Nurse/non-nurse & pt danger

[Thornbird]

Hoping not to get flamed by all the non-nurses in these forums. Here goes.

I think everyone is aware of the petition started in CT for LPN's with experience to take RN Boards. Not only will this never happen, but IMHO it's the wrong approach.

The CT BONE has over-interpreted a very vague Nurse Practice Act to severely limit the practice of LPN's in the state. Oddly enough, CT LPN programs are longer than in many states that have a broader scope of practice. We have neighboring states that allow for LPN"s to do far more, especially outside of hospitals where most LPN's work.

It seems to me that if all nurses in the state could practice to the full potential of their current licensure, it would cut down on the very real problem of patients being cared for by unlicensed persons such as medical assistants and PCT's. I also think that the state should in some way regulate the practice of these individuals to protect patients.

Although LPN education is at a different level, LPN's are nurses who are educated in nursing process, nursing diagnosis and nursing care planning. When I went to LPN school, LPN's were taught "basic" assessment, whatever they may call it, LPN's still are trained to do that.

I believe that the bottom line is this: All patients deserve to be cared for by licensed nurses with the education and training required for that patient. Nurses have accountablity that UAP's don't. ONLY licensed health care providers should be allowed to administer medications and prescribed treatments.

There should be uniform enforcement by the state. Medical assistants and most doctors believe that MA's work under the physician supervision and can give some meds, call in prescriptions and other duties that should be done by nurses. They often call themselves nurses or lead patients to believe they are. In CT, MA's are not allowed to do any of these things. Doctors are not supposed to be supervising clinical practices of MA's. Unfortunately, the CT BONE has also interpreted the law to mean that LPN's cannot work under the supervsion of a doctor either, an RN must be present in the office while the LPN is working. I don't believe that it is what was meant by the statute, it doesn't even make sense. I see many LPN's working in doctor's offices where no RN is employed. These LPN's are violating BON rules and could be disciplined. I doubt any of them even know this. But, isn't it far safer having a nurse do this job than an unlicensed assistant?

There are now "pilot studies" on medication aides being used in LTC in this state to give routine meds. First, what is a "routine" med? There are meds taken every day like anti-hypertensives and anti-diabetics that have potential for danger. Second, the med pass is a chance for the nurse to interact with each patient and actually see how they are doing. I have found many patients who were in an early stage of a problem that responded readily to prompt intervention and would have otherwise gone unnoticed.

I really wish that all nurses in this state, and especially thosein the DPH and on the BONE, would confront this problem. LPN's were originally created to provide trained, educated basic nurses to handle the patient care that didn't require the more advanced expertise of RN"s who were in great shortage. I believe this is a role that will always be needed. This was the solution, not turning lots of unlicensed people with non-standardized training loose on unsuspecting patients. Keeping patients safe should mean providing them with a nurse, even if the nurse is an LPN.

[CTPCTstudent]

I have to tell you that I believe there is a pilot program to allow persons in nursing homes who are given speciality training to dispense meds! A friend of mine was offered a job at a nursing home as a cna and was told that the home was licensed to allow non-nurses to give out meds, after completing a course at the home. This is worrisome to me; I don't believe a nurse is on the floor when this is done. What happens if a patient has a reaction?

[Thornbird]

I'm sure this program is moving forward. In the states where medication aides are already allowed, the nurse has to be on the unit while meds are passed. I still think this is a terrible unsafe idea and not really necessary in a time when nurses are having a hard time finding jobs. Facilities are always looking for the cheap way out.

What would make sense to me would be to train CNA's to do routine topical treatments, all the oinments and powders that should be applied when the patient is freshly washed anyways. I know in many cases, CNA's are actually doing a lot of this because the nurse isn't there and patient care is held up. But, it's not legal. If this was legalized, it would free up a lot of licensed nursing time and probably improve skin condition. Many years ago, when I was a CNA, we did all but sterile treatments.

I find myself in LTC's where along with paperwork and doctor's orders, the nurse does all the meds, treatments (most of which are non-prescription like A&D ointment), take vital signs, do blood sugar checks and even sometimes have to do all the "flow sheets" for patient care. All of these are things CNA's should be able to safely do. Except for treatments, all these things are legal for CNA's to do.

I also find myself doing things that a facility may allow CNA's to do and answering lights, helping with lifting, etc because CT nursing homes are drastically understaffed for CNA's to meet the patient needs!

If adequate staffing was mandated and everyone could function to the upper limit of their licensure whether it's RN, LPN or CNA the patients would get better care without need for "medication aides" and others who may put the patient at risk. The majority of LTC nurses are LPN's who are trained to be "bedside nurses" and that's where they should be, not doing paperwork while an aide does the med pass!

