Scope of Practice for LPN

[anononurse]

I have checked my state BON re: scope of practice for LPNs, and in general find things a little vague on certain subjects. I understand that an LPN can hang a pre-mixed IV med, but can an LPN w/IV certification mix the IV med as well? Some LPNs on our floor say they can, others won't do it. The BON site does not address this.

[TheCommuter, BSN, RN]

The LPN scope of practice varies from state to state. Some states, such as Ohio and Pennsylvania, have very restrictive LPN scopes of practice. Other states, primarily the Southeastern states, have wide open scopes of practice. Therefore, it would help if we knew which state you were referencing.

My state of residence (Texas) has a purposely vague LPN/LVN scope of practice which permits the individual facilities to determine how little or much IV therapy their LPNs perform. Some hospitals allow LPNs to give meds via IV push, mix IV meds, etc.

[caliotter3]

If you can communicate with your Board, someone there should be able to answer your question directly, provided you can get in touch with anybody. In my state LVNs can not give IV meds nor mix meds. Since rules differ from state to state, it is important to get an answer on this. Another possible resource would be someone who is an instructor at an IV cert course.

[picurn10]

I'm in LPN school in the south and in my state we can do IV's, but not IV push, we can hang blood dependent on facility policy. We can't do the initial assessment or create the care plan. As far as I know those are about the only restrictions. I think it varies a lot from state to state and from facility to facility. I know just in my city, we're allowed to do NG tubes, but some hospitals don't allow it, some allow LPN's to hand blood and other's don't. Before starting LPN school, I'd always planned on going for my ADN or BSN and I didn't realize just how much LPN's can do in my area. I had the misperception that LPN's were just a bit more knowledgable than CNA:rolleyes: I learned quickly that's not the case and decided to get my LPN and bridge into RN after graduation.

[nerdtonurse?, BSN, RN]

At my shop, all I can't do is initiate a care plan, and a RN has to validate my assessments on a new admission. I had to take a TON of classes when I was hired, and the floor I'm on is what determines the meds allowed; we can't hang insulin drips or certain cardiac meds, and others we can maintain once they've been titrated in ICU or ER first. The hospital down the road, the LPNs can't spike blood, and all the RNs do is walk in, spike the bag, and tell the LPN to do the initial monitoring. I can start IVs all day long, they have an IV team that does theirs. It really is facility dependent in my state.

[nickola]

I've found the BON scope of practice for LPNs to be vague as well. I wish that they had national guidelines for scope of practice, rather than state to state and facility policies. I have worked w/LPNs that graduated from the same school who had different ideas of what their scope of practice is! I don't see how this can be safe.

[pagandeva2000, LPN]

If you can communicate with your Board, someone there should be able to answer your question directly, provided you can get in touch with anybody. In my state LVNs can not give IV meds nor mix meds. Since rules differ from state to state, it is important to get an answer on this. Another possible resource would be someone who is an instructor at an IV cert course.

I've found the BON scope of practice for LPNs to be vague as well. I wish that they had national guidelines for scope of practice, rather than state to state and facility policies. I have worked w/LPNs that graduated from the same school who had different ideas of what their scope of practice is! I don't see how this can be safe.

I think it is best to contact the BON of your state to inquire, and make sure that you keep copies of it for future reference, if needed. My BON is very approachable-most times, they have answered my questions within 24 hours and they also send me files to keep regarding my inquiries. Also, the facility itself may have more restrictive policies for their LPNs. Just keep in mind that the facility can limit what they want, but they cannot supercede the BON. And, make sure that you keep a copy of the policies and procedures of your place of work and compare it to the BON.

[TiredMD]

It's good to know that I'm not the only one confused about LPN scope of practice.

I once had an LPN tell me that she couldn't witness a surgical consent; only RNs could do that.

I just had the patient's wife witness instead . . .

[pagandeva2000, LPN]

it's good to know that i'm not the only one confused about lpn scope of practice.

i once had an lpn tell me that she couldn't witness a surgical consent; only rns could do that.

i just had the patient's wife witness instead . . .

while each state does work differently, i have to say that i believe this nurse is full of sugar honey ice tea. hate to say it, but some lpns also try to hide behind "only the rn can do that...". once, in my clinic, a physician went to one of our laziest lpns and asked her to administer clonidine to a patient and she told her "lpns don't give clonidine". now, it can very well be that at your place of work, that lpns cannot witness consents and this lpn may, in fact, be telling you the truth. i may be speaking too soon, but as an lpn that does care about what i do, i am especially angry when i see some of them that play games. okay...i am off of the soap box, now...:spbox:

[nerdtonurse?, BSN, RN]

We get a lot of the "I can't do that" when we get new hires from other hospitals. One reason I chose the one I'm at is I get a wider scope of practice (and therefore, learn more). I've heard in some states, an LPN is pretty much limited to FSBS, vitals, and PO meds.

The only time I've "hid behind my title" was when we had a surgeon that we all called "Dr. Death" who wanted me to pull the staples out of an abdominal resection patient -- I'd called him to see the patient because every time this patient took a breath, you could see the skin pucker open between the staples, pt's temp and WBC were going up, and you could SMELL infection from the guy's gut. So, Dr. Death tells me to pull out ALL the staples -- not even pull out one and see what happens, just go ahead and remove them all. I told him "no, sir, I'm an LPN and pulling staples out of an unstable patient is beyond my scope." (no idea, but it sounded better than what I was thinking, which was, "you're not pinning this #*@! on me when Mr. X's guts hit the bed.") He screamed and yelled at me, I stood my ground. He got a RN he'd been having an affair with to yank the staples, and you guessed it, the pt dehisced and then eviscerated. Thank GOD that surgeon's not here anymore...

[classicdame, MSN, EdD]

What does your facility policy state? If it is not clear, then address it with the Chief Nursing officer.

[kpnurse16]

As others have said each state is different. In Virginia each facility is different. The state law is very vague. I have done alot. Heparin, Dobutamine, Cardizem, blood, platelets, all salines, PCA (morphine & dilaudid), piggybacks and IVP. My friends in Cali that are RNs haven't done the things I've done. My advice is know your state and facility policy. Know your limits! I stop and read about the drug know what it does and know the dosage it must be delivered, review the orders! Don't take what the nurse before you has it at or has done. Be safe!!!!