I work on a stepdown surgical unit that uses a 70/30 RN/LPN mix. We are trying to work out a policy of what gtts the LPNs can take (or can't and why not) and I'm looking to see what others are doing in their practice. We use a lot of Nipride and Esmolol and the LPNs don't take those patients, but there are some grey areas, such as PGE and titratable insulin drips. Does anyone have any policies and practices based on the following?
PGE
Insulin
Octreotide
Lasix
Dopamine (titrating vs. renal dose)
Fenoldopam (renal dose)
Thymoglobulin (not a drip, med w/ high adverse reaction rate).
To clarify further, our state code is vague and simply states that the LPN provides care under the supervision of the RN, MD, etc.
The hospital policy is just as vague as to LPN and RN scope of practice, so it's up to individual units to devise policies. Thanks in advance for everyone's help. MMB
I'll try to clarify...LPNs are operating on their license and they must take competencies and continuing hosp. education to practice in a given area. That being said however, statutorily the RN or MD, etc. must supervise the LPN in their practice. That means delegating appropriate patients and changing assignments when patients become unstable, which is difficult to do at times. It becomes even more difficult if the LPN was deemed competent to perform a given task, then failed to accomplish it...she would be responsible, but the RN potentially gets pulled into it as well b/c she should have been supervising to ensure it was done, done correctly, etc. If I "redelegate" this to my NM, there is a concern that LPNs will suddenly be taking new gtts after taking "competencies" and I'm concerned that this may be a variance from the scope of practice from the national standards (or whatever standards I can glean from this board). Taking my bar exam next year is looking better all the time :). Thank you for the sites, I'll be reviewing them. MMB
First Thank You for a well written, and well thoughtout presentation, on your unit's dilemma with this situation. I can understand your concern, and the frustration you're feeling. I agree that it might be a good idea to bring in the MDs in on this. I also think that maybe the policy could be worded to hold each LPN who takes and succeeds at passing the competencies, acountable for the performance of the skills they have supposedly acquired.
I have read Nurse Practice Acts, which state, that the LPN is responsible for the skills they have acquired, and have documented compentencies. and will be held accountable for the preformance of said skills. To me it would seem to be the same as holding them accountable for any med, and or care they would give.
But then again, you're correct in saying the RN could be called into account, for not properly supervising the LPN for the care she has delegated. This is really a no win situation in many respects. Plus you must worry about the one time an LPN who normally preforms well, makes a mistake, or just is careless in the preformance of the skills delegated.
What I'm wondering is, have you contacted your board of nursing for guidance on this problem??? I think that is where I would go, as they have the resources, and the ability to give the best information, and or direction on the development of such policies. I mean isn't that one of their functions???
How do the LPNs feel about taking on these new requirements being added to them????
The majourity of the LPN's are new to nursing and are dealing with adjusting to caring for stable patients...they still need experience and education to move away from simply "performing tasks" to understanding why they do what they do and be able to analyse the whole situation. This is not limited to the LPNs however, as we have a small senior staff and a great deal of new grads, mainly RNs with the same issues. I am awaiting a response from the BON...but as I've said previously, I don't hold out much hope since this particular state dislikes regulations and the BON in the past shifts the issues to the institution. MMB
I'm sorry MMB, I must have missed your posting on how unhelpful your BON was, as it seems we were both posting at the same time. I sincerely hope you find a solution to your problem, that will give your patients, and your new staff the best outcome.
Brownms46
2,394 Posts
First Thank You for a well written, and well thoughtout presentation, on your unit's dilemma with this situation. I can understand your concern, and the frustration you're feeling. I agree that it might be a good idea to bring in the MDs in on this. I also think that maybe the policy could be worded to hold each LPN who takes and succeeds at passing the competencies, acountable for the performance of the skills they have supposedly acquired.
I have read Nurse Practice Acts, which state, that the LPN is responsible for the skills they have acquired, and have documented compentencies. and will be held accountable for the preformance of said skills. To me it would seem to be the same as holding them accountable for any med, and or care they would give.
But then again, you're correct in saying the RN could be called into account, for not properly supervising the LPN for the care she has delegated. This is really a no win situation in many respects. Plus you must worry about the one time an LPN who normally preforms well, makes a mistake, or just is careless in the preformance of the skills delegated.
What I'm wondering is, have you contacted your board of nursing for guidance on this problem??? I think that is where I would go, as they have the resources, and the ability to give the best information, and or direction on the development of such policies. I mean isn't that one of their functions???
How do the LPNs feel about taking on these new requirements being added to them????