and providing patient safety.Technically the RN would be at fault
for not correcting the error.By not voicing your concern at that particular moment when you felt she was not using contact precautions. You then put the patient at risk for getting a communicable diease. Always go to your co-worker first, let them know your concerns before going to the manager.
From what you wrote about the LVN's incorrect knowledge about certain procedures, then you should for sure ask for a new preceptor. And it shoudl be an RN.
At the surgical floors I work on, LPN's are orientated by LPNs and RNs are orientated by RNs. I've never seen it done differently. I wouldn't want to orientate an RN. I don't know how to mix IV bags or do PICC dressings or total up PCAs etc. Sure, I could show the new RN around, where stuff is, general ward procedures, but not the nitty gritty stuff that is different about our scopes.
ETA: I think overall, if the situation were appropriate, an LPN could orientate an RN, but it doesn't sound like this that situation.
Just wanted to elaborate on this topic! I feel there is nothing wrong with a LPN training a RN. The reason for this conclusion is because I am a new graduate LPN who works in the OR at a Metro-Detroit hospital. And I have had the opportunity to work with 2 excellent LPN's who has been working in the OR for more than 25 years. And I can say they know there jobs. Actually one of the LPN's is a Team Leader in the OR and both of them train and precept RN's. No one knows Cystology like these two NURSES. The surgeons trust and respect there judgement and opinions when it comes to the procedures, instruments, and equipment. The entire staff in the OR ask these two nurses questions in regards to cystology and Urodynamics.
These LPN's have worked in the ICU, ER, OR, and med-surg. They have been in charge, gave IV-push medications, assessments, admissions and whatever else. You name they have done it! These LPNs has more knowledge than majority of the nurses in the OR currently. So as a new nurse I suggest you look at each particular situation and learn from it and know you are not going to be that type of nurse. Because it does not matter whether you are a LPN or RN. If the work ethics is not there it's just not there. But there are others LPN out there who are just as knowledge as a RN, who are excellent nurses and know there jobs and been a nurse probably before you were even born. So show respect and learn from nurses whether they are a LPN or a RN. Know your job before being so critical of someone else. It's not the amount of school and years of school you attended but the experience and the knowledge in a clinical setting. As a nurse if you were so concern about her wearing gloves why didn't you tell her your concerns. As a nurse part of your responsiblity is being a patient advocate and providing patient safety.Technically the RN would be at fault
for not correcting the error.By not voicing your concern at that particular moment when you felt she was not using contact precautions. You then put the patient at risk for getting a communicable diease. Always go to your co-worker first, let them know your concerns before going to the manager.
In South Africa, we do not have "scrub technicians", as I believe the practice is in the USA (please correct me if I am wrong), qualified nurses train in Theater Technique and become scrub nurses. The majority are RNs, but there are a good few ENs, or LPNs/LVNs as they are known in the US. One of the finest scrub nurses I have ever encountered is an EN; she is easily the equal of any of her more highly-qualified RN colleagues, but she is such an absolute perfectionist that she frequently outshines them.
I have been a PACU RN for 20 years, and approaching retirement age I have decided to expand my experience base by becoming an all-rounder, the easier to get travel or short contracts after I turn 60. I have started with anaesthesia, and although my unit manager is my official "mentor", I am learning the practical side from some truly brilliant ENs. Once I have that under my belt, the scrub EN whom I previously mentioned is going to start me out on scrub technique-we already have a date!
Certainly, you get nurses who are not as proficient as others, but the rule applies to all ranks; there are ENs who sometimes desperately need a swift kick to the butt, and there are RNs who should never have been admitted to the profession. I hope whoever precepts the OP is as good at her job as those who are teaching me.
As for people being caught up with titles, don't the titles differentiate between different roles and responsibilities. I don't know about you guys in the US but here in Australia the RN supervises the EN. If the sh*t hits the fan then it will be the RN who wears it.
Well, that shows the differences around the globe. In Canada (at least in Alberta) an LPN works under their own practice permit, independently. We answer to the Charge Nurse (RN) just as every RN on the floor does. We do not work under "supervision" of the RNs.