[gonzo1, ASN, RN]

You raise many good points. Unfortunately nurses can't seem to get their act together and truly advocate for each other. Until we can help raise each other up instead of knocking each other down nothing is going to be accomplised

In my opinion med techs are a horribly dangerous idea. You need to have a thorough understanding and education of meds and interactions and how body systems work together and against each other in order to safely and effectively give meds.

[trepinCT]

wow..this is all very interesting. first I would like to know, what is BONE?? I will graduate in May 09 with my RN and I know how hard I have worked to even get this far. Before nursing school, I was a CNA and the 2 roles are vastly different on their focus of care. I will tell you, that I will not work at a facility that allows unlicensed persons to practice like this. I will not risk losing my license because that is what it boils down to when the S#@$ hits the fan and something goes wrong. As for LPNs, I think that they belong working along side the RN, especially in hospitals, but the reality is we still need the support staff..who will do the tasks the CNAs do? certainly the LPNs dont want to be utilized as overpriced CNAs- that is an insult. There is a place in healthcare for the RN, the LPN and the CNA..what I have a hard time with are the MAs. the few that I personally know spend a lot of their time making everyone believe that they are nurses and that makes me mad. I am all for LPNs taking the NCLEX-RN when they decided to go to school to earn it like I did.

[Thornbird]

CT Board is called the Board of Examiners for Nursing and also referred to as Board of Nursing Examiners. BOEN or BONE.

It's good that there are new nurses like you out there who appreciate everyone's role. Even CNA's are tested, certfied and registered with the state. PCT's and MA's are not. What a hospital requires a PCT to be is up to the hospital. To be fair most are CNA's and some in the ED's are EMT's - but it's not required and nobody but the hospital oversees it. And, I have actually witnessed these PCT's starting IV's!!! The state says no-no, but it doesn't stop the hospital or the unlicensed person from doing it. Those of us with licenses (including CNA's) have to worry about losing them, no worries for those without them.

There are PCT training programs and there are actually Associate Degree programs for MA's and national certfication for them to obtain. As long as the state pretends these people don't exist and don't regulate them, there is no way to tell whether they were adequately trained or just someone off the street. Nobody does anything but the fact that about 90% of the time when the doctor's office says "Dr. S0-and-so's nurse will be right with you/call you back" the person is not a nurse and has passed no certfication testing whatsoever!

There is no valid reason that LPN's cannot work in doctor's offices unless an RN is there at the same time, but, it's the law. If nurses follow the law than it allows proliferation of non-nurses doing the job.

Other states I have worked in offered at advanced training for LPN's to gain skills such as starting IV's and legally performing them. Most states allow LPN's to supervise in long term care because there are RN's (DON, ADON) to oversee patient care planning. This prevents a common scenario in CT, an agency RN who has never been in the building before gets paid $45 to $50 an hour to provide the required supervsion for LPN's that may have been on staff for 20 years and getting $25/hr. There's no valid reason for this either since any change in condition must be reported to the MD and in case of emergency the patient goes to the ED.

We must all support each other as nurses. It needs to happen at the nursing organizational level (ANA and CT NA) who promote professional nursing only and don't seem to care what happens to those patients who can't or don't need to be cared for by an RN.

Although I believe that there are many things LPN's are trained or could safely be trained to do in the care of stable or chronic patients, I do not believe that LPN training programs provide enough of a scientific framework for LPN's to be capable of performing RN tasks in the care of acutely patients or those requiring a more in-depth advanced level of assessment. I know many good, intelligent LPN's who give excellent care and think they are doing all the RN does. In fact, except for cases where they have other education, they are lacking the science and pathophysiology education to understand why something is hapenning with their patient. If you don't understand why, you are unable to plan appropriate interventions. LPN's who want to practice as RN's need to have the education, not just the skills.

As you can see, I am not an overall proponent of any kind of strictly on-the-job training at any level in healthcare. It will inevitably endanger patient safety.

[Thornbird]

You raise many good points. Unfortunately nurses can't seem to get their act together and truly advocate for each other. Until we can help raise each other up instead of knocking each other down nothing is going to be accomplised

In my opinion med techs are a horribly dangerous idea. You need to have a thorough understanding and education of meds and interactions and how body systems work together and against each other in order to safely and effectively give meds.

Absolutely right. LPN programs place a great deal of focus on pharmacology and safe med administration. Still there are many things new grads aren't aware of. (Actually, any new grad nurse) I believe it's the minimum training required to safely give any meds to any patients. Medication aides are a bad and dangerous addition to healthcare.