LPN's Role in the ICU?

[Nurse-o-Matic]

I am an RN in a 24-bed ICU. Currently, we have 1-2 LPN's scheduled per shift. Our policy is no more than 2 patients per RN unless you have an LPN working along with you, in which case you may have 3 patients. My experience with LPN's in citical care is that they seem to want to step outside of thier role-for example, push meds or draw off picc lines. Also, when the patient is crashing and I'm starting a new drip, calling the doc, etc., they will sometimes go off on break?!? Because RN's are paid more, some they feel they shouldn't do as much work and will bring a book to read while I run around at the end of the shift getting I&O's, restocking, or boosting patients.

I have worked in other departments with LPN's where each of us did our role and got the job done. In ICU it's different because our LPN's do have additional skills and want to function at a higher level. 10 years ago our ICU had LPN's taking care of thier own patients including IV pushes, IV's, and calling docs. There are a few of these LPN's left who practiced under those conditions and are now bitter to the rules. They feel they are stepping backwards in thier profession, but don't wish to pursue the RN degree.

Does your ICU employ LPN's?

[SaraO'Hara]

Speaking as an LVN in California, and knowing my scope of practice, even though I am IV-certified (can hang blood, start IVs, hang PPN) - I think that in an ICU, the LVN would mostly function as a second pair of eyes/hands for the RN, assisting with the q 1 hour assessments, hanging fluids, administering tube feeds, etc. This could certainly be very helpful, but it would be strange and silly to have a nurse who cannot hang IV meds, do IV pushes, etc, be the primary on a patient with more than a couple of such things.

[ddoosier]

In my state and hospital, LPNs have a broad scope of practice with few restrictions. The charge nurse, who takes no assignment, covers what is outside of the LPNs scope. I certainly keep my charge nurse informed about my patients, but honestly, there is little that she/he needs to do that I am unable to do myself. I do not take new admissions, I don't give IV chemo products, I must check several IVP meds and all blood products with an RN. I don't write care plans or serve as a patient's primary nurse. I don't take charge or train to be an ECMO tech. Everything else, I manage on my own. There are at most two LPNs per shift, and that is rare. Usually there is one or none. Most of the LPNs who work in the units have 25+ years of experience and are very competent nurses. There are not many left, and when they leave they are often replaced with RNs.

The ICU came into being in the early 1960s and I signed on to work there several months after it opened. Before that, very sick patients were called "constant cares". That patient was 1:1 care with the nurse AND the doctor constantly at the bedside. Nobody can tell me I don't belong in the ICU, because I've been doing critical care since critical care was invented..and its been my life's work and passion ever since. My "instructors" if you will were some of the best specialists, doctors, nurses, and therapists of the past fifty years. My mentors were truly pioneers in critical care and I have been blessed to have worked with such talented people.

That said, the LPN is the ICU is an exception to the rule, but exceptions exist and one size fits none. I've said it before, experience is the best teacher.

Are you assigned the stable patients or are you able to care for the really sick ones that are on drips, ventilated, dialysis, on CCO and have central lines. Can you draw off the central lines? Are you ACLS certified and able to push emergency meds? Are you able to push narcotics, benzos ect.? Are you able to travel with your patient? Just curious. I'm just being honest, but the limitations that you mentioned above is reason enough not to work in the ICU. If your scope does not include any of what I mentioned, then even more so. Your experience probably surpasses many RN's that you work with but your scope of practice is limited. No disrespect to you and all of your years of practice. But I stand by my belief that a LPN should not work on the unit and for more reasons other than what is mentioned on this post.

[HazelLPN, LPN]

Are you assigned the stable patients or are you able to care for the really sick ones that are on drips, ventilated, dialysis, on CCO and have central lines. Can you draw off the central lines? Are you ACLS certified and able to push emergency meds? Are you able to push narcotics, benzos ect.? Are you able to travel with your patient? Just curious. I'm just being honest, but the limitations that you mentioned above is reason enough not to work in the ICU. If your scope does not include any of what I mentioned, then even more so. Your experience probably surpasses many RN's that you work with but your scope of practice is limited. No disrespect to you and all of your years of practice. But I stand by my belief that a LPN should not work on the unit and for more reasons other than what is mentioned on this post.

