New LPN - asked to triage (please help!)

[labonita271]

Hi everyone! This is my first post here and it's going very long, so please bear with me. I just graduated as an LPN last month, and was hired into a rural ER. I was concerned about working in the ER, because as an LPN I am not allowed to triage as it is outside the scope of my license. I expressed this in my interview and was told that I would not be triaging, but may have to do something called "first contact" on occasion.

My very first day I was shown the ropes by another RN (I did not have a preceptor or official "buddy"). Here's my problem: all day I sat in the room labeled "triage." I was shown how to enter everything into the computer, etc. I watched her do it 5-10 times, and then was left, on my first day of work as a nurse EVER, to do it alone for the next 5 hours or so. I was told to call if i needed help. This is pretty much what I was doing: calling the pt. from the waiting room after they registered, taking their vitals, brief history, complaints and treatments for it, putting in the standing orders for whatever they're presenting with, classifying them as "non-urgent," "urgent," "emergent," or "critical," and then either returning them to the waiting room or bringing them back to the floor and assigning them to a nurse. I again expressed concern to my charge nurse, because to me, this sounds like triage and I am not willing to put my license at risk.

I went home that night very upset. There are no other LPNs on the floor so I had no one to ask for advice. The next morning when I went to work, I again approached my supervisor and told her that I was very uncomfortable with the situation, particularly the fact that I was not trained to triage in school, and the only training I was recieving in the facility was how to use the computer. I was very calm and open minded, but within 15 seconds she became irate and defensive and demanded to know who in the hospital told me I was doing triage. I told her that it wasnt a coworker, but that in the computer I was listed as a triage nurse, and also on the paperwork. She claimed that I knew what I was getting into when she hired me, but then also repeated that it wasn't triage. She insisted that I see the DON, who was also upset with me for causing problems. The DON then told me that what the admitting clerk was doing could be considered triage, so I shouldn't worry! I have not been back to work since then.

Advice, please?! As a new grad, I don't know if I am over-reacting or justified in my suspicions. I'm not someone who takes a job and quits a week later when things get tough, but I'm not going to put myself at risk because they're understaffed and cutting corners. Can anyone help me?

-Lola

[angel337, MSN, RN]

first i would like to commend you for being smart enough to realize that they are using you. everything you described sounds like triage to me. in the ED where i work, we don't hire LPN's, but a new grad RN is not allowed to be in triage until after 9 months of being in ED. they should not be upset with you for standing up for yourself. you mentioned that you have not been back to work since then. did you quit? anyway, if i were you i would follow this issue through with HR and the DON. if you don't they will try the same thing with another LPN. good job!

[labonita271]

Thanks for your response. I haven't been in because I haven't been scheduled, but I don't think I will be going back. My supervisor's response made me think that they've had problems like this in the past. When I spoke to the DON she told me that yes, I'm an LPN, but they trust my clinical judgement. I was like, "I've been a nurse for 2 weeks, I don't trust myself and neither should you!" They're currently using paramedics to triage, so I guess in their eyes hiring an LPN was a huge step up. Ugh!

[mariedoreen]

I'm a naive student, but am wondering.. couldn't you call your state BON and request some assistance with understanding the parameters of your scope of practice and where a situation like this one would fall?

[Antikigirl, ASN, RN]

Great job on sticking up for yourself!

I feel I am constantly having to remind administration where the line of nursing ends, and other fields begin! I am called upon to make choises that MD's should be making, and when I remind admin of this...they give me the same song and dance you got! But here is what I did...maybe you can too, because I will not do anything a nurse of my experience and field shouldn't do!

I got the business card of a sweet RN that works for the State Nursing Boards, and I will use it if I feel a patient is in danger, or my role as a nurse is stretched beyond my scope (you may be able to get a contact to speak to by calling your State Board Department). I know that if you do something outside your field, it isn't the employer that will get into trouble...it will be you, since ultimately you have the power to say no..and according to most states, you must practice that NO in those given situations! So, I rely on that connection, and the 'name drop' I have had to do too to have my voice heard!

Also, remember...you are a professional, and should be treated accordingly! If you feel that you are being put in a position that threatens this, you may have to make a tough choice and leave that employer in order to protect your hard work and energy you put into this endevor! If they are already starting out making you uncomfortable..trust me, it doesn't usually stop...it tends to continue till you either accept what they say you should do, or you quit.

It may also help to get a copy of your states administration rules (SAR's)for LPN's and see for yourself if this is right! I have had to do this many times where LPN's have been asked to do things they really shouldn't, or something an RN must assign or delegate before they can (you can also contact your State Board and ask). And each of those LPN's have thanked me for taking the time (and I gave them copies highlighted for their records, because I find LPN's are always asked to do things that make them wonder if they are going out of their scope) and I felt great helping them out..and learned quite a bit for myself too!!!!

Good luck to you! And I would be very happy to read what happens, and the steps you took! I think it would not only help me when I come up to these issues (either me or someone I work with!)...