My hospital is breaking the law...

Nurses General Nursing

Published

My employer is breaking the law asking me, on med surg, and all other RNs to accept 10 patients. They give us an LVN and say that the LVN has "their patients" and I have mine. However, I am still expected to give all IV meds. If I give ANY med am I not therefore, assessing that patient thereby making him/her "my" patient? What should I do? I KNOW its illegal and fear that I may make an error an will have no one to back me up.

Advice?

Specializes in Medical.
In my place of employment the charge nurse is the one who pushes the IV meds and hangs the blood. It just works better for everyone on the floor to keep the charge nurse out of staffing and she can follow the LVN's, co-sign their assessments.
When I'm in charge on a shift I often barely have time to get handover, let alone help EN's (our LPN/LVN equivalents) with their meds! We have ratios (1:4 in acute care), with EN's and grads combined to total no more than 33% of the staffing, and work in two-nurse teams. Those EN's who are not IV endorsed are still capable of monitoring the patient, and retain responsibility for this even if someone else given their patient medications, provided they were notified.
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Specializes in Med-surg, ICU.

Double-check the scope of the LVN's first. That way you'll really know what's going on out there. The issue is not in the patient assignment, but with the scope of practice among LVN's.

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Specializes in PeriOp, ICU, PICU, NICU.
When I'm in charge on a shift I often barely have time to get handover, let alone help EN's (our LPN/LVN equivalents) with their meds! We have ratios (1:4 in acute care), with EN's and grads combined to total no more than 33% of the staffing, and work in two-nurse teams. Those EN's who are not IV endorsed are still capable of monitoring the patient, and retain responsibility for this even if someone else given their patient medications, provided they were notified.

I completely understand that; however, please ReREAD my post. I clearly state that it is better to for us as a team to keep the charge nurse out of staffing (read: no patient assignment) that for the LVN to be hunting down a nurse to push a med for her etc. LVN's at our hospital carry the same pt load as the RN's but obviously need an RN to be available to push pain meds, etc. Also, as she discharges she gets admits but since she cannot do the initial assessment, that is where the charge comes in and then transfers care to her.

Btw, we each have rations of 1:8 this is on pediatrics, MS

That is what works FOR US :)

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Specializes in Medicine.
I know this will start a controversy, but LPN/LVN's should not be doing bedside care if they are not allowed to do the bedside care.

How does hanging an IV medication sum up to an LPN/LVN not doing bedside care? It all matters on the scope of practice outlined for RN's and LPN's determined by the nursing body.

OP: It's a team environment, I hang IV medications and yes I would be responsible for the outcome because I took responsibility for it. But the LPN is absolutely capable of assessing/monitoring their own patient's. In certain areas LPN's are not allowed to hang certain Iv medications so an RN will have to do it. It's not breaking any type of law that I know of anyway.

Do the IV medication like you would for your own patients, and monitor as needed if that's what it takes. It is a teamwork. You can always work with the LPN if your busy (example asking him/her to assist with your patient's toileting needs etc while you hang the medication).

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
I know this will start a controversy, but LPN/LVN's should not be doing bedside care if they are not allowed to do the bedside care.

LVNs can do bedside care. They just cannot hang IV meds.

I'm not allowed to do breathing treatments - I have to call in RT to do that. Doesn't mean I shouldn't do bedside care. There are things that RNs cannot do in the course of caring for their patients, that they must call in specialized people to do. One could say that it's analogous to this situation with the LVNs.

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I know this will start a controversy, but LPN/LVN's should not be doing bedside care if they are not allowed to do the bedside care.

by lpns monitoring for adverse reactions of injectable drugs, they're doing much more of a nsg action, versus a 'task' of nursing.

giving ivp's, does nothing to hinder or increase their nsg role.

most of good nursing, revolves around keen assessment skills.

leslie

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I think the only state that cares is California. Def no laws like that where I live, I had 10 patients on med surg by MYSELF with no LVN. I would have loved to have the help. I have worked with some great LVNS that taught me a lot.

