Dixiedi

We do have to take an IV therapy course before we can do anything more than regulate flow. We start PIVs, hang NS, LR, D5, 1/2NS or any combination of them We start antibiotics For PIVs with MVI, K, etc in them, an RN must hang the first bag but we do hang subsiquent bags. We also do restarts...but that goes along with starting. In Ohio we can not hang blood, but as always, we do monitor and stop. We also can not give any IVP meds. The only thing we can do with PICC or other CIVs is monitor/adjust flow rate. I work with several RNs who think the PICC/CIV rules are just rediculous. Nobody could act fast enough, RN, LPN or even MD to make a difference in the maybe 10 or 12 seconds difference in time to reach circulation up the arm. And to think it's becuase of the postion and possibilities of infection, bleeding, etc. Well, CNAs and PCAs provide care and they are just as likely if not more likely to run into a disconnected line. The rationale just doesn't follow through. It's like the BON decided they have to keep LPNs from being 100% useful to med-surg and other non-critical areas of the hospital by restricting procedures that just don't make sense to restrict. Oh well...there I go again.

Cincinati, Ohio Long list so I will try to make it orderly: personal care of course foleys and st caths trach care (including changing if needed) G-tube care and feed, flush, sx, asp, etc. NG just as G-tube Drains (nurses do not remove chest tubes but do care for them) dressings (no restriction as to packing, meds, etc) sutures (though it's rare that one of our ortho pts has any and the staples stay in past discharge) Meds PIV solutions and antibiotics (Ohio has a rather lengthy, odd IV and LPN policy) CIV "simple" solutions only. Treatments - I can't think of any treatment that LPNs are not allowed to provide to their pts. (this does not include some "unit" treatments/procedures that are not performed by any nurse on the floor.) Update the care plan. Pt. Teaching (on my floor, it's usually anticoagulant tx, pain control and reinforcing PT teaching, walker walking with new hip/knee, etc.) With the exception of CIV and IV push and of course "charge duty" the LPNs in my hospital care for their pts and accept total responsibility for our pts just as the RN staff nurses do. Just as I would answer a call light and give pain med PO or IM to one of my co-workers pts, my co-workers will give my pts IVP meds for me. Now, if Ohio will just catch up with Colorado and others and expand the LPNs role in IV therepy to include CIVs and IVPs. Ohio is soooo slow to catch on and they will never give LPNs credit for what we really are worth! We are not be RNs, but the average pt (not in one of the special care units) can be cared for quite competantly by most LPNs. Oh, but that's my soap box and I'm not going to go to that here.

Cincinnati here! I work in a small hospital on the orthopedic floor. Sports medicine, joint replacement. Love my job! Oh, I am an LPN for some 30 years.

Excellent answer. I hear so many younguns say you CAN find an RN program that will work for you. Yep, I suppose there's one out there someplace, but darned if I can find it. Get a loan? Excuse me, loans have to be repaid. for the 5$ more on the hour that I would make, it's not worth the effort just to hang blood and be a "charge nurse" in my hospital. I graduated LPN school in 1977 when there was far less diference between LPN and RN (the hospital where i went to LPN school had an LPN head nurse in the ER). Now, hanging blood and being in charge just aren't worth repaying a large loan and taking high school and nursing fundamental classes all over again because it's been so long since I graduated. I love my job, what more could a person ask for in this life?

I don't know any personally but would love to hear about your duties.

Unfortunately it sounds to me as if you are letting her get away with it. This you can not do. She is being insubordinate and disrespectful to not only you, she is being disrepectful to your pts. Remind her of this and that her behavior must change or their will have to be corrective action.

