litlamp

Where I work LPN's can do alot. The scope of practice in TN for LPN's is very minimal and mainly covers medication administration (push meds). We do everything but hang blood and there is a short list of meds we cannot administer (sedation, oxytocics, chemo, and titrated meds to name a few). Per our scope we cannot push meds anywhere but in a peripheral line and only to pts over 80lbs (never to peds or pregnant pts). I work on a telemetry unit and take my own patient load (up to 4 pts), do the initial and daily assessments (a RN does one initial assessment too but it's very short) deliver patient care, IV meds etc. If certified (IV cert course 40hrs) we can also push most meds.

I forgot to add.. always check the policy where you work :)

Where I work they go into the sharps boxes. Never into the trash.

Thank you all very much for the replies. I'm still learning that all cases may be different for post op dressings, initially I thought how I learned... that you initially just observe the dressing and change when ordered and it's is usually after the Dr. performs the first change. I need to go with the -when in doubt, ask/call - from now on, and get it in an order. Am I wrong to think that some dressings wouldn't be changed, just observed and if there were to be drainage that would be reinforced or circled and monitored? If so, could you tell me which this may apply to? Thanks again!! You all are always so helpful.

When would you change the dressing on a *new* PEG tube if there were no written or standing orders besides "remove sutures 7 days postop"? Would you change the dressing with or without an order or would you assess the dressing and if being clean, dry and intact wait until the 7th day to change it? For my question, keep in mind there is no order written for a dressing change and there is no facility policy written for new PEG tube dressings. The only facility protocol is written for existing PEG sites and daily dressing changes. Any input is appreciated.

Our facility has been faced with unusually low census the past few months. This has lead to staffing changes and many nurses getting "called off" or put "on call" for the shift. The problem with this is there is no policy or procedure to do this fairly, no rotation schedule in place. I inquired how they decided who to call off and I received different answers. For the most part they call off per diem first, then part timers, then they go by how many hours the full timers have. That may sound ok but they only go by the two weeks viewable on the schedule and don't take into consideration that the previous two weeks you may have been called off 2-3 times and others 1-2 times, you can see the issue. My question is, how do your facilities keep track of called off low census days, and how far back is the time examined? Do you use a calendar? Spreadsheet? Can you offer any ideas to better track these days visually and for a longer period of time? I'd appreciate any input!!

I just wanted to post an update in case anyone was looking for the same information: I called the TN BON today and asked for clarification of the scope of practice with administering push medications. I asked if administering medications through a syringe on a pump was considered a push medication. She stated that in fact it was not and what they consider a push med is holding the syringe in your hand and infusing a medication directily into an IV line. As long as it's not a medication/serum listed in the scope of practice that we cannot administer, it is within an LPN's scope of practice in TN. I believed I had interpreted it correctly but it is such a relief to know for sure. Thanks for all your replies and advice too, this site is invaluable!

Nope, but it is similar in set up. It's unlike excel in that there are check boxes with pop up choices and small areas for type in comments.

The IV was KVO 30ml/h only for a q 24h antibiotic that the charge nurse changed to PO, and only required the doctor to sign off on it in the am.

I think I'm a bit perplexed being that we don't use meditech, however, when the information is entered the previous three entries are already visible to me at that time in the electronic charting system our facility uses. I documented in the flow sheet directly before and after her last entry, factually as required as of that timed entry. I guess what I'm questioning is because this is where both of my entries were made..... or it could be that it's just too darn early and my neurons need a jump start this morning..

We use a different application. Entries are made with your personal login. After your digital signature upon completion, the entry is locked and uneditable. I couldn't change another nurses electronic charting just as I couldn't change their handwritten charting. I'm still new to the system myself so perhaps there is a way to do a "late entry" but again, that would be something she would need to do.

Yes it is sad and disheartening to see this happen. I've learned mostly through this forum and on my own that no matter what others may do, my actions as a nurse must stand alone. I know I am my patients advocate and as long as I do what I know is right than I can sleep at night, even if it may get a peer into trouble.

Thank you!! (((sigh of relief))) :)

Let me know if you would have done this differently please... I had a patient whose IV was not infiltrated but at the point of access was showing irritation. I reported to my charge nurse and she assisted me with removal and assessent of the area herself. She said to leave the IV out until the doctor assessed her in the AM. (it was KVO 30ml/h) I charted everything accurately in my nurses notes. I reported this to the next shift, in detail. The following day I had the same patient. (doctor had not been in yet)While entering my flow sheet which is basically a head to toe assessment and in a different window from nurses notes (computerized charting) I noticed that the night shift stated the patient still had her IV and it was infusing at 30ml/h!! When you enter your assessment you can see the previous three entries at the same time, I "assume" she may have just copied what the previous entry was? My assessment was in the morning and prior to IV removal. We only do 1 of those flow sheets per shift, all other info is in the nurses notes. So, I entered on the flow sheet that she had no IV, it was removed at ___ as stated in report on ____. I also let my preceptor know. I know it may send trouble that nurses way, but I didn't see to do it any other way. What would you have done?

I completely understand and I am a new nurse myself. Working on time management, as I have found out personally can have a huge effect on how your shift may go. For instance, when you receive your assignments and report, look at your patients and their diagnosis and current condition, which patients need to be seen first, set a priority list and try to go by it. Take a few minutes after report to set a list in order. Although we use electronic charting and flow sheets I always carry a notebook with me along with my patient list and a copy of their paper kardex. I use a multi colored pen and for instance use red to make notations to check blood pressure if I received in report that they were running low, or for accuchecks if they are q2 .... whatever the case may be. Granted, I'm still working out my own way but thats what it takes, trying different ways in order to find out what works for you and your patients. I don't know your patient load but for vitals I get my vitals first thing at the beginning of the shift when making my initial assessment that way I know myself what they are. If your NA get the vitals maybe try talking to them? Give them the heads up based on what you receive in report.. ex.) "Sally, room __ or Mr. ___ has had a high blood pressure, could you let me know what his next blood pressure is?" or "Sally, could you please let me know when you get vitals on ____ or if it's at this range ______? I'd really appreciate it, Thank you". Or, when in doubt, get them yourself when doing your rounds, it may add a few minutes but it would save you the anxiety and you would have your patients information for yourself. Keep in mind, and remind yourself often that there is a learning curve. It takes time, allow yourself that. Always ask questions. Do you have a preceptor or someone you could ask at work? Look at how your senior nurses prioritize and take a que from someone you admire as a nurse. As to charting, chart what you see, be accurate, detailed, and confident. Be aware that it is a legal document but don't let that overwhelm or paralyze you. If you do a complete assessment, you have all the information needed to chart accurately. If in doubt, find that 'mentor' and have them read over a few entries to get feedback. It takes time, let yourself breathe, hold your chin up. You never stop learning, and thats a good thing!! You can do it.