My hospital is breaking the law...

Nurses General Nursing

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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?

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! :-)

Off topic, but I hate that, too! I'm not a chair, or a shirt. I'm a person. I would never call another person "my". They have names............just saying!

mc3:nurse:

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Where Im at, LPNs have very few restrictions and work right alongside the RN in a hospital setting. Right out of LPN school (which is a rigorous 1 year program + 1.5 years of prereqs) I landed a job in med/surg. I had 6-8 pts a night. I hung my own IVs, charge nurse hung my first unit of blood, i hung all after that with appropriate second nurse checks, I pushed my meds.Some of my pts had 3-4 drips running at a time.The rules stated an RN had to do the initial assessment and cosign my careplans.Depending on where you are, LPNs still play a vital role in hospital settings.

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Specializes in stepdown RN.
Just a thought...........an LPN asked me to push Reglan on her pt. A very simple IVP . 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.

That is completely YOUR fault. I would never push a med without knowing what the primary fluid is. Your mistake not the LPN.

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

I feel the same way!! I cannot stand it when someone says "my aide", I dont work with LPN's any more but I never called them "MY" LPN.

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Specializes in Medicine.
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 ...

I absolutely agree with you, especially the administration of medications and the limitations that are placed on certain routes. A PO/IM medication can be as easily lethal as an IV medication. If a nurse is able to administer medications, it should include all routes.

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Originally Posted by imintrouble Just a thought...........an LPN asked me to push Reglan on her pt. A very simple IVP . 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.That is completely YOUR fault. I would never push a med without knowing what the primary fluid is. Your mistake not the LPN. I m thinking that what was meant by "not labeled" was that something had been added to the bag, and no additional label afixed.....frankly i think the LPN should have been written up.

I have been gone a week , what happened to the quote button?

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Specializes in medical surgical.
Off topic, but I hate that, too! I'm not a chair, or a shirt. I'm a person. I would never call another person "my". They have names............just saying!

mc3:nurse:

And the docs say "my nurse practitioner".

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I've done team nursing like this before and it can work very well but if you don't trust your partner it will create a lot more work. We no longer do this at the hospital I currently work at. We each have a pt load of 5-6 on average and are a mix of LPN's and RN's and it works well for us. I have worked in an ICU setting as an LPN and carried my own patients. The RN had to co-sign care plans and initial assessment but other than that I was on my own after orientation. I hung blood, pushed IV meds and managed vent patients in conjunction with RT and a lot more, point is each hospital makes their own guidelines based on their states BON regulations.

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Specializes in Oncology/Haemetology/HIV.
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.

Several issues.

The primary problem is that the bag was not labeled. ALL additives should be listed on the bag, and whoever injected the additive without marking the bag is the primary offender. There is no acceptable excuse for not properly labeling the bag.

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Specializes in Medical.
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. 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.
I don't need to re-read your post - I wasn't advocating that your unit should emulate ours, just reporting what the situation is like where I work, and commenting that it wouldn't work here.

Our in-charge person also has no patient load during the day. Our enrolled nurses, however, are able to assess new admissions.

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Specializes in LTC Rehab Med/Surg.
That is completely YOUR fault. I would never push a med without knowing what the primary fluid is. Your mistake not the LPN.

You are correct. It was entirely my fault. I believe I stated that in my post. However, it would not have happened if 1) The bag had been labeled. 2) The LPN reported to me that NA Bicarb was added 3) The patient had been mine to start with.

Therein lies the problem with pushing meds on pt's you don't know. The potential for disaster unnecessarily exists.

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Specializes in Medical.

That's a potential issue whenever we give someone else's patients meds, regardless of the level at which they practice.

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