I have seen that happen before, twice. The staff should have prepared you. Nurses are just humans. It's very emotional for the staff when they have to "turn somebody off". It's a very different perspective from what the family feels but does remain very difficult. Most pts who are vent dependant just stop breathing and their heart follows within a couple of minutes. Your grandfather, as you said, was non-responsive when on the vent. Maybe he didn't know he was vent dependant. This does not mean there were no other brain functions working so when the vent was discontinued, he became frightened and this fear elicited the response you and your family witnessed. It is no indication that he might have survived if he had remained on the vent. It only indicates his basic survival instincts were intact. I believe every pt, even those who are non-responsive should be talked to, they should be told what is going on. He should have been told what was going to happen. I find fault with the nursing staff for not preparing you or your grandfather. But again, nurses are only human and so many these days get so involved with "gadgetry" that they forget there is a human being on the other side of the machines and bodily functions they are so proud they know all about. It's very difficult for all nurses and when you are new it will be even more so. You will learn and "get used to it". Remember, do not become emotionally involved; remain empathetic but not sympathetic. Keep an emotional distance while being supportive and understanding. And above all, always talk to your pts, even those who never respond, we just don't know enough about the brain to know how aware they are what's going on around them. And last but not least, inform families of as much as possible, they are not in the way, they are your pts best hope for an excellent outcome, even if that outcome is death.

LTC LPN - Don't you change tubes? I was suprised when I read they have to go to hosp for tube replacement. Earle 58 - We always keep spare g-tubes or buttons just for replacement for damage or age. Usually damage, they never seem to last long enough to have to be replaced because of age with all the pulling and tugging so many kids seem to be able to "give" their tubes.

hehehe... When I read your post my imediate thought was "close to wonderful states like Kentucky, Tenn, West Va... totally the other direction!

Finding LPNs who want to work in the hospital is not a problem. Finding RNs who is another story. There are more LPNs wanting hospital work then their are postitions available so they will not advertise. On the other hand, there are not as many RNs looking as there are positions, so they advertise. It's true many hospitals do not hire LPNs these days, but really now. Would you want to be in one of those hospitals? Not me, the administration is more interested in appearances (we have the best trained staff) than in quality nursing care. Not that RNs do not give quality care, they do. It's that you can hire more LPNs, thus providing better care simply because no two nurses can care for as many pts as 3 nurses can.. There are many who would disagree with me, but that is how I see it.

Back up your calls with email if possible. Be sure to mention "as per our telephone conversation" so as to back you up on it. Phone calls can so easily be forgotten and there's no proof they ever did. And, as the last poster said, please watch your back!

I am returning to acute care in August and one of the hospitals I am interviewing at does offer 12 hours weekend shifts, I am not sure about the other two. hehehe I am hoping the hospital of choice does but it's one of the two I don't know about yet. I'll find out Tues when I go for my interview. Most hospitals around here require 3 days, not two. Usually every Fri, Sat, Sun.

I too am in Ohio and around here, the schools with special needs kids will use an agency LPN (who works with some of the kids during off school hours) when the regular school nurse is off. Of course, this is not a regular school nurse job but it is a foot in the door if that's the way you want to go. Can't hurt to ask your school district of somebody "in the know" in your area.

Foul language in front of pts/families is not a nitpicking complaint. Respect of your pts and their families is most important. A nurse can be sharp as a tack, but if she verbally comes off like a street walker, then she doesn't leave a very good impression. Making fun of others, well, that is simply immaturity and has nothing to do with age. It's not just in nursing either, it's running rampant all over this country in all walks of life. No solution to offer unfortunately.

That's one person's opinion and just reading through the threads here, you will see there are a lot of nurses who feel differently. Anyone with a license can get a job. Maybe not what they thought they were going to get, but a job they can get. It's up to them to make the best of it instead of the worst.

Now that a few days have gone by his opinions are beginning to show themselves with increasing regularity. When addressed as Mr. F by a nurse he doesn't know he is cooperative, when addressed as Ray, the nurse he doesn't know yet will be ignored and with increasing frequency resisted. Yet, most of the nurses continue to come in and call him Ray.

I ditto on the never flush. Your instructor is correct and the nurses you have seen flush first and think last really need to stop doing that!

This is great news! The last time I read something about it, the average was 5th grade level. And that includes the average college graduate! The Readers Digest used to be written at the 5th grade level, sorry to see that they have had to drop that.

