I have been working on the same floor at my hospital for ten years,I have recently transfered to the stepdown unit were they have until this new possition been working with a all RN staff.The policy in the hospital is that lpns are not to push iv meds,we can hang iv piggybacks but no direct push meds,my pt was asking for his iv dilaudid push so I asked the charge nurse who was covering this pt if she would give him his dilaudid she asked me why I would not give it to the pt and I told her it was against policy and it was not within my scope of nursing,she gave me the typical huff and puff and said ok I will sign it out in the book and then you can give it,I said again I cannot give push meds,she proceded to march into the pts room mumbling under her breath about me,later in the shift I overheard her talking with other RNs about me.My problem is I am on this new floor and am trying to make a good impretion,but also I feel that I have to protect my license,lately I feel that mabee I should have just given the med,has anyone been in a similar situation,any advise would be greately appreciated
Specializes in Community Health, Med-Surg, Home Health.
It is just a hard decition to make being new to the floor and all but I know your right,she would fry me in a minute.
I have TOTAL empathy for you. It is very hard to work with new people, trying to be nice and agreeable. I have a co-worker that really placed things in perspective for me over situations like that: she said "This is all I know how to do, so, I am not risking my license for ANYONE". That is a rule that I go by. I have been an aide, phlebotomist, patient care assistant and medical assistant. I know nothing else but patient care in some capacity, so, my license is just as important to me and my livelihood as an RN's is to her.
It sounds to me like maybe some education is in order. Especially if you are worried about this happening again, I would speak to the manager or maybe just the charge nurse about what is within the LPN's scope of practice. I know only because I just graduated and we covered delegation and what was within different medical personnel's scope of practice. It surprised me the number of RNs on my floor who did not know what an LPN could and could not do and it has to be reviewed every time an LPN floats to us because sometimes we need to consider our assignments a little differently. Especially for the charge nurse who may by making assignments, education may be needed to teach or simply remind everyone what is within your scope of practice.
Perhaps you may be able to "trade" tasks that can help an RN who does some of your IV push meds. But I think as it was mentioned before, picking your own battles may need to happen.
And--it was no excuse for the charge nurse to grumble and mumble to other co-workers about pushing an IV med. That was unprofessional and uncalled for. Maybe education may help, but don't take it personally--and don't let someone push you around! You know what's right and what you did was the right thing to do! :)
Specializes in Ortho Rehab, LTC, Med-Surg, Telemetry.
I recently started a new job. In general orientation we had one of the Case Managers come in and talk about staying within your scope of practice, safeguarding your license and maintaining your ethics/integrity if faced with a nurse who is the sort to cut corners, take shortcuts or flat out ignore policy and procedure when it suits him/her.
Her bottom line was... It took you HOW long to get your license? Do you want it to be taken away? Don't do anything you are ever uncomfortable with and remember that you are NOT there to make friends, you are there to take care of patients. This includes being THEIR advocate and speaking up when someone asks you to do something that is not within your scope of practice. Whether or not you are capable of carrying out that task isn't the issue, it's against policy. End of subject.
Don't let a lazy charge nurse make you feel bad because he/she doesn't want to get off their ass and do their job.
Good for you for standing up for yourself! I am an RN and work with lots of LPN's. I never ever get an attitude for an LPN asking me to push a med for them. To me it shows that they have the integrity to do what is right. To push a med for an LPN is part of my job as a nurse on that floor. I work with lots of great LPNs who have many more years of practice than I do and often go to them for things that I am not familiar with (being a new grad nurse myself). In our hospital, the LPNs can go through a special training course after a year of employment that certifies them to perform IV pushes (in our hospitals only), but the ones I work with are great about ensuring they don't do anything they cannot do. I know that we are all very busy and sometimes it can be a minor inconvenience to stop to give a push for an LPN, but it is not their fault and should not be treated with an attitude about it since they are only doing the right thing by asking an RN. And really, how long does it take? 5-10minutes?