Specializes in Med/Surge, Geriatrics(LTC), Pediatricts,.
Speaking as an LPN, and who has been in charge of orienting new nurses, that's NURSES, RN's, LPN's, BSNRN's, all sorts of alphabet soup behind names, an experienced LPN can very competently orient any new nurse to the unit to which they are experienced in. As far as the tasks specific to RN's, you will be oriented to that with an RN. And there are some facilities who utilize LPN's, and do "inhouse" training, for example in some states LPN's aren't allowed to start IV's, however, in that particular facility, they are allowed to, so they are "IV certified." And have taken the training to be certified to not only do IV sticks, but administer IV meds etc. Is that LPN also an EMT, more specificaly an advanced level EMT? If so, they, in most states, are more trained than an RN, and some facilities respect and honor that as well, and have provisions for that LPN to assess/document findings typicaly thought of as an RN assessment.
As far as the glove issue, how old is this LPN? I'm from an age, that when I first started in the health care field, we didn't wear gloves, only washed our hands before and after each pt contact, wore gloves only if they were included in packets, such as a foley catheter kit or suction kit. That may explain why she didn't wear gloves only a couple times. Not defending her not wearing gloves, but explaining why she may not wear gloves, or is it a test to see how you will react? Either way, like in other posts, keep it shut, that's the LPN's quirk, not yours.
But major point, don't rock the boat! You go snitching every little detail to the Nurse Manager, DON, Nursing Supervisor, etc, you will soon see how miserable that LPN can make your life. You start doing the "I'm better than you because I'm an RN" attitude, you won't have any respect from that LPN when you are the charge nurse of that unit. And the older nurse, LPN, or RN who know's the ropes, can and will make your life miserable, and you will then be put under the microscope and the least little thing you do wrong will be brought up front and center. So, as in another post, vent your frustrations in this forum. Think twice before you blow any whistles. Take a good look at the entire picture where you work, what is the reason why that nurse doesn't wear gloves? Stand back and look at all the trees, rather than just the forest.
I'm also in wonderment about something, you seem to have issue with being oriented by an LPN, what is your issue if your BLS or ALS/ACLS CPR class was taught by a CNA? Or someone simply from the community? Do you want only RN's to orient you on everything? There are loads of people out there, who aren't RN's, but have training that far exceeds your RN training. Do you know what to do when you see a STEMI on a 12 lead? I do. And I'm only a "Lowly LPN" right now.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
i agree with the one above in that things you addressed were of some concern. however, for the time being, i would not go to the nurse manager about anything. it is far too early and it will just cause problems for you in the future. you have to remember that you are a newbie and everyone else has probably been there a lot longer; they are in routine and do things the way they like to do it whether it be harmful or not. that being said, i would just remember everything you learned in school and be role model for them as well as protect yourself and other patients. i think that writing a letter to the state addressing your concerns will help. as far as the lvn training you. lvn's are nurses too and i think we all (rn's) need to get over the whole "i am better than you b/c i'm a rn" kinda thing. in 2 semesters i will be an rn and i am guilty of those thoughts as well eventhough i'm not even an rn yet! i just think that the lvn is getting you acquainted with the hospital you work in, policy, etc. not truly training you, you were trained your skills to be an rn in school. right?
let me make sure i understand this -- you think that writing a letter to the state addressing your concerns would help? the op hasn't suggested that the lpn training her did anything to harm the patients, only that she did things "incorrectly" meaning, i think, not as she was taught in school. in the real world, we do a lot of things that weren't as you were taught in school, and they're neither "incorrect" or harmful.
in two semesters, you will have a degree which entitles you to take the nclex. you may or may not be an rn. you have no idea what's out there yet. "writing a letter to the state" is going to, at best, set the op up to think she knows better than the veteran nurses she's working with -- something she already has a head start on. at worst, it's going to make her a pariah on her unit, if anyone gets an inkling of what she did. (and these types of things rarely stay anonymous. people may correctly assume she authored the letter just because of her attitude.) people won't want to train her; they won't even want to work with her. and then we'll be getting posts from her claiming that she's being victimized by big fat bullies eating their young.