I agree with you that somebody should not work in the units if they can not do most of these things. I certainly do titrate my own pressors and so on and so forth. LPN practice here is certainly is nothing like LPN practice in your state/hospital. I respectfully and politely stand by my belief that LPNs can work in the unts given a broad scope of practice with few restrictions. I've done it very well for a very long time. Thank you for being polite about your disagreement...we need to see more of that here. LPNs probably won't be in the units in the next 10 years at all. I've decided to fully retire at the end of the year and most of LPN colleages are not that far behind.

Best to you,

Mrs H.

[Indy, LPN, LVN]

It does make me sad to know that with the retiring nurses, whether they be LPN or RN, there goes experience that won't be regained easily. There goes possible mentoring, teaching, etc. Good mentors don't grow on trees, neither do good students unfortunately. Where I work there do exist a few nurses -of varying licensure- who are just not teachable. The rest are a joy both to teach and to learn from. One of our RN's has started teaching LPN students lately at the local tech school, and she's one of the more dense people on this planet. It's too bad they don't allow LPN's to be the clinical instructors because I know about 20 people personally who could really make a difference in that area.

[HazelLPN, LPN]

It does make me sad to know that with the retiring nurses, whether they be LPN or RN, there goes experience that won't be regained easily. There goes possible mentoring, teaching, etc. Good mentors don't grow on trees, neither do good students unfortunately. Where I work there do exist a few nurses -of varying licensure- who are just not teachable. The rest are a joy both to teach and to learn from. One of our RN's has started teaching LPN students lately at the local tech school, and she's one of the more dense people on this planet. It's too bad they don't allow LPN's to be the clinical instructors because I know about 20 people personally who could really make a difference in that area.

:up:It was a real pleasure to read this post. You only have 2 years of experience, but you write as if you have been a nurse for 25 years. You're right, there are some nurses who simply don't have it. One of the WORST nurses I have known has her BSN with a CCRN who is very proud of her initials. I often wonder how they she made it through the rigor of her academic program and how she ever managed to pass the CCRN test. I hate to follow because she leaves such a terrible mess and it takes me a the first hour to clean up after her. Sloppy nursing is something that I will not tolerate. A good nurse on paper isn't always the best nurse. So many times young nures with few years of experience want to tell me "LPNs don't have critical reasoning skills" or "LPNs should only take care of stable patients with predictable outcomes"or "You know so much, why aren't you an RN?" I can tell these gals are repeating what their instructors are telling them and they have very little life experience to make such judgement calls. They have obviously never worked in an ICU with a competant LPN who has a full scope of practice. All older nureses have a responsibility to mentor the younger ones. Maybe LPNs can't be clinical instructors, but they can certainly be informal mentors in the unit. In this "Indian Summer" of my career, the mentoring of younger nurses has been one of the most fulfilling parts of the job.

Best to you,

Mrs H.

[Judeevee]

WOW!!!!! Very disturbing attitudes here! I've been a Licenced Practical NURSE for more than 27 years. Longer than many of the Registered Nurses I work with have been breathing. Most of my career has been in critical care, ER & cardiology. I'm also a paramedic outside the hospital doors. To say, or even imply, that to work with me would be dangerous, is a very ridiculous and degrading comment to make. I work with several RN's who would rather have me with them in a critical moment than a RN without experience. No, I can't push the meds, but I know them as well as anyone. I can start the needed 2nd or third IV in a flash, hand the right meds to my team mate before she asks, charge the defib, jot down med times and events, run and post rhythm strips, and even figure out med doses and drip rates in my head before the i-med can be programmed. I can program the i-med with her watching at the other side of the bed and she just needs to push the start button. We work as a team. This way I act as her extra hands. I stay within my scope of practice and she can focus on her level of duties. Believe it or not, there is more to taking care of a patient than pushing meds and transcribing orders. Nursing is an ART. More than the technical stuff, a nurse needs to reach the soul and heart of her patient, their families and their coworkers. There is never a good reason to put someone down whether it be due to their race, color, creed or title. It's rather interesting that the nurses who are remembered and loved by their patients and coworkers are not the ones who were able to titrate the IV meds, but the ones who took the time to be with and reach out to the patient and their family. Your title won't matter so much, but your professionalism, teamwork, and compassion will.

[RN34TX]

"You know so much, why aren't you an RN?" Mrs H.

As a former LPN, whenever I heard that type of remark I always considered that to be a back-handed compliment if you know what I mean by that. Well-meaning yes, but to me it always inferred that the best and brightest of the nursing profession was exclusively reserved for RN's.

It's assuming that LPN's "don't know as much" and for the few that do know more, well they need to go back to school.

We are obviously not teaching our RN students enough about the value and function of LPN's.

