"I do the same thing as an RN"

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WheresMyPen

129 Posts

RN education don't offend me. I honestly wish I was an RN and hope to one day have the resources to become one. RNs are the hierarchy of our profession. There educated at a level beyond us LPNs. They have a wider scope. They go deeper into many subjects while we cram the basics of a little bit of everything. But we work very hard for out license and learn so much in a short time.

What offended me about the the post was "Bedside nurse who had time to laugh with the patients,". I'll have you know that I am a charge nurse. I barely have time to speak a few words to the patient only when I'm admin. Meds and I got to hustle. I have tons of physicians orders to take care of. Loads of nurses notes to do. Admit assessments and paperwork to complete. QA chart checks to do. The poster painted a picture that the LPN is a direct care bedside nurse and this sends a message to people considering becoming LPN. Yes RNs have a wider scope. Yes RNs have more education. Yes every LPN should have desire to be an RN. We are both Nurses and every One should strive for better if they have the means to do so. But many don't. But point of the matter is a Nurse is a Nurse and the jobs are not that different although there are differences obviously.

Saying the difference between an RN and LPN is comparable to the difference of an RN to CRNA or N/P is kinda wild. These are advanced level providers with masters/doctorate degrees. Let's just examine reality here , an RN program at a community college is about 2 years of pre reqs and a year and a half of actual nursing program. In my area an LPN program at a trade school is 19 months. A year and a half of education and 19 months of education is not that far fetched. How could it be ?? There both nurse programs teaching very similar things. There's no denying the fact that RNs are more educated, better and assessing and seeing the big picture, and have a wider scope by the board. But even though LPNs are nurses and not assistants I would say a better comparison would be a Physian Assistant to the Physician. Even though doctors are far more educated, the train In a shorter time to carry out much of the same job. To the general public they are both providers and both have prescriptive authority. So there job "appears not much different". It's kind of the same thing with nursing in my opinion.

i definitely do not have time to laugh with my patients lol. Wish I did. I love being a bedside nurse and I love caring for the elderly. Which is why I love being an Lpn in LTC. But I am almost done with BSN cuz family influence and fear of less job opportunity had me seeking out more schooling. I don't regret it but I know they'll throw me into a supervisor position once I get my Bsn and pass the boards. So I may go back to the hospital to be a bedside nurse.

If it were possible to stay an LPN and not always be threatened with job opportunity and security in my area, I would do that. Because I love being an Lpn. I hope that I can still be at the bedside, until I physically can't anymore . I just don't like when I relieve the charge nurse. I hate when they make me do charge with a passion!

WheresMyPen

129 Posts

Also I do comprehensive assessments, in my state and facility. Just need a signature from the RN. My whole point of this is not to demean anyone. Being in BSN program some of my classmates say things like, "you're spending all this money to be something you already are" and when I saw some posts here it just irritated me a bit. That's where I was coming from.

KateFF

4 Posts

Specializes in Cardiology, Hospice HPNA member.
In Texas, the line is extremely thin so this conversation has become a hot topic down here. Just for example...

I've seen posts regarding an LPN's inability to push IV meds or even start IVs, both things LVNs do in Texas except for very specific drugs (and truth be told, those very specific drugs also tend to be facility-dependent and based on previous negative incidents).

We can't spike a blood bag or do the first 15 minutes of monitoring, but everything else wrt blood transfusions is within our scope. We (well, any facility employee) can receive blood from the lab, monitor vitals, and complete the documentation.

We can't do an initial admission or post-op assessment, but we can do the interview and history.

We can't pull blood from a PICC line/midline or access/de-access a port-a-cath, but we can administer meds and fluids through both.

Hospitals around here have started phasing out hiring LVNs altogether and actually hiring RNs at a lower pay rate, which is pretty awful IMHO. I was one of the last LVNs to come up, and that was mainly because I was already an aide at my facility.

The major issue with LVNs now is that the state has started placing a higher level of liability on having them in specialty areas so a 20-year LVN can no longer work in the nursery she essentially helped to create. A coworker of mine was an ICU nurse for years before LVNs were removed from critical care. The pediatricians aren't comfortable with LVNs caring for their kiddos even though we're all PALS certified. It's all become a matter of liability, which I understand in this highly litigious society we live in.

