Question for the LVN/LPN's

TheCommuter, BSN, RN · Mar 2, 2008

How should a LVN respond when asked to perform a task outside of their scope of practice?

I'd simply reply, "That task is not within my scope of practice. Find another person to accomplish the task."

Kashia, ASN, LVN · Mar 3, 2008

Are you legally/morally obligated to object to the order, would you be risking your license if followed through with the task, would you simply say "its not my job?" I've looked high and low for a "text-book answer" because I need some sort of reference, but I figured why not ask directly from the source. I'd appreciate any help whatsoever.

Hi,

I am LVN 8 yrs. You are legally required to not do anything out of your scope ( all nurses,all levels) of practice.

As for the moral aspects...I imagine a situation could arise where a patients life depended on your action, no one else around, you knew what to do, so could do it safely...well I think as this point it is a very personal question. What would you do??

If you decided to follow through, you could be liable legally if outcome wasn't good, could lose job, on other hand if you did right and it saved a patients life....would it be wrong that you did it?

I have never had this situation occur, I believe it would be rare in

usual work settings where there are others to help.

It is one of those ethical questions if you carry it to the extreme I just did.

In hospital settings if you are asked to do something out of scope

you could say I am an LVN but will get an RN right away something like that.

Hope this helps, but most likely the more you hear the more questions arise....:-))

Kashia, ASN, LVN · Mar 3, 2008

I wanted to offer some reasoning to " there could be a situation"

DON of nursing program told a story:

She RN, working in an ER . Female patient. The nurse had taken

medical history and viewed labs. The patient was bleeding out, internally. The nurse knew this, Dr did not know or did not agree, nonetheless, Dr. ordered IV fluids TKO....nurse knew patient was in serious trouble, she decided to quietly open line and bolus IV....

saved patients life.

She was legally out of her scope, in fact was practicing medicine!

Well, it was this story I had in mind and what I have always remembered..there could be a situation that presents itself and you

would need to make that decision...

Fiona59 · Mar 3, 2008

A simple, "it's not within my scope at this time, I'll get Susie, RN, (or whoever the skill belongs to) to assist you.

Believe it or not neither a PN or RN in my hospital can apply a cpap. It's a Resp. Tech's job or the patients.

NURSESOMEDAY? · Mar 3, 2008

I have had a similar situation in medical records where they gave me rubber stamps of all the doctors so I could "sign" the paperwork for billing the insurance. Now that I have a Health Information Technology degree and will sit for the RHIT, I have found that practice is illegal. Good thing it was 10 yrs ago. I did present this to my husband, an RN for 20+ yrs. He said you simply say it is outside of your legal capabilities. By the way, here in Las Vegas, we have made the national news with the endoscopy clinic that reused single dose vial and syringes for the past 4 yrs. The paper said the staff was told to do this. Just follow orders??? Isn't that what the Nazis said inWWII?

seneyka · Mar 3, 2008

Hi all
I'm new to the site and currently a nursing student working towards my BSN and they threw me this question as a homework assignment:
"How should a LVN respond when asked to perform a task outside of their scope of practice?"
Are you legally/morally obligated to object to the order, would you be risking your license if followed through with the task, would you simply say "its not my job?" I've looked high and low for a "text-book answer" because I need some sort of reference, but I figured why not ask directly from the source. I'd appreciate any help whatsoever.
Thanks
Sam

Can LPN administer blood or do IV puncture? I was told by school instructors that LPN do not adminster blood, IV push, piggybag (spelling), or start IV.

In dialysis job description, LPN duties include blood aministration and IV puncture. I really also need to clarify about this. I do not have any IV certification though.

I think this is also r/t the question you just asked. If anyone can read this far, I hope I can get the specific answer for my question and general response from your question.

seneyka · Mar 3, 2008

I wanted to offer some reasoning to " there could be a situation"
DON of nursing program told a story:
She RN, working in an ER . Female patient. The nurse had taken
medical history and viewed labs. The patient was bleeding out, internally. The nurse knew this, Dr did not know or did not agree, nonetheless, Dr. ordered IV fluids TKO....nurse knew patient was in serious trouble, she decided to quietly open line and bolus IV....
saved patients life.
She was legally out of her scope, in fact was practicing medicine!
Well, it was this story I had in mind and what I have always remembered..there could be a situation that presents itself and you
would need to make that decision...

What if what she did had caused sth more serious? I am sure she did a good job saving the pt's life, but not all the time I could be able to do certain things not within my scope of practice! Still trying to figure out who complicated nursing is!

joyflnoyz, LPN · Mar 3, 2008

Can LPN administer blood or do IV puncture? I was told by school instructors that LPN do not adminster blood, IV push, piggybag (spelling), or start IV.
You MUST know your BON regulations, scope of practice.
They vary from state to state
From what I've found out (someone please correct me if you have other info!) in Texas LVNs cannot pronounce a death, cannot hang blood. Things such as starting IVs are "facility specific". If one hosp allows LVNs to start IVs, they must "teach" you according to their policies, and ensure you know what you are doing. Change employment to another hospital, you must go through the new facilities teaching program

Fiona59 · Mar 3, 2008

Can LPN administer blood or do IV puncture? I was told by school instructors that LPN do not adminster blood, IV push, piggybag (spelling), or start IV.
In dialysis job description, LPN duties include blood aministration and IV puncture. I really also need to clarify about this. I do not have any IV certification though.
I think this is also r/t the question you just asked. If anyone can read this far, I hope I can get the specific answer for my question and general response from your question.

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IV starts and meds are usually facility specific. I can and do start, hang primary and secondary lines. No nurse on my floor does "iv push", that is an icu or er skill, only a doctor resident would push on my floor.

I don't think you understand the concept of dialysis by your statement. Dialysis cleans the blood via circulation from the body to the dialyzer and returns to the body. No nurse of any level administers the blood. Yes, PNs work in dialysis. The main difference between an RN and PN in my area when it comes to dialysis is the RN can give epoiten upon return, the PN winds up giving it subq when an RN isn't available. This is not a frequently administered med. I worked in a busy diaysis unit and it was given maybe twice in a week (out of 360 runs). Oh, and the RN made $14/hour more than a PN (one of the main reasons the dialysis branch here cannot keep PN staff). Also there is no "iv puncture" in dialysis. Both levels of nurses access a graft, fistula or cvc.

pagandeva2000, LPN · Mar 3, 2008

My answer would be that I am not legally allowed to follow that order. Would get the RN. If it were a situation that really needed fast intervention, and I WAS ABLE TO CONFIDENTLY AND SAFELY PERFORM THAT PARTICULAR SKILL, then, I might do it if it meant life or death. But, on the regular...nah...

jelorde37 · Mar 5, 2008

i would say, "sorry man, not in my scope of practice."

lvns with iv cert can start ivs, hang simple solutions, and i think hang simple atb. i think we used to be able to hang blood but not anymore. also, we cant do ivp meds.