[RN34TX]

WOW!!!!! Very disturbing attitudes here! I've been a Licenced Practical NURSE for more than 27 years. Longer than many of the Registered Nurses I work with have been breathing. Most of my career has been in critical care, ER & cardiology. I'm also a paramedic outside the hospital doors. To say, or even imply, that to work with me would be dangerous, is a very ridiculous and degrading comment to make. I work with several RN's who would rather have me with them in a critical moment than a RN without experience. No, I can't push the meds, but I know them as well as anyone. I can start the needed 2nd or third IV in a flash, hand the right meds to my team mate before she asks, charge the defib, jot down med times and events, run and post rhythm strips, and even figure out med doses and drip rates in my head before the i-med can be programmed. I can program the i-med with her watching at the other side of the bed and she just needs to push the start button. We work as a team. This way I act as her extra hands. I stay within my scope of practice and she can focus on her level of duties. Believe it or not, there is more to taking care of a patient than pushing meds and transcribing orders. Nursing is an ART. More than the technical stuff, a nurse needs to reach the soul and heart of her patient, their families and their coworkers. There is never a good reason to put someone down whether it be due to their race, color, creed or title. It's rather interesting that the nurses who are remembered and loved by their patients and coworkers are not the ones who were able to titrate the IV meds, but the ones who took the time to be with and reach out to the patient and their family. Your title won't matter so much, but your professionalism, teamwork, and compassion will.

Forgive the comment I'm about to make (see my post above) because I don't want to be one of those RN's who say "Well you're so smart and experienced, why aren't you an RN?" but.....why aren't you?

We need more RN's who used to be LPN's and paramedics for that matter to change the culture and attitude.

Although we have no LPN's on my unit or entire hospital for that matter, my unit consists of a large number of RN's who used to be LPN's and I truely believe that it makes a big difference.

Case in point: A co-worker recently stated "I took my kid to the doctor and this person who was not even a nurse, she was just an LPN and she......."

Another co-worker busted in "What do you mean she was not even a nurse? Didn't you just say that she was an LPN? They are licensed nurses just like us."

[mommy.19, MSN, RN, APRN]

How does this idealism evolve even further to LPN's who got their license through applying for equivalency after finishing the 1st year of an accredited RN program, would people feel that they are any "better"? I honestly had never heard such dissent "amongst the ranks" between the roles of LPN and RN, on the gen med floor we did clinicals on, the only way you could tell the difference between an LPN and RN was the tiny print on their name tag. I have learned much reading these posts, thanks to the OP for starting this thread.

[HazelLPN, LPN]

How does this idealism evolve even further to LPN's who got their license through applying for equivalency after finishing the 1st year of an accredited RN program, would people feel that they are any "better"? I honestly had never heard such dissent "amongst the ranks" between the roles of LPN and RN, on the gen med floor we did clinicals on, the only way you could tell the difference between an LPN and RN was the tiny print on their name tag. I have learned much reading these posts, thanks to the OP for starting this thread.

It would have no effect on what others in this forum feel, because training is not the main issue. The issue is scope of practice. Nurses such as lindarn and ddosier work in states and hospitals where LPNs scopes are very limited and this places additional work on the RN.They fear that their licenses are in jeopardy with the additional work load that would come from covering patients cared for by an LPN. This is a valid issue and argument.

However, no poster can speak for all states and certainly are not able to speak for me. I work...well worked (I've been retired since this past July) in a state where the LPN scope is very broad. I took care of very sick patients and there was little that my RN charge nurse had to do who "covered" my patients. By "covering", she or he would be the one to check blood products with me and double check certain drug calcs with me before I gave them. That was never an issue. The only thing that was occasionally an issue is that LPNs don't take new admissions. We used to take them with an RN cosigning the admission assessment, but it was decided that it made no sence for an LPN to do an admit as LPNs do not serve as the patient's primary nurse who is responsible for the careplan and that writing the initial admission assessment is not in the scope of practice for the LPN. Fair enough. To some RNs, it was an aggrevation to change her assignment mid shift to take a new admission.