I would never say I do the same job as an RN, but here at least, it's a very thin line between the two.

I'm an LVN in Texas and the pulled blood and pulled PICC's, Access Deaccess PAC's that was part of my job in a large hospital in the Houston Medical Center once again one of those facility policies. At one hospital I pushed IV drugs narcotics and cardiac meds. I even pulled sheaths after heart caths.0 It's Magnet that killed off our ability to be nurses in the units. I am ACLS, PALS certified worked PCU, CCU and ER. I was taught the gtts and vents. No longer I was one of 6 LVN's left in a 700 bed hospital. I've left and found my love of nursing again in Hospice where I feel valued. There is a thin line between the two. I've met nurses of both licenses that were great or scary. Libility and Magnet too many good Nurse's weren't grandfathered in. I'm going back to school to do my job sad but true

ERnursebyday

38 Posts

Im an RN (ohio) in the ER and unfortunately we do not hire LPN's at all anywhere in the hospital. we hire RN's, medics, and techs. LPN's were phased out (for lack of a better word) many years ago. We still hire ADNs, but they have to sign an agreement that they will get their BSN in 5 years. i think that it was a cost saving strategy. I realy dont know much about the scope of practice of an LPN bc Ive never worked along side them.

I did have an MA tell me that we do the same job, except I start IV's. hmmmmmmmm

Horseshoe, BSN, RN

5,879 Posts

I'm an LVN in Texas and the pulled blood and pulled PICC's, Access Deaccess PAC's that was part of my job in a large hospital in the Houston Medical Center once again one of those facility policies. At one hospital I pushed IV drugs narcotics and cardiac meds. I even pulled sheaths after heart caths.0 It's Magnet that killed off our ability to be nurses in the units. I am ACLS, PALS certified worked PCU, CCU and ER. I was taught the gtts and vents. No longer I was one of 6 LVN's left in a 700 bed hospital. I've left and found my love of nursing again in Hospice where I feel valued. There is a thin line between the two. I've met nurses of both licenses that were great or scary. Libility and Magnet too many good Nurse's weren't grandfathered in. I'm going back to school to do my job sad but true

Actually Texas is one of the states which puts the most limits on the LVN scope.

TiffyRN, BSN, PhD

2,315 Posts

Specializes in Nurse Scientist-Research.
Actually Texas is one of the states which puts the most limits on the LVN scope.

Ok, I don't know the exact answer to what LVNs can or cannot do. What I know is that through the years, as I've worked at a variety of hospitals and States, the story changes all the time, even within the same State. Apparently, scope of practice is often a matter of interpretation and different facilities interpret things differently. I did work at one facility that had expanded LVN's skill list in regards to CVLs. It went that way for about a year. I guess someone decided to check with the State Board. Game over, State Board says (and I paraphrase): "You're doing what?".

So just because an LVN could do XYZ in whatever facility in whatever year, does not make it the final word on if that was within their scope of practice.

Not dissimilar to years past when myself and coworkers would administer tylenol and get the order later (not within our scope of practice). Or nitroglycerine SL to certain cardiac patients who didn't currently have an order for it.

Now. . . Please do not chastise me for the tylenol and NTG thing. I KNOW it was not appropriate (now), but it's an example of how what done commonly may not have been in alignment with our scope of practice. And yes, our managers knew about it and would give us guidance (don't give NTG for chest pain to patients that are here with neurosurgical issues, call the neurosurgeon first).

downsouthlaff, LPN

1 Article; 317 Posts

Specializes in Nursing Home.

Lousiana is one of the states where LPNs have the widest scope of practice. Don't know how true this is but from what I'm told LPNs in southern states are permitted to do much more than LPNs/LVNs in northern states ? Maybe just a general stereotyping. I do know this though, everytime you read a generalized national job description of an LPN, you see things like "LPNs provide basic care such as bathing, feeding, alchohol rubs, enemas, V/S, and inserting and monitoring catheters, and in some states LPNs may be permitted to initiate IV therapy and administer medications,". Question? Do those states exist up north where LPNs can't administer medications [emoji15][emoji15]?

