Skills

I've been floating around allnurses.com for a few days now and think something's fascinating. When I went to school in 1978 we had a very cursory overview of a few things that since have become part of the RPN programme here in Ontario. We old girls have had to upgrade of course. But there is such variety in what the RPN/LPN/LVN's here do regularly.

Want to do a thread where we discuss our location and what tasks we are regularly assigned?

In rural Ontario I ... give meds (not IV), I can monitor and discontinue an IV but not flush the lock. Dressings but not packing. Insert and deal with urinary catheters, remove sutures and drains ... and of course personal care. That's all I can think of off the top of my head.

Anyone else?

Cincinati, Ohio

Long list so I will try to make it orderly:

• personal care of course
  
• foleys and st caths
  
• trach care (including changing if needed)
  
• G-tube care and feed, flush, sx, asp, etc.
  
• NG just as G-tube
  
• Drains (nurses do not remove chest tubes but do care for them)
  
• dressings (no restriction as to packing, meds, etc)
  
• sutures (though it's rare that one of our ortho pts has any and the staples stay in past discharge)
  
  
• Meds
  
  
• PIV solutions and antibiotics (Ohio has a rather lengthy, odd IV and LPN policy)
  
  
• CIV "simple" solutions only.
  
  
• Treatments - I can't think of any treatment that LPNs are not allowed to provide to their pts. (this does not include some "unit" treatments/procedures that are not performed by any nurse on the floor.)
  
  
• Update the care plan.
  
  
• Pt. Teaching (on my floor, it's usually anticoagulant tx, pain control and reinforcing PT teaching, walker walking with new hip/knee, etc.)
  
  

With the exception of CIV and IV push and of course "charge duty" the LPNs in my hospital care for their pts and accept total responsibility for our pts just as the RN staff nurses do.

Just as I would answer a call light and give pain med PO or IM to one of my co-workers pts, my co-workers will give my pts IVP meds for me.

Now, if Ohio will just catch up with Colorado and others and expand the LPNs role in IV therepy to include CIVs and IVPs. Ohio is soooo slow to catch on and they will never give LPNs credit for what we really are worth!

We are not be RNs, but the average pt (not in one of the special care units) can be cared for quite competantly by most LPNs.

Oh, but that's my soap box and I'm not going to go to that here.

I read somewhere on allnurses.com that in some areas, only RN's do nursing assessments. We do that too, even initial assessments and care planning. I forgot tube feeds. Everybody is supposed to teach and document that we did. But you do a lot more with IV's than we do.

I read somewhere on allnurses.com that in some areas, only RN's do nursing assessments. We do that too, even initial assessments and care planning. I forgot tube feeds. Everybody is supposed to teach and document that we did. But you do a lot more with IV's than we do.

We do have to take an IV therapy course before we can do anything more than regulate flow.

We start PIVs, hang NS, LR, D5, 1/2NS or any combination of them

We start antibiotics

For PIVs with MVI, K, etc in them, an RN must hang the first bag but we do hang subsiquent bags.

We also do restarts...but that goes along with starting.

In Ohio we can not hang blood, but as always, we do monitor and stop. We also can not give any IVP meds.

The only thing we can do with PICC or other CIVs is monitor/adjust flow rate.

I work with several RNs who think the PICC/CIV rules are just rediculous. Nobody could act fast enough, RN, LPN or even MD to make a difference in the maybe 10 or 12 seconds difference in time to reach circulation up the arm. And to think it's becuase of the postion and possibilities of infection, bleeding, etc. Well, CNAs and PCAs provide care and they are just as likely if not more likely to run into a disconnected line. The rationale just doesn't follow through. It's like the BON decided they have to keep LPNs from being 100% useful to med-surg and other non-critical areas of the hospital by restricting procedures that just don't make sense to restrict.

Oh well...there I go again.

LVN responsibilities

Here in TX, LVN's are allowed to (at my hospital)

Pass all meds

Administer almost all IV push medications (including Dig, Cardizem, Lopressor, Lasix, Narcan, Protonix, etc.)

Hang all IV fluids (NS, LR, D5, etc)

Hang IV Piggy Backs

Monitor certain IV drips (Heparin, Cardizem, Lidocaine--all the one's that our floor takes, we can watch)

PCA Pumps

Foley's

Dsg Changes

We can pack and change picc lines and central lines

We can remove chest tubes

We can remove EJ's but RN must remove PICC, IJ, etc.

We can insert NG tubes

Start/DC IV's

Pack lines with heparin

Take care of vent/trach patients

RN must spike blood but we can be witness and we can monitor

RN must do initial assessment.

etc....

Basically only difference between RN and LVN responsibility on my floor is initial assessment, blood, and removal of PICC lines. Everything else LVN's are allowed to do. I work on a Cardiac Intermediate Floor, on the medical floors, LVN's are a little more limited on what they can give IVpush (no cardiac drugs) and no drips because other floors don't take drips or ventilator patients. Other than that I think it's across the board for the hospital, but you can go 5 minutes to another hospital and not even be able to start an IV as an LVN.