i learned the majority of what it was to be a nurse from the wise lpns and nas i worked with when i was a new grad. there are very few things a new grad cannot learn from lpns and nas. those few things, you're right, she'll need an rn preceptor for. but let her learn as much as she can from the seasoned colleagues she'll be working with before running to mommy manager and tattling about "lucy lpn didn't wear gloves." hopefully, by that time, she'll have realized just how much she has to learn and how much of it she can learn from lucy lpn.
as far as "doing everything the way you learned in school and being a role model", nothing is going to set you up to not get along with your new colleagues faster than acting like a know-it-all, which is what you're advocating here. and then we'll have yet another thread about nurses eating their young, lateral violence, bullying, etc.
it takes a very short time to earn a reputation as someone who is a know-it-all or who is not a team player, and a very very long time to overcome it. i'd advise the op to learn as much as she possibly can from the nice lpn who is trying so hard to show her the ropes, and to never once hint that she knows better or that she requires an rn as a preceptor. the rns can show her the ropes of the very few things she needs to learn that an lpn can't teach her, but they don't need to actually be her preceptor to do so.
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DaneluvinLPN
8 Posts
First to comment on the OP list of concerns, it would seem to me that the LPN orienting you could use some education on things.
Having said that As an LPN I have oriented many RN's, and am surprised at the procedural things that new grads have only ever done on dummies in a clinical lab. As an LPN student we were required to perform just about every procedure a minimum of 3 times in the clinical setting before being allowed to pass that portion of our clinicals. Our instuctors would purposly find us patients on the floor that needed things like catheter changes etc. So again from the new grads I have oriented I've been very surprised how little they knew about how to perform most procedures.
I live in Ohio and LPN's are not allowed to admin. TPN or blood products or IV push meds. But many new grads are unsure of how to even work an IV pump or how to mix TPN ect. and come and ask me. They ask me things lke how much saline should they flush before and after giving IV push meds or how to admin. certain IV push meds. LPN's in can hange fluids and antibiotics through a peripheral line only. We were allowed to hang them through a PICC until very recently when the laws changed.
So again I'm surprised on how much procedural knowlege many RN grads don't have. After talking with a lot of new grad and LPN's that became RN's I feel this is because the focus of an LPN education is more patient based and and RN education seems to focus a lot on delegation. Now I know not all RN schools are the same just as no two LPN schools are.
The other issue I feel is ( and someone else said it in an earlier post) RN's have NO CLUE what the LPN scope of practice is. I had a DON try to write me up a few times for doing things she said was out of my scope of practice, only for her to feel pretty stupid when I told her I wouldn't sign it because she was wrong and sure enough she was.
So I think the biggest problem is many RN's come out of school with a preconceived notion that an LPN is basically an over glorified STNA/CNA that can pass meds. I actually had an RN tell me that LPN's are not taught critical thinking in school and I wasn't a "typical" LPN to be so knowlegable lol.
The fact of the matter is that while some acceptions are out there LPN's are the redheaded step children among nurse and we get screwed CONSTANTLY. I see it all the time, inexperienced RN's are given charge of patients they wouldn't have the first clue of what to do if something happened and the pt. started to crash over an experienced LPN simply because they have RN next to thier name. I;ve seen SOOOOO many horrible and even life threatening decisions made by RN's that get over looked and the RN's gets babied and "it's ok mistaked happen" and then an LPN's that make a mistake 1/10th as sever and the LPN either gets written up or fired.
Bottom line is that while I know several RN's that have a great deal of respect for LPN's, most do not and that I'm sorry to say will never change. That's why I'm back to school in Jan to get my RN's because I"m tired of most RN's treating me like I'm less before they even know my capabilities I have LPN after my name. But believe you me I suddenly because very capable when they need someone to work and there is no RN available lol.