Horseshoe, BSN, RN

5,879 Posts

Apparently, scope of practice is often a matter of interpretation and different facilities interpret things differently. I did work at one facility that had expanded LVN's skill list in regards to CVLs. It went that way for about a year. I guess someone decided to check with the State Board. Game over, State Board says (and I paraphrase): "You're doing what?".

So just because an LVN could do XYZ in whatever facility in whatever year, does not make it the final word on if that was within their scope of practice.

A facility may limit the scope even more so than the NPA, but the facility absolutely may not expand the scope of any nurse, whether LPN or RN, beyond that given by the Nurse Practice Act. In Texas, the body who interprets the NPA, and who can make or break a nurse's career, is the Texas BON.

Note that these are interpretations of the NPA of Texas by the Texas BON:

https://www.bon.texas.gov/practice_bon_position_statements.asp

*The LPN cannot function independently-they must be under the supervision of a RN, APRN, physician, or podiatrist.

While LPNs may do focused assessments, they cannot do comprehensive assessments.

The LPN cannot initiate care plans.

The LPN cannot do phone triage unless they have detailed "scripts" to utilize (https://www.bon.texas.gov/faq_nursing_practice.asp#t15)

The LPN cannot do medical triage in the ER

The LPN cannot pronounce death.

The LPN cannot engage in venipuncture or IV therapy without getting post licensure training.

The LPN cannot start PICC lines.

The LPN cannot give drugs via epidural or intrathecal catheters, nor can they "manage" those catheters (but can care for patients who have them).

The LPN cannot administer to or monitor patients receiving moderate sedation.

Delegating tasks to unlicensed assistive personnel (UAPs) is beyond the scope of practice for LVNs; however, LVNs may make appropriate assignments to other LVNs and UAPs according to 22 TAC § 217.11(2).6

*It is not appropriate and is beyond the scope of practice for a LVN to supervise the nursing practice of a RN.

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These are some pretty strict restrictions placed on LVNs by the State of Texas that go far beyond the "just can't hang blood" myth. But that leaves a WHOLE lot of things LVNs can do and do with expertise on a daily basis. If I were an LVN in Texas, I would definitely go for the RN because it's not that much extra time, and would result in a pretty good pay raise. LVNs are seriously underpaid, from what I've heard.

the way I try to look at it: jobs and scopes are different. Value and importance is equal.

I love talking to RNs who were LPNs. Soon that will be me.

Here is a great example!

Charles Plumb was a US Navy jet pilot in Vietnam. After 75 combat missions, his plane as destroyed by a surface-to-air missile. Plumb ejected and parachuted into enemy hands. He was captured and spent 6 years in a communist Vietnamese prison. He survived the ordeal and now lectures on lessons learned from that experience.

One day, when Plumb and his wife were sitting in a restaurant, a man at another table came up and said, You're Plumb! You flew jet fighters in Vietnam from the aircraft carrier Kitty Hawk. You were shot down!”

How in the world did you know that?” asked Plumb.

I packed your parachute,” the man replied. Plumb gasped in surprise and gratitude. The man pumped his hand and said, I guess it worked!” Plumb assured him, It sure did. If your chute hadn't worked, I wouldn't be here today.”

Plumb couldn't sleep that night, thinking about that man. Plumb says, I kept wondering what he might have looked like in a Navy uniform: a white hat, a bib in the back, and bell-bottom trousers. I wonder how many times I might have seen him and not even said Good morning, how are you?' or anything because, you see, I was a fighter pilot and he was just a sailor.”

Plumb thought of the man hours the sailor had spent on a long wooden table in the bowels of the ship, carefully weaving the shrouds and folding the silks of each chute, holding in his hands each time the fate of someone he didn't know.

Now, Plumb asks his audience, Who's packing your parachute?” Everyone has someone who provides what they need to make it through the day. Plumb also points out that he needed many kinds of parachutes when his plane was shot down over enemy territory-he needed his physical parachute, his mental parachute, his emotional parachute, and his spiritual parachute. He called

on all these supports before reaching safety.