If it continues to be a problem for you, I would first talk to her, and show her the policy, explain that it is YOUR license (AND hers if she is telling you to just do it anyway), and if it continues to be a problem, go to your unit manager...How many other LPNs is she telling to "Just give it yourself"? I realize the LPNs are highly educated, and in some cases know more than RNs (esp if they have years of experience), but if you are not supposed to do it you should never be put into a position where you are made to feel badly because you refused to go against policy and your scope of practice. I had a situation where I worked as a nurse assistant in school, and we could not disconnect IVs from the pt so they could shower, change etc. We had to let a nurse do it. I had a problem with one nurse who would say to me "You're a nursing student aren't you? Just disconnect it and reconnect it when you are done." Well yes as a student, I did those things with a clinical instructor present, and under her guidance. As a NA, I was absolutely not allowed to do this. I explained to her the policy, and that it was not in my scope of practice unless I was in clinicals. This continued to be an issue, and I finally had to go to my NM, since I was having to either nag her until she would do it, or ask another nurse. Trust me, she never again told me to do it myself, although we never really did get on well at work...Oh well, I can't get along with everyone all the time! The bad attitude was still there, but I can let that roll off my back, I know I was doing the right thing.
You did the right thing by not giving the IV push med....Your license would have been on the line. I agree with the others...Post a copy of the policy in your med room.
I am constantly in the position of having to ask RNs to do things for me that are beyond my scope of practice. I work on a busy cardiac floor where many of the RNs believe that LPNs have no place, and I understand their reasons for thinking this. We are constantly administering vasoactive drips, anticoagulants, and performing procedures that LPNs are not allowed to do. We get patients that could circle the drain in a heartbeat, literally.
When I am assigned a patient that needs things that I cannot do because of my licensure, it is a hardship on the RNs around me who must do these things for me. They are busy with their own patients. I understand this. I also understand that it is up to me to be aware of my scope of practice and to advocate for the patient and myself and never, ever do anything outside that scope, even if it's something as simple as modifying the care plan.
A strategy that has helped me on more than one occasion is to offer to do something in exchange. For example, one time I had a patient who needed an H2 blocker pushed through a central line. While my scope of practice would have allowed me to do this through a peripheral, I cannot push anything through central lines. It's not that I don't know how; I have pushed meds through central lines several times as a second year nursing student and am competent at that skill. But at work, under my LPN license, it is outside my scope, so I don't do it.
Anyway, I asked the RN nearest to me if she would do it, and offered to do something for her. She had me put some lotion on one of her patients' eczema. I was happy because my patient got their nexium and she was happy because her patient got their lotion.
Another strategy is to be proactive. At the beginning of my shift, I identify procedures that I am not allowed to perform, and I notify the charge nurse promptly, instead of waiting until it's time to do it. The charge nurse will either volunteer to do it for me, or tell me to call a resource nurse, or to ask another nurse nearby. I think they appreciate my proactive approach and it makes them more likely to just do it for me when the time comes without any grumbling or resentment.
ETA: While I am assigned complex patients at times, I am not assigned unstable patients, and the RN I work under the supervision of is the charge nurse. But they have a lot of confidence in me and give me a lot of independence and really, the buck stops with me when it comes to identifying what is in my scope of practice and knowing when I am in over my head and need help.
Nancy nurse, I do the same thing, I will help them with their po meds, and I start their peripheral iv's . I have made myself a great Iv starter and they ask me all the time to help them. We all have things we are great at, and they dont mind ppushing my meds and i don't mind helping them. ManLPN you are right! once they get it in their heads the scope of your practice, then they won't bother you so much, they get paid a lot more than us LPN's and we do a lot more than I did when i graduated in 72. After they get to know you, i bet things will get better, they did for me at the hospital. Greatest of luck...
RN BSN 2009
1,289 Posts
That charge nurse would have been the first to report you if she saw it signed out and given by you!