Professionalism as an LPN

[RoyalNurse]

Hi everyone,I just wanted to get some opinions from some LPNs on a topic.I recently worked with an LPN who was assigned to 6 "urgent-care" patients, I was the charge nurse. My duties included administering any IV medications that the LPN's patients needed, as well as mixing any antibiotics, and monitoring anyone who ended up on a cardiac monitor. One of her patients ended up needing insulin IV. I was not told about this order by the LPN, and I did not administer it. When the LPN gave report to the next LPN coming on duty, she said it was my fault that the insulin wasn't administered, as I was "in charge" of IV injections. I feel that the LPN is responsible for her patients as a nurse, and should have told me about this injection. I know that as an RN, I'm "supervising" this LPN, but she is the nurse assigned to these patients, and still ultimately responsible? What do you think?

[marda]

It is the LPN's responsibility to let the RN know what IV meds she needs and times.....where I work, the RNs have their own patients to worry about...no way they can keep up their 6 and mine too...that was the LPN's mistake..not yours.....

[jadelpn, LPN, EMT-B]

The LPN should not have had 6 "urgent care" patients to begin with, especially with interventions that were outside her scope of practice. With that limited scope, (assuming that she can not do any IV medications at all) I wouldn't know what I would do other than a supportive extra nurse. Or the nurse that would take all of the PO med only patients. Cardiac monitoring is a new one on me that an LPN can not do, as they have techs in other hospitals that do tele monitoring, and Insulin drips perhaps should not even be done on a floor where an RN can not monitor 1:1. As the primary care nurse for the patients, it is up to the LPN to keep up on the orders, and if it becomes apparent that it is not within the LPN's scope, then the charge nurse needs to be aware of that, and arrange the assignment accordingly. It is not safe for an LPN to just not do anything with that order. With all that being said, if you are charge and do not have a patient assignment, then part of your duties, or one that you delegate to an RN is to keep up on orders--and what the LPN's patients are up to. Sounds like either an LPN's scope is limited, or the LPN is not aware of her scope or most importantly her responsibilities and needs some re-education.

[CynicallyVexed]

As a LPN who has taken on primary nursing roles under supervision of an RN and allowed to do IV therapy/push as long as it wasn't IV insulin or cardiac drugs on telemetry acute and ICU, I would suggest both are at fault. One LPN not communicating the order. Two CHART CHECKS!!! I do not know your hospitals policies but chart checks are mandatory at all hospitals I have worked at and also where I have worked only RN's can sign off on a new orders of any kind. Plus a LPN shouldn't take an order like that from the MD in my opinion. In those type of settings I would think it would be the RN's responsibility to deal with the MD/NPs orders and progress.

I would suggest you suggest your LPN's to get a list of IV meds/pushes at the beginning of his/her shift and hand them too you, if you do not trust your LPN's to do this then you can check the mars and make yourself a list. Sounds to me the LPN you had has poor communication/professional skills with poor training. Maybe an inservice on communication among co-workers on patient progress and care would be helpful at this point and those fail to comply face consequences.

[LadyFree28, BSN, LPN, RN]

As a LPN who has taken on primary nursing roles under supervision of an RN and allowed to do IV therapy/push as long as it wasn't IV insulin or cardiac drugs on telemetry acute and ICU, I would suggest both are at fault. One LPN not communicating the order. Two CHART CHECKS!!! I do not know your hospitals policies but chart checks are mandatory at all hospitals I have worked at and also where I have worked only RN's can sign off on a new orders of any kind. Plus a LPN shouldn't take an order like that from the MD in my opinion. In those type of settings I would think it would be the RN's responsibility to deal with the MD/NPs orders and progress.

I would suggest you suggest your LPN's to get a list of IV meds/pushes at the beginning of his/her shift and hand them too you, if you do not trust your LPN's to do this then you can check the mars and make yourself a list. Sounds to me the LPN you had has poor communication/professional skills with poor training. Maybe an inservice on communication among co-workers on patient progress and care would be helpful at this point and those fail to comply face consequences.