Just don't answer the phone, like many others have said. Very likely, the other nurses won't help out because they have already been burned out. On the other hand, do try to understand where management is coming from. It's their responsibility to find coverage AND stay within budget. They probably do not like it any more than you do, but it's there job and just as you must do yours, they must do theirs.

i'm not in cali but i would bet if i took the couple of minutes to go to the bon website and look at the lpn scope of practice i would find that lpns coordinate and supervise cnas. and, in specific situations can act as supervisor in ltc even if there is an rn on staff that shift. too many nurses misunderstand the definition of facility supervisor and supervision of clinical activities. also, just because the rn supervises the clinical activities of the lpn, it does not mean that an lpn can never supervise an rn. say there are 3 nurses, an experienced rn, she is the charge nurse, an experienced lpn, she is assigned her pt load and an inexperienced rn also with her assigned pt load. the charge nurse is very busy with new orders, a new admission she is going to "take," or any other thing that keeps her busy and the new rn needs to do trach care and change the tube, she's never done it before. what would be the best action? the lpn should "attend" or suprvise the new rn to ensure it is done correctly and safely as she is performing this skill that she is unfamiliar with but the lpn has been doing for years that would be supervising, yet it is not against the scope of practice for any of us. it would, imho, be against the scope of the rn to perform this procedure without an experienced nurse present and if an experienced lpn is the only one available, well, the lpn is going to supervise the rn. i don't know what brought about your post but you really need to calm down. try not to read so much into things, you are going to wear yourself out. supervise is a relative term, there are things the lpn can not do that the rn can but for the vast majority of nursing responsiblities our scopes of practice are much the same.

It is deplorable when a nurse refuses, to assist another nurse. I wonder where he/she got the idea they had all that much expertise? LOL Hang in there, this RN won't last. He/she is one of those who came out of school thinking they know everything, that kind never lasts. He/she will be long gone and you will still be there to continue to provide great nursing care to your pts. The next nurse will very likely be great and you'll forget about this one and "un"fondly remember him/her as you read a thread like this sometime in the future.

Like I said, I had just come into the room and my sister and was leaving. We do not all stay. We are talking about an 82 year old man who is very likely dieing. We take turns staying with him as much as possible. When I worked in acute care, I was happy to see so much family with my elderly pts. I was never so busy with lines and assessments and other nursing tasks that I forgot there is a human being who needs his or her family with them. Even if that meant the room was crowded for a few minutes as they came and went. So tell me, why would you be concerned that the room was crowded? Are you so professional that your needs as a nurse become more important than the needs of your pt and their family? The following day many errors were found. I kept them between her and I, as true professionals would at least attempt.

I do not have a problem with RNs. That's just plain silly, we are all nurses and until a specific nurse gives me reason to think she is less than acceptable I really don't care what her title is (or his title for that matter) I am a big proponent for LPNs and our usefullness in the acute care setting and the abilities many of us have. However, this discussion is not about RNs/LPNs or CNAs. It is about rudeness within our ranks, treating our pts in a professional manner, nothing more. The ranks includes ALL nursing staff. She happened to be an RN, that is something I can not change. I would have had the same complaint if it had been a CNA or LPN or even a new Doc on the case. I think, by the way you talk, you may have a big problem with LPNs and accepting the fact that we are nurses and not (usually) too stupid to recognize unacceptable nursing in those with a presumably better license. You may presume RNs have more responsiblity than the LPNs, but a pt is a pt. And when a nurse accepts the assignment, she is responsible for that pts care. The RN may have more tasks, but she is no more responsible for my pt than I am, even if the RN does have to come in and "do" the IV pushes or TPN. I am still responsible for making sure my pt is responding correctly to the entire plan of care/treatments and to make sure action is taken (usually by the RN assigned to the lines) to correct the situation if not.

Pretty standard around here too.

No, you are not to forward in asking. I firmly believe the only stupid question is the one not asked; therefore, all questions are valid. The beef is exactly as stated. I am not a complicated person. She entered the room at the speed of light addressing my dad by his first name. Turned to me and asked ME if he goes by Ray or Raymond instead of asking him. Simple as that. Nothing else to it. The other issues I have mentioned since the original post were all after this initial introduction. I didn't even evaluate her nursing care until laer that evening, after I had gone home and didn't think any more of it than she is young and inexperienced. It was the next day before I found out that so many errors had been made, and not just by her. So, my beef was and still is the familiarity with which many "professionals" address their elders at the first meeting. My family is very strict with these things. I know he would never tell a "kid" to call him Ray. Anyway, it's as simple as I put it. I have no other beef and really don't see where you find in my opst that their may be one.