I am the charge RN in an innercity 40 bed ER that averages 250-300 patients per day. Many are hight acuity, telemetry or ICU patients since this hospital is a large heart - lung transplant center. I know many hospitals will not hire LVNs to work in the ER, but we do. We run a hefty "fast-track" business and the patients on that wing were appropriate for the scope of practice for an LVN staff and one NP. When we remodeled, someone had the bright idea to cancel the fast track idea and mix all patients into the one big new ER. The LVNs came with it. Initially the LVNs were dispersed equally on each shift, but over the last two years as bid for shift came around all the LVNs have come to nights. Now on each night shift we are down to 2 RNs and 3-4 LVNs. Since one RN must be the charge nurse and the other RN must do triage that leaves all LVNs to care for patients. It is not unusual for our ER to be giving three cardiac meds/drips at the same time or cardiac push meds at the same time. What a nightmare it has become when I am trying to go to each room and monitor the cardiac patients and their meds as well as run the department. We are a teaching hospital as well so I spend a great deal of my shift making sure the newbie residents don't kill any patients. In this week's charge nurse meeting our nurse manager asked that RNs cosign all LVN charts on tele and ICU patients. She says that their scope of practice doesn't cover these high acuity patients and that the RN should become familiar with these patients enough that we are comfortable with the care being given by the LVN and give all the cardiac meds and sign off on the chart stating that appropriate care was given and we agree with the LVNs care. I AM FURIOUS!!!!!! On the day shift where the staff is all RN with the exception of one LVN, this may not be a problem, but on nights this essentially means that I must essentailly take care of all the cardiac patients, ICU patients, run the department, arrange transfers to other hospitals, facilitate department flow, guard patients against dangerous residents and push all cardiac meds and manage all cardiac drip meds. AM I CRAZY, OR HAS MY NURSE MANAGER JUST HAD A TIA????? Would this bother you guys? Let me know what you think.
pointhope, I was just at the home page of this Website, and clicked on the story "Nursing Shortage....." by Carol Kleinman. In it, she discusses an organization called AFSCME, American Federation of State, County and Municipal Employees. It is a group which represents nurses and their issues. I wonder if this could be of help to you. Sounds as though it is for nurses who are employed by the government, which it sounds as though you may be (County Hospital?).
because lvn/lpns work under the direct supervision of the rns, they can do some things that are considered *out of their scope* if the rn is present & feels confident that they can do the task at hand.
i would've thought that the ana & the nln would've put a stop to rns having to have to co-sign for lvn/lpns since they do have a license of their own. rns have their own license & work under the direct supervision of md/do/apns & they don't have to co-sign for the rns. somethings should be done about this. lvn/lpns entry level should require at least an aas degree like the adns of today & the rn entry level should be at least a bsn. this would free-up the rns from having that responsibility of co-signing for another license. this co-signing stuff was o.k. back in the '50s when acuity of patients weren't has high as it is today.
i think you can even access your sbon on line:
here's what i found regarding the lvn/lpns' scope of practice from texas state board of examiners...according to this site...lvn/lpns don't have a spelled-out scope of practice...that they can practice within their educational level...whatever that means...good luck!
LVNs in Texas do not have a scope of practice. They do come under the Ocupational Code. They are allowed to do anything that a hospital will train then to do...with very few excepts.
But that said...I agree with the poster who stated that maybe these LVNs feel why should they go back to school...and become RNs only to be placed in the same situation you are. I however don't agree with their excuses ...if the hospital pays for their tutition....especially if they aren't making much money.
I think when you go into that meeting...I would have another job lined up. And be prepared to actually walk....not that I think it will come to that. I agree with the person who stated...that they would stroke out...if they were in your shoes. Your NM shoud have never allowed these transfers...if there weren't enough RNs to cover them....with the proposed changes.
Evidently something has hppened that probably bought about this new change you're seeing. But that is their problem not yours. Good Luck.