Ironically, the last shift that I worked in July, I had to change assignments with an RN in her mid 20s so that she could take an admission....a 16 year old meningococcal meningitis direct admit from the pediatrician's office. She is a very sweet girl who isn't the strongest nurse yet....smart enough I think...but no self esteem and way too soft. She REALLY didn't want the admission so she asked the charge nurse "can Mrs. H do it with me?". So we did it together. He crashed in the pediatrician's office and was nearly dead by the time he arrived on the unit. I hadn't worked that hard in years...he was a handful...I thought he was going to die on us..coded twice....I gave the meds...the young RN did compressions (I'm definately too old for that on a 16 year old!)...but we got him through it and he left the hospital with no major complications when all was said and done. It was a nice way to end my career. I gave my patient and family the best care that anyone could give ...and the young RN learned a great deal about organization and problem solving...and a few things about technique and human relations.

So thoes of you who still maintain that I should have worked up on the floor or in long term care because I'm "just an LPN"....we can agree to disagree. My colleagues and the patients and families that I took care of will disagree with you as well. And if you had a chance to work a shift alongside me I would imagine that you would change your mind. Good nursing comes with experience and a self motivation to learn...as well as inborn talent that can not be learned from any accredited nursing school.

I think that nearly everything has been said that can be said about this post. Its a simple matter of scope of practice. Where LPNs have a full scope, LPNs can work in the units very well. Where their scope is limited, it dosen't work nearly as well.

Best to you,

Mrs. H

[xixp111]

wow seriously??? ive pretty much read through this entire thread... and i am astounded by some of you people, so let me begin by saying that in certain states where lpns are not allowed to hang bags titrate drips or do other essential jobs needed in an ICU then they should probably not be there ...not because RNs are magical or better educated ..cause guess what guys you really arent ( all a nursing license and school really is , is a license to learn your job.. which you do at work... nursing school is just the basics) but because as a lpn you really cant do the job due to scope or practice issues lpns in most states probably dont belong in an ICU , now having said that a little about me , i am an lpn student about to take my boards.. now before you go he knows nothing hes a student ..let me say i spent 8 years as a military medic and held a civilian emt-b ...crappy cert right... glorified first aid ...well heres the point of what im saying ...in the military you dont have to be licensed to perform medical task's just trained ... would it suprise you if i told you i have assisted and done things im sure most you RNs havent ...i taught IVs ... hell i gave one under fire in night vision.. id like to see any of you RNs pull that off ..i can suture, i spent time in the casting room , i have assisted (and by assisted i mean had a doctor stand over me and talk me through the majority of an amputation) my point is ...just because i held an emt License.. does that mean im dumber , or less educated than an RN ...not if i had the privilege of working with excellent trauma doctors and Special forces physicians assistants who had the time and patience to teach me on a daily basis ....listen the letters after your name are just that ...letters ...it only matters what you have absorbed , your personal capabilities, and the hands on you have received during your clinicals ..lets face it ... you cant learn most invasive tasks from a book , and unless im really daft , you arent learning the majority of your job from a textbook at least in trauma ,,the theory ..yes ill give you that, but the skills to do what you need to do quickly and safely... only through experience so im willing to bet if the restrictions of lpn tasks were lifted and an lpn of normal intelligence was privy to the same orientation an RN had at the ICU he could pull it off fine ..cause i damn sure worked the emergency room like a pro in the military with just an emt-b

[cpcnurse]

I noticed that no one has posted on this thread in some time, however I felt the need to make a statement.

I have been a LPN for 1 year (and am currently working on my RN) and work in my hospital's Emergency Department and Intermediate Cardiac Care Unit. I cannot work, per say, in Intensive Care, however our ED and ICC is very high acuity. My skills have never been questioned by my managers and most of my peers prefer me to work on a shift with them than most our RNs.

LPNs in my facility are allowed to push most IV meds, manage a patient on a gtt (as long as the RN titrates), take orders and complete a shift assessment (as long as an RN performs initial/triage assessment). I have never had an issue with any of the RNs that I work with signing off charting or managing my medications that I was unable to give per policy.

A LPN's ability, just as much as any RN, is based upon the person's work ethic and dedication for their patients rather than the letters behind their name. My primary concentration is with chest pain and acute coronary syndromes. I have ran STEMIs by myself, managed patient's on NTG, diltiazem, amiodarone, heparin, Integrilin, dopamine, and dobutamine gtts without difficulty and without danger to my patients. My patients have ALWAYS appreciated the care that I provide and have NEVER felt that I was unqualified to care for them.

I have trained, and still educate, many RNs on policy and procedures that are implemented in our facility. Most RNs seek me out with cardiac and medication-related questions based upon my experience. I attended a school that taught, and held their LPN students, on higher levels than was in the same school's RN program. I would never trade my clinical experience I received in LPN school for anything.

I feel that I will be a better RN because of my experience as an LPN.