Question about LPNs in Hospice

[curiousauntie]

We are a small office in a large, national for profit hospice. We have 3 full time case managers, 1 part time case manager (who works about 10 hours a week), 2 LPNs, and 2 full time night/weekend on-call nurses (although one of the night on-call positions is vacant right now, a new person is starting in a week or so) and an average census of about 60-65. The LPNs are getting the impression that their positions may be done away with in the very near future. When asked, they cite being told that they are not needed at IDT meetings, being told they did not need to attend an inservice to reinforce the correct way to document on the new clinical notes (changed a couple of months ago due to the CoP changes), the director's attitude that only RNs are nurses (she tends to say "I need the nurses and the LPNs..." or "there are only 2 nurses here" when there are 2 RNs and an LPN sitting in front of her). I have been on medical leave, due to an injury at work necessitating surgery, for the past 4 weeks and the LPNs are the ones who have been basically managing my patients...but one of them is my best friend and we talk at least 2 times a day and she and the other LPN have been calling me for advise as needed.

My question is...has anyone heard of the LPN role in hospice being phased out? If not for the LPNs we would have a hard time managing our case load. I have 3 out of 18 patients who require daily visits for wound care, and there are 6 or 7 total patients who require that level of visits in our census. Both of the LPNs are bracing for the news that they are being laid off, and soon. To tell you the truth, if not for the LPNs, I would never be able to handle a case load of 18. Any one out there have any information on the changing roles of LPNs in hospice?

[caliotter3]

It sounds as if you are dealing with the attitude and prejudice of one person. She might want to change the agency so that there are no LPNs, but is most likely not able to do so. It depends on how much the LPNs want to stay in this job as to whether they want to stick around and take this kind of treatment. To find out if the agency is actively seeking to go all RN one should question the people in authority. Sounds a tad toxic for LPNs.

If I were those LPNs, I would be getting very proactive about stabilizing my paycheck, elsewhere.

[Hal_Dol]

LPNs are certainly valued by VITAS, a national for profit hospice organization that operates in a number of states.

Yes RNs are the “team leader” and make the visits to see how the patient is and what his/her needs may be. Then when the patient’s condition becomes unstable around-the-clock care is started and staffed until the patient is again stable. In the day ---when family, or the visiting RN can give meds---staffing is with a CNA. However, night shifts are ALWAYS staffed with an LPN. That way meds can be given, wound care done when needed, etc. and the family can get some much needed sleep.

I have been working for this company for 3 years as an LPN and absolutely LOVE my work. I feel I am being treated well, appreciated, and respected by my superiors. LPNs are still being hired, as the census increases.

[curiousauntie]

Hal,

Thanks so much for your reply. I have always maintained that the LPN role in hospice should be expanded and feel that any RN who does not believe that the LPN is a very valuable resource needs to examine why they feel that way...I think some RNs are threatened by LPNs, afraid that they may one day be replaced by an LPN. I worked many years in long term care before coming to hospice and learned (the hard way as a young RN) that the LPN is your eyes and ears, that although an LPN may not be "allowed" to assess, they frequently have better assessment skills then some RNs and that if we are to care for our patients (or residents, in the case of long term care) in the best possible way, every member of the team should be used for their abilities, not for the letters after their name.

I will continue to fight for my LPNs, knowing that without them I cannot care for my patients and their families as they deserve. The day that we are told that the LPN is not a valuable asset to the team is the day I look for another job. Maybe with Vitas!

[kaylee3]

Regarding Vitas---I live in Ohio and saw an ad for on call LPN position=but they are asking for some home health or hospice experience-how does one even get a job working for hospice or home care if they do not have these experiences? and what is an on call lpn?

[Hal_Dol]

Kaylee3:

I think I understand your question/dilemma; had the same problem when I first approached a hospice provider. My solution was to quit the nursing home job I had and go work for an agency. They frequently placed me in private homes, and occasionally I even ended up doing hospice cases.

When I went for my interview with VITAS a year or two later, the nurse administrator looked at me and said, "Aha, now I can put the application and the face together!" My application was good enough to get me the interview; but it was the fact that the she remembered me---favorably it seems --- for the care I had given to one of the clients she was looking in on when I was on duty. From there the interview was a breeze.

In fact, what I remember most about the interview was her comment, "Never insult another nurse in the county....someday you'll be asking him/her for a job."

[jaf0066]

no argument here. i am a new nurse, new to hospice, rn case manager. i am very grateful for the work and support i get from my lpn team members. they are a wealth of knowledge and intuition that i can only hope to emulate in my practice as i grow. that being said, i need some help in building stronger relationships with these team members. being a new nurse, i am filled with the rights and wrongs of delegation and documentation and scopes of practice and have on occassion offended, hurt or diminished persons without intending to do so or knowing that I have harmed someone. any words of wisdom regarding how to build better alliances would be much appreciated.

[AtlantaRN, RN]

I work for Healthfield Hospice. There are currently 2 LPN's that see patients on a bimonthly basis. RN's are the case managers, and they fill in secondary to high census. (one additional LPN does medical records). One of the LPN's just finished with Excelsior so she is preparing for the boards; the other LPN has found out this week that her position is being phased out. Thankfully there are some openings locally in the home health setting with Healthfield. She is looking into the bridge program at a local community college that has a wonderful reputation with their bridge program.

For my company, yes, LPN's appear to be being phased out.

linda