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

[LPNalmost!]

I posted this in the TN Nurse's Forum, but since that one doesn't get a lot of traffic, I thought it would be a good idea to post it here as well. Here goes: 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.

[Maggie in NC]

My thoughts...

You have a legal and ethical obligation to discuss this with your employer now that you are aware of the TN BON rules. Your employer should not put you or any other nurse in a situation that violates states regulations. Bring it to their attention puts the responsibility to stop the behavior on them. If they choose to do nothing, I don't think I could continue to work in that facility. It would clearly show their lack of ethical and legal considerations for their employees and their patients.

Good luck to you!

[Maggie in NC]

My thoughts...

You have a legal and ethical obligation to discuss this with your employer now that you are aware of the TN BON rules. Your employer should not put you or any other nurse in a situation that violates states regulations. Bring it to their attention puts the responsibility to stop the behavior on them. If they choose to do nothing, I don't think I could continue to work in that facility. It would clearly show their lack of ethical and legal considerations for their employees and their patients.

Good luck to you!

[TinyNurse, RN]

I wouldn't do it. Though I practice in TN now, I don't know the LPN laws because there are no LPNs in my ER.

In Ohio, LPNs were allowed to hang certain antibiotics and normal saline and LR. NO IV Push even with an IV/med class

like someone else said print out the BON stuff and show it to your supervisor. They have to be aware of the BON laws.

xoxo Jen

[TinyNurse, RN]

I wouldn't do it. Though I practice in TN now, I don't know the LPN laws because there are no LPNs in my ER.

In Ohio, LPNs were allowed to hang certain antibiotics and normal saline and LR. NO IV Push even with an IV/med class

like someone else said print out the BON stuff and show it to your supervisor. They have to be aware of the BON laws.

xoxo Jen

[LPNalmost!]

Thank you all for the advice. You all told me the same thing my "gut" was telling me. I did take the paper to work this morning...was told they would "look into it". I made sure everyone understood that I would not be administering IVP meds at this time. The nurse manager that is "looking into it" has placed a phone call to one of the higher ups in the hospital chain to get clarification on what we are to do. I don't understand the need for clarification. The board's policy is very black and white. So...I'll keep you all informed and let you know what happens from here. If I get the "it's hospital policy" answer I'm afraid I'm going to get, I may be looking for a new job. I gave up too much and worked too hard to become a nurse to work for a system that expects me to do things I'm not licensed to do.

[LPNalmost!]

Thank you all for the advice. You all told me the same thing my "gut" was telling me. I did take the paper to work this morning...was told they would "look into it". I made sure everyone understood that I would not be administering IVP meds at this time. The nurse manager that is "looking into it" has placed a phone call to one of the higher ups in the hospital chain to get clarification on what we are to do. I don't understand the need for clarification. The board's policy is very black and white. So...I'll keep you all informed and let you know what happens from here. If I get the "it's hospital policy" answer I'm afraid I'm going to get, I may be looking for a new job. I gave up too much and worked too hard to become a nurse to work for a system that expects me to do things I'm not licensed to do.

[CritterLover, BSN, RN]

I have worked as an RN in TN for over 5 years now. In my first job, I worked with LPNs. The only difference I noted in their ability to give IV meds was with blood: blood had to be checked by at least one RN; the other person checking the blood could be an LPN. The LPNs I worked with did every thing else: IV pushes, piggy backs, even hanging TPN. I think they were allowed to hang chemo, too, though we didn't give much chemo on that unit. Now, they were experienced LPNs, so problably met the condtions you read in the BON guidlines, but it seems as though LPNs have a greater responsibility for giving IV meds than in other states I've worked in (AZ, PA).

[CritterLover, BSN, RN]

I have worked as an RN in TN for over 5 years now. In my first job, I worked with LPNs. The only difference I noted in their ability to give IV meds was with blood: blood had to be checked by at least one RN; the other person checking the blood could be an LPN. The LPNs I worked with did every thing else: IV pushes, piggy backs, even hanging TPN. I think they were allowed to hang chemo, too, though we didn't give much chemo on that unit. Now, they were experienced LPNs, so problably met the condtions you read in the BON guidlines, but it seems as though LPNs have a greater responsibility for giving IV meds than in other states I've worked in (AZ, PA).

[ERnursie172]

hi.... i'm not familiar with tn nursing laws but in ca the board of nursing states that no lpn or lvn can push any iv meds. they can start iv's and hang normal saline but under no circumstances can they ever push meds. if that happened in ca. i would guess that not only would the lvn/lpn be held accountable but the rn in which she/he was working under too!!!! good luck....

[ERnursie172]

hi.... i'm not familiar with tn nursing laws but in ca the board of nursing states that no lpn or lvn can push any iv meds. they can start iv's and hang normal saline but under no circumstances can they ever push meds. if that happened in ca. i would guess that not only would the lvn/lpn be held accountable but the rn in which she/he was working under too!!!! good luck....

[SKM-NURSIEPOOH, BSN, RN]

if i were you, i'd cover my butt while the higher-ups are 'looking into this further.' the last thing you'd need is to be fired on a bogus charge....something as simple as omitting what you might regard as over-looked documentation.

since you've brought the matter up to your supervisor's attention, i wouldn't take it any further than what you've done. i was going to suggest that you contact the department of state & make inquires with them regarding the practices/policies of your facility...but that would put you in a bad light to your employers.

however, should they come back with an 'it's alright for you to...' answer, then i'd start looking elsewhere & may be report them...once another position was obtained. just be sure that if you do go else where, you ask about their policies regarding lpns pushing ivps.

good luck ~ cheers,

moe

[SKM-NURSIEPOOH, BSN, RN]

if i were you, i'd cover my butt while the higher-ups are 'looking into this further.' the last thing you'd need is to be fired on a bogus charge....something as simple as omitting what you might regard as over-looked documentation.

since you've brought the matter up to your supervisor's attention, i wouldn't take it any further than what you've done. i was going to suggest that you contact the department of state & make inquires with them regarding the practices/policies of your facility...but that would put you in a bad light to your employers.

however, should they come back with an 'it's alright for you to...' answer, then i'd start looking elsewhere & may be report them...once another position was obtained. just be sure that if you do go else where, you ask about their policies regarding lpns pushing ivps.

good luck ~ cheers,

moe