^^^Agreed...When I was a LPN...if the RN had to provide interventions that weren't in my scope (depending on BON AND facility policy), we usually collaborated at the start of the shift, as well as if something had came up, especially a new order that was outside of my scope, she would be aware of it, regardless of the order...I would do a follow up and clarification if she saw the order...I would not pull off that particular order because of my scope. You should be doing chart checks, especially for any high alert meds that need monitoring, because you have to administer the med...the monitoring of potential complications...such as if pt is on amiodarone, the LPN can monitor VS...you would still collaborate, because you administered the med, as well as make sure you are on the same pg if the pt is not tolerating the med well. Communication is needed on both sides.

[RoyalNurse]

I get it of it's a stable telemetry situation, or med-surg situation, but this was a emergency room/urgent care situation, we didnt know who was coming in, and what they would need. Then the professionalism/ scope of practice comes into practice.

[kmmr]

As a RPN working in an ER I would not be responsible for a patient as acute as this one. The RN would be. We have CTAS that would determine the acuity of care for patients in the ER. I could help the RN such as take VS and other skills in my scope. Both disciplines were wrong in this situation. They are both responsible to give the patient the best care possible.

[libran1984, ASN, RN]

I'm also an LPN in an ER. I also initiate and administer medication and blood products through IV therapy (both drips and push). My hospital does restrict me from initiating IV insulin and IV cardiac meds. I do also preside over acute patients on the monitor as that the hospital made me ACLS and PALS.

The LPN should have informed you about the need for IV insulin, however you also should have reviewed the chart to verify completed and incomplete tasks. There was obvious communication difficulty and both parties are equally responsible

[Bringonthenight]

I kind of think both the LPN and RN are at fault here. Yes the LPN should have told the RN about the IV insulin but I also think as the supervising nurse, the RN should be responsible for checking charts as well as collaborating with the LPN about what needs to be done.

My questions are, if the LPN scope is so limited in the facility they work in why do they put an LPN in an urgent care section of an ER? Where I work LPNs are not allowed to work in ER or ICU due to the scope limitations.

My second question is why wasn't the RN allocated the urgent care section, with the LPN assigned to assist the RN rather then the other way around?

[KRSLPN, LPN]

Correct me if I'm wrong, but what I'm getting from the original post is the fact that the RN felt it was unprofessional for the LPN to claim it was the RNs fault because the insulin order was missed.

If this is so, first off I'd consider it a professional courtesy to inform the RN of an IV she is responsible for. BUT, I also believe that if this was part of the RNs duty, she should also have checked the orders. I wouldn't want an RN working for me who did not check their orders for their assignment but instead waited for someone else to tell them that it needed done.

[1hotnurse08]

I am an LPN and it was many years ago that I worked on a med-surg unit. I do remember having patients that required IV medications but we always communicated with the RN that was in charge on the unit. I'm just wondering in report / or did you receive a report regarding IV medications that had to be administered because this type of pertinent information is usually communicated between the oncoming/off going shift and I know we always had to do a 24 hr chart check to see if any changes (orders/treatments) had occurred. Maybe your facilities is different. I'm just speaking from my experience when I worked in a hospital setting . Personally I believe in teamwork. Everybody is not perfect and I usually just double checked my own orders whether they were to be administered by me or not so that I could also inform the RN in charge on shift for the night of the IV medications that I could not administer. When we received our patients for the shift the RN was the one who delegated which patients that we would receive by the patients acuity level so usually she/he knew which patients required IV medications and like I mentioned earlier I made it my business to remind the person in charge, so the blame game would not take place.

[applewhitern, BSN, RN]

In my facility, the RN takes a full patient load, PLUS has to perform IV pushes for the LPNs. The RN also has to perform any duties pertaining to IV ports, central lines, blood products. Each state is different, and each facility has it's own policies. Our LPN's cannot initiate any type of blood product whatsoever. It is the LPN's job to tell the RN if she needs you to perform a duty that she/he cannot do. It would be impossible for the RN to check several LPN's charts to hunt for anything the RN needs to do for them, plus their own load of patients. I keep reading posts here about how LPNs want to be respected; then take responsibility for your patients. Blaming the RN for this is ridiculous. YOU are the patient's primary nurse. At my facility, if the LPN did this, they would simply replace her with an RN, then the problem would be solved.