Bad, bad, bad, plan. I am an LPN/Paramedic and I work in ER doing sort of an expnaded tech type thing, but I would never let them let me take patients that really deserve an RN. No matter how much experience an LPN has or how good she is an LPN is NOT an RN and has no business taking critical patients. LPNs should be taking stable patients with predictable outcomes, not patients who might crash and burn and die at any moment!
Right now, the only patients I would consider taking by myself are the clinic level patients, maybe some sutures or fractures here and there...I'm more than willing and capable of assisting with just about anything, but as far as having total responsibility? Not a snowball's chance...
I agree totally. I am a LPN in Tennessee. I worked in an ER where at times I was stuck with myself as charge with 2 emts. Know I find my self in a lawsuit over a OD. The patient was not harmed. But in his "high" frame of mind at the time, he thinks he was sexually assualted when he had a foley inserted. I was the nurse who put it in and I also am a male. Hows that for luck?
But stick to your guns. ER is reallt for RNs, not LPNs
OH MY GOD!! Not only is that a dangerous situation, I think it borders on illegal. No way would I risk my License like that!!!
I work in a very busy ED also, not inner city, we have 25 beds and see between 150 and 200 per day, and we have an RN to LPN ratio of about 7/1 in the entire department. As a charge RN you do not have the time to monitor critical drips, push drugs and monitor CCU/ICU patients while trying to manage the department. I am guess that your NM is at home tucked warmly in bed when this is going on????
Go to upper management, and if they wont do anything. change jobs. Quick, before something happens.
I am the charge RN in an innercity 40 bed ER that averages 250-300 patients per day. Many are hight acuity, telemetry or ICU patients since this hospital is a large heart - lung transplant center. I know many hospitals will not hire LVNs to work in the ER, but we do. We run a hefty "fast-track" business and the patients on that wing were appropriate for the scope of practice for an LVN staff and one NP. When we remodeled, someone had the bright idea to cancel the fast track idea and mix all patients into the one big new ER. The LVNs came with it. Initially the LVNs were dispersed equally on each shift, but over the last two years as bid for shift came around all the LVNs have come to nights. Now on each night shift we are down to 2 RNs and 3-4 LVNs. Since one RN must be the charge nurse and the other RN must do triage that leaves all LVNs to care for patients. It is not unusual for our ER to be giving three cardiac meds/drips at the same time or cardiac push meds at the same time. What a nightmare it has become when I am trying to go to each room and monitor the cardiac patients and their meds as well as run the department. We are a teaching hospital as well so I spend a great deal of my shift making sure the newbie residents don't kill any patients. In this week's charge nurse meeting our nurse manager asked that RNs cosign all LVN charts on tele and ICU patients. She says that their scope of practice doesn't cover these high acuity patients and that the RN should become familiar with these patients enough that we are comfortable with the care being given by the LVN and give all the cardiac meds and sign off on the chart stating that appropriate care was given and we agree with the LVNs care. 
I AM FURIOUS!!!!!! On the day shift where the staff is all RN with the exception of one LVN, this may not be a problem, but on nights this essentially means that I must essentailly take care of all the cardiac patients, ICU patients, run the department, arrange transfers to other hospitals, facilitate department flow, guard patients against dangerous residents and push all cardiac meds and manage all cardiac drip meds. AM I CRAZY, OR HAS MY NURSE MANAGER JUST HAD A TIA????? Would this bother you guys? Let me know what you think.
AngelGirl
113 Posts
pointhope, I was just at the home page of this Website, and clicked on the story "Nursing Shortage....." by Carol Kleinman. In it, she discusses an organization called AFSCME, American Federation of State, County and Municipal Employees. It is a group which represents nurses and their issues. I wonder if this could be of help to you. Sounds as though it is for nurses who are employed by the government, which it sounds as though you may be (County Hospital?).
Hope it helps,
AngelGirl