Sometimes in the daily challenges that life gives us, we miss what is really important. We may fail to say hello, please, or thank you, congratulate someone on something wonderful that has happened to them, give a compliment, or just do something nice for no reason.

As you go through this week, this month, this year, recognize people who pack your parachute.

TiffyRN, BSN, PhD

2,315 Posts

Specializes in Nurse Scientist-Research.
LVNs are seriously underpaid, from what I've heard.

I quoted the above as what I think helps us understand why sometimes scope is interpreted differently.

I think you misinterpreted some of my intent. I have no disrespect for Texas. I have extensively reviewed their NPA and it seems far more specific than other States'.

The message I intended to communicate is you can't necessarily trust your facility to watch out for your scope.

It might be to their (financial) advantage to allow an LVN to perform skills that might not be in their scope. Such as the situation I described where LVN (actually LPNs in that State) were allowed to perform CVL related tasks that turned out to not be ok when someone bothered to check with the BON.

I don't know this for sure, but I find it likely that some med/surg units were able to change their staffing mix to be all LPNs except the charge RN, and save a whole lot on nursing costs.

Horseshoe, BSN, RN

5,879 Posts

I quoted the above as what I think helps us understand why sometimes scope is interpreted differently.

I think you misinterpreted some of my intent. I have no disrespect for Texas. I have extensively reviewed their NPA and it seems far more specific than other States'.

The message I intended to communicate is you can't necessarily trust your facility to watch out for your scope.

It might be to their (financial) advantage to allow an LVN to perform skills that might not be in their scope. Such as the situation I described where LVN (actually LPNs in that State) were allowed to perform CVL related tasks that turned out to not be ok when someone bothered to check with the BON.

I don't know this for sure, but I find it likely that some med/surg units were able to change their staffing mix to be all LPNs except the charge RN, and save a whole lot on nursing costs.

Oh, I believe you. I'm sure there are just some facilities where LPNs are tasked with things beyond their scope simply because they don't know any better. And at others, it's a willful deception.

The Texas BON has done a better job than most imo in clarifying just exactly what they interpret the scope of both LVNs and RNs to be.

NurseNHowell

93 Posts

In Texas,

I've seen posts regarding an LPN's inability to push IV meds or even start IVs, both things LVNs do in Texas except for very specific drugs

We can't spike a blood bag or do the first 15 minutes of monitoring, but everything else wrt blood transfusions is within our scope. We (well, any facility employee) can receive blood from the lab, monitor vitals, and complete the documentation.

We can't do an initial admission or post-op assessment, but we can do the interview and history.

We can't pull blood from a PICC line/midline or access/de-access a port-a-cath, but we can administer meds and fluids through both.

In California I can start an IV but only hang IV hydration(no meds/minerals/vitamins) and no IV pushes but I CAN HANG BLOOD! I can't touch a PICC/midline/port-a-cath even for meds or blood.

Here I am no longer allowed to assess a patient since legislation changes. I think it's complete crap but whatever. Since I am not allowed to assess a patient I now refuse to hang blood. If I am not allowed to assess for an adverse reaction then I have no business monitoring them during a blood transfusion I am doing. I have been written up for it and I won't sign it and I've taken it to HR. I have had my Director try to argue that I am fully competent to do it which I am but the assessing part leaves my license liable. When doing an admission or while working my assessments are "data gathering" so during an adverse reaction are they expecting me to then bring the RN my "data" to determine what I should do? No! I am expected to use my nursing education and critical thinking to make the appropriate interventions which if I was in court I would not be permitted to say I assessed the patient and determined they were having ____ reaction and required ______ immediate intervention. I would be required to say I looked at the patient and it looked like _____ reaction so I did _____ then waited for my RN. Nope and nope. Majority of the time the RN isn't just wandering the halls twiddling their thumbs waiting for me to need their help. I shouldn't be performing something I am not legally allowed to assess and intervene with life threatening adverse effects.

I worked too damn hard for that license to lose it to legislative BS

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