New LPN with BIG concern over TN scope of practice re: IV Push

guest59126 · Dec 25, 2004

Hi, all. I've been working as an LPN for less than 3 weeks now. I started training on the med cart this weekend and part of my training was pushing meds such as phenegran and nubain. All the LPN's in my hospital do it, so I accepted it as a normal part of my training. But today I was looking at the TN BON website and stumbled onto the board's amended policy regarding LPN's and IV therapy. Basically, it states that the LPN must have a minimum of 3 years experience or 2 years experience with completion of a formal IV training program at their facility in order to administer IV push medications. I have neither as I have been a LPN only since the 13th of this month and IV therapy is not included in the curriculum in TN LPN schools! I guess one of my questions would be: are any of you LPN's pushing IV meds without meeting the above conditions? Also, I did sign off on meds I pushed while training this weekend...is my tail end going to end up in the frying pan for this? And if this is standard policy at my facility, even though it is outside my scope of practice, what should I do? Am I interpreting "IV push" correctly when I assume it refers to any medication installed into the vein via the IV port? I'm really confused and concerned on how to address this with my new employer. All suggestions are appreciated.

First thing I have to say is breath and relax. Yes you are right on what an "IV push" is. Yes it is something that I would bring up with someone above you. Most facilities also have someone that it's there job to know the rules and regs of all the licences and if they don't know it's their job to look it up. For the time being untill the issue is clearified, i would defenetly cover you butt....a very good practice to learn now. When you come across a medication that is to be pushed, simply let your team leader/ orientator know that you are not allowed to push these meds yet, and politly ask them to do it for you. If they are a good nurse they won't ask questions or give you a hard time, but understand that you are limited being a new nurse, and they will do it.......just be nice about it. Just remember that untill you are comfortable doing something get help with it. Nobody should give you a hard time about asking a question or asking for assistance. They teach us a lot in school, but there is so much to learn out on the floors that isn't taught.

Another thing to check into is a loop hole I had when I was in NY where we can't push any med no matter how long you've been a nurse. If you take the med and dilute it into a 10cc syringe and hook it up to the secdary port on the IV pump and then run it at 100cc/hr. It goes in just a little slower that a normal push, but faster than hanging it.....and with morphine most patients prefer this (doesn't hurt as bad). This is concidered a Piggyback in NY. So check for down here. I'll be working here soon too, i'm just waiting for my licence to transfer.

Hope it all works out for you. Good Luck!

eltrip · Dec 28, 2004

.Another thing to check into is a loop hole I had when I was in NY where we can't push any med no matter how long you've been a nurse. If you take the med and dilute it into a 10cc syringe and hook it up to the secdary port on the IV pump and then run it at 100cc/hr. It goes in just a little slower that a normal push, but faster than hanging it.....and with morphine most patients prefer this (doesn't hurt as bad). This is concidered a Piggyback in NY. So check for down here. I'll be working here soon too, i'm just waiting for my licence to transfer.
Hope it all works out for you. Good Luck!

Excellent thought! This is being done with phenergan (as well as other meds) at my facility. The dilution and speed of administration saves veins and allowing the pump to do it saves the nurse (both RNs & LPNs) time!

barefootlady, ADN, RN · Dec 29, 2004

I never really thought about how difficult it was for LPN's today to be caught in the IV med quandry. When I worked as an LPN we could do NO IV meds. How things have changed. I have always mixed phenergan and given it as a drip. It saves site, is less painful and still have the desired effect. I hope you take the excellent advice of the about posters and ask questions about the doubts you are having. I think you are starting out on the right foot to protect the license you worked for so long and hard. Best wishes on your nursing career.

DutchgirlRN, ASN, RN · Dec 29, 2004

I just North of Nashville and in my hospital the LPN's are not allowed to administer IVP medications. From what I understand it is up to the hospital to write their own policy on what LPN's can and can't do including IVP. My hospital has decided that they will start letting LPN's push IV meds. Jan 16th they are having an IVP class for all LPN's. If they pass, and of course they will, they will then be allowed to do IVP's. As it stands now they can put any IV med into a 25 cc piggyback and run it. I really don't see alot of difference. I can't tell you how many times I've pushed pain meds, slowly, only to have the patient say "that doesn't hurt, when the other nurse pushed it in fast it burned". I wish some of the RN's would have to go to class too, a refresher. Good luck with your new job.

eltrip · Dec 29, 2004

This is interesting. When I worked at a teaching hospital in Nashville (guess which one!) LPNs weren't allowed to do IVP at all. When I moved to a small hospital outside of Chattanooga, all of the LPNs were doing IVP. I wondered then and I wonder now...were they supposed to be doing this? So many of them pushed narcotics or phenergan quickly & then I had glorious opportunity of restarting the IV site.

happytobehere96 · Dec 29, 2004

I am a new LPN living in FL. We were taught in school that we cannot do IV push, only an RN can. We were also told even if the place of employment says you can do it, if your scope of practice says you can't, DON"T DO IT. Who cares if the other LPN's at your facility do it. If the state says you need a few years experience and an IV course and you have neither, you should refuse to do it. Remember, it is your license on the line. This statement was grilled into us in school. If your facility does not support you in protecting your license than find one that will. Again, I am no expert on this subject, I'm just restating what I was taught. Good luck to you:)

DutchgirlRN, ASN, RN · Dec 29, 2004

I think I'll have to disagree here. What a school teaches you and what your employer allows you to legally do are two totally different issues. School is taught with the vision that everything goes by the textbook all the time and we all do everything perfectly and on time. Our shoes are polished, our hair put up, our scrubs stay clean, yeah right! The problem with that is that in hospitals it's the nature of things to not run according to plan. I say if your employer allows you to push IV meds then it is legally allowed as they are not going to risk their license. If they have faith in you then you should have faith in yourself. Make a list of all the IV meds you can push. Look them up in the PDR. Make a little memo book of the proper dilutions, what they do or don't mix with and the rate at which it should be pushed. Follow the recommendations of the drug companies and then be at peace with it. If you do your job correctly you won't have to worry. It's those who get lazy or in a hurry who are risking their license.

It's been 3 years for me and I still carry my memo book everyday. Never take anything for granted. You don't know how many memo books I've made for my co-workers by request because they want to do the right thing also.

dangRN · Aug 8, 2007

I also work in TN. I put together an LPN IV Course for our LPNs and did a lot of research on this. It is my understanding that you can take the course after 6 months of being an LPN. You do have to take a TBON approved course in order to be certified to push IV meds. If your institution is requiring that you do this without the course, I would question it. I also would refuse. The only one to lose is you and your hard earned license. Your CNO should know better. I would also question where you work if they are not knowledgeable about the Board of Nursing requirements. Hope this helps!!

ernursen · Aug 31, 2007

You really need to follow the scope of practice that TN has set forth as far as attending and passing the approved course and such. That is the only way you can protect your license.

As nice as it was to finally allow us to push certain drugs, it seems as though all they are doing is allowing us to do more work for less pay. There are very few things a RN can do now that a LPN can't.

tnlpnstudent · Dec 23, 2008

My TTC LPN course is teaching IV certification and allowing us to be IV certified in school. So we will be using this in our training throughout the time we spend in clinical. I thought that was normal.:santa:

allefromtn · Jul 21, 2010

Arer there currently any IV medications that LPN's can admister by push? This is for our clinical TONIGHT and we are told there are SIX that can be given but we have no idea what they are or whre to look (the nursing home computer wont let us onto the TN Board of Nursing believe it or not! HELP!!!!! (and thanks!)