It is not that CA is the only state that "cares". Its that CA nurses have fought and organized for conditions that are best for patient care, including a manageable nurse to pt ratio ( in addition to excellent wages and benefits for nurses GO CNA!) The med surg floor where I work has one or two LVNs that work per diem, and being partnered c them is a pain in the ass :( Don't get me wrong, the two in particular, have many years exp on me, they could be a fantastic resource, very knowledgeable, very excellent nurses. Its just more work to be partnered with them, and that's the last thing I need with my shift. LVNs are no longer hired to work the floor and haven't been for some time now.

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Specializes in LTC Rehab Med/Surg.

Just a thought...........an LPN asked me to push Reglan on her pt. A very simple IVP med. Not associated with a lot of SE. A piece of cake.

The LPN failed to mention the primary NS had Sodium Bicarb added. Reglan and Na Bicarb are not compatible. The bag wasn't labeled, and I didn't check the MAR for primary solution additives. I checked for the Reglan only.

I pushed the med and the pt immediately began c/o SOB. The pt was alarmingly SOB. I stayed with the pt, the symptoms were over in probably 5 minutes. The pt experienced no long term adverse affects from the drug.

I immediately suspected what had happened, reported it, questioned the LPN. She wasn't upset at all as the med error was on me as I pushed the med.

I learned alot of lessons with that error, and needless to say I do alot more checking when pushing meds on pts I don't know.

Unfortunately doing all that checking on someone elses' pt takes alot of time.

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Specializes in Spinal Cord injuries, Emergency+EMS.
How does hanging an IV medication sum up to an LPN/LVN not doing bedside care? It all matters on the scope of practice outlined for RN's and LPN's determined by the nursing body.

OP: It's a team environment, I hang IV medications and yes I would be responsible for the outcome because I took responsibility for it. But the LPN is absolutely capable of assessing/monitoring their own patient's. In certain areas LPN's are not allowed to hang certain Iv medications so an RN will have to do it. It's not breaking any type of law that I know of anyway.

Do the IV medication like you would for your own patients, and monitor as needed if that's what it takes. It is a teamwork. You can always work with the LPN if your busy (example asking him/her to assist with your patient's toileting needs etc while you hang the medication).

the issue of the medication administration is just a focus for the whole debate over the utility of the 'second level' Registered Nurse whether that's the US LPN/LVN, the Canadian RPN or the UK /Antipodean EN ...

Second level Nurses fall one way or the other over the summit of the dividing line, they either end up being 'under educated' RNs doing the same role as the First level RN - as the role went in the UK - and has effectively been mandated as with Agenda for Change role specs and Job descriptions ( plus of course the number of ENs who were RNs who failed some aspect of their third year and were allowed to take the EN finals) alternatively they end up as an 'expensive' Assistant / Auxiliary grade with an unclear role ...

while the issue of second level Nursess not doing Certain assessments or not being able to admit a patient 'unsupervised' are perhaps a realistic refelction of their more limited preparation for practice, but with respect to technical skills, if the law allows you to possess, administer and account for Medications restricting routes is a little bizarre ...

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I typically have 12 patients assigned to me, and an LPN (to give meds to the 12 patients) and sometimes a CNA (to do patient care on the 12 patients).

Gosh... I couldn't imagine receiving report on 12 patients... how long does that take?

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Specializes in Emergency, Pediatrics.

I don't know why, but after 10 years as an LPN I always hated when people said "My LPNs" or "My aides." I was AN/A LPN not someone's possession. Just a pet-peeve. Carry on! :-)

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that's the way it works where i am. each nurse has 5-6pt's and one of every 3 nurses is an rn. the rn is responsible for the iv meds for her 5-6 and the other 10-12 pts. the nurses work as a team. rpn's have the knowledge skill and judgment to monitor the pt's. all the rn does is the physical task and chart it of course.

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