The Roll of a LVN in California Hospitals.

[Weebee]

I was recently let go from my position as LVN on the Med/Surg floor. A few days after I was let go, I was told by someone in HR, that the hospital is trying to fire all the LVN's for any reason they can.

This year they also said they would no longer employ LVN's inside the hospital.... This is the 4th hospital in my area to remove and never again employ LVN...

In fact for me to find a job as a LVN in a hospital I have to travel over 100 miles from my current location.

My Question... As a Nurse in a hospital... what type of trends are you seeing when it comes to LVN's

Are they a dying breed or is it just in California this is happening?

[Weebee, LVN]

I wish that hospitals in Arizona all used LPNs. I think they would be a great help.

Funny thing.... After working as a LVN, I have said when I get my RN I will not work for a hospital that hires LVN's

If you have never worked "Team Nursing" its not all what its cracked up to be IMO....

With team nursing my hospital requires each "NURSE" be it LVN or RN gets 4-5 patients... However, since the RN must be the "Primary Care Giver" They put the LVN and RN on the same "Team"

This means the RN now has 10 patients to be responsible for.... The LVN, also has the same 10 patients... but the LVN is still required to do all the things they did for the 5 patients but with all 10 now... pass meds... admits and discharges etc. Same goes for the RN but only pass the IV meds... but chart on all 10 instead of 5..

Basically the work load for the LVN gets doubled... They also removed the CNA because "you now have 2 nurses instead of just a Nurse and a CNA" --- Although the RN no longer gets vitals and passes PO Meds, they must now keep track of 10 patients instead of just 5"

It gets to the point were you just have way to many patients and not enough time.... this is why they are pulling LVN's from the local hospital.. They find that to pay say 3 RN's and one CNA for 15 patients is better than 2RN's and one LVN.

I tend to agree... its much easier to give better care to 5 patients than 10 even if you have help from another nurse.... If you disagree... next time you go to work.... talk to another RN and share her patients with her for the day...

[Amanda1985]

Weebee: I am completing a RN Internship at a hospital in California. There are LVNs working on the floor. Each RN and LVN get 4-5 patients each. There are 3 or sometimes 2 CNAs. The RN has to cover for the LVN for IV meds and anything that requires assessment. Usually when I work there is 1 LVN so his/her patients are divided among all the nurses. So as the RN I usually have my 4-5 patients and sometimes 1 of the LVN's patient to cover.

[mandykal, ADN, RN]

I am moving to Ca this summer, and I would like to know what Hospitals' in Ca is hiring LVN's?

[NurseCubanitaRN2b, BSN, RN]

It all goes back to cost effectiveness. Having LVNs and CNAs in the hospital setting isn't cost effective so therefore most go primary care. It's cheaper to have all RNs doing primary care with only 5 patients. IMO, that's more than a full load for the RN because he/she is expected to do ALL THE PATIENT CARE. Just think of the CNA who is having to take care of 8 patients doing just the basic bedside care, and that's very hard. The RN may have only 5 patients to care for but the RN does the CNA, LVN, & RN work. So this type of primary care is only cost effective, and it's not patient friendly. LVNs and CNAs are needed in the hospital. If the staggered the patients correctly they can assign LVNs the less acute patients. I love being a LVN but we have no business taking care of a patient who is on IV push meds. Pushing IV meds takes time. Assign that patient to the RN. Assign the LVN the patients who are about ready for discharge, who don't have complex IV issues or no IV. In CA we can hang blood so it would be ok to assign the LVN that patient. The one who makes the assignments doesn't seem to know how to divide the groups properly. The Charge nurse is responsible for the whole floor anyway they can do the initial assessment on the patients that the LVN is assigned to. Having a LVN on the floor isn't hopeless. Some RNs feel that they don't want to be responsible for the LVNs patients, but guess what, they're the RN and IT'S THEIR JOB to be responsible for those patients. If they don't want that type of responsibility then maybe being a RN isn't for them. Team nursing can work if it's done properly, and is also more patient friendly than primary care. I worked in a hospital where we had team nursing. It was they way it should have been done. The Charge was assigned a group with 2 LVNs and the charge did the initial assessments on the pts. Most of the time the 2 LVNs were assigned the less acute patients, but sometimes they were assigned those with complex IV issues and the Charge handled the IVs. The LVNs ended up being the primary care giver but the charge went in there when needed. They still had a CNA taking the vital signs because the LVN was the primary care giver while the RN was still available as needed. It seemed to work that way and there were no complaints from anybody except for your usual busy busy busy days.

[Weebee, LVN]

Weebee: I am completing a RN Internship at a hospital in California. There are LVNs working on the floor. Each RN and LVN get 4-5 patients each. There are 3 or sometimes 2 CNAs. The RN has to cover for the LVN for IV meds and anything that requires assessment. Usually when I work there is 1 LVN so his/her patients are divided among all the nurses. So as the RN I usually have my 4-5 patients and sometimes 1 of the LVN's patient to cover.

My hospital also worked this way... until they got sued by a RN claiming when the LVN took care of her husband the LVN did most of the documentation thus showing she was the Primary Nurse as all the RN did was the assessment and IV meds.

Supposedly the ratio laws state the RN can only be responsible for no more than 5 patients on a non tele med/surg floor. (If anyone can direct me to that that would be great). Based on that law... our management made a change and forced the LVN and RN team to take on 8 tele or 10 non tele patients depending on how the assignment was played out. This of course as I stated before now doubled the work load of the LVN and although cut a lot of work out for the RN, forced them to do all the charting and be responsible for all patients. This has gotten so overwhelming for both RN and LVN, that the hospital has lost half of its nursing staff since Aug 2010.

Again... it got so bad.. im not sure I want to go back into nursing. (im currently unemployed)

[Weebee, LVN]

I am moving to Ca this summer, and I would like to know what Hospitals' in Ca is hiring LVN's?

DITTO

I need a new hospital

[Weebee, LVN]

It all goes back to cost effectiveness. Having LVNs and CNAs in the hospital setting isn't cost effective so therefore most go primary care. It's cheaper to have all RNs doing primary care with only 5 patients. IMO, that's more than a full load for the RN because he/she is expected to do ALL THE PATIENT CARE. Just think of the CNA who is having to take care of 8 patients doing just the basic bedside care, and that's very hard. The RN may have only 5 patients to care for but the RN does the CNA, LVN, & RN work. So this type of primary care is only cost effective, and it's not patient friendly. LVNs and CNAs are needed in the hospital. If the staggered the patients correctly they can assign LVNs the less acute patients. I love being a LVN but we have no business taking care of a patient who is on IV push meds. Pushing IV meds takes time. Assign that patient to the RN. Assign the LVN the patients who are about ready for discharge, who don't have complex IV issues or no IV. In CA we can hang blood so it would be ok to assign the LVN that patient. The one who makes the assignments doesn't seem to know how to divide the groups properly. The Charge nurse is responsible for the whole floor anyway they can do the initial assessment on the patients that the LVN is assigned to. Having a LVN on the floor isn't hopeless. Some RNs feel that they don't want to be responsible for the LVNs patients, but guess what, they're the RN and IT'S THEIR JOB to be responsible for those patients. If they don't want that type of responsibility then maybe being a RN isn't for them. Team nursing can work if it's done properly, and is also more patient friendly than primary care. I worked in a hospital where we had team nursing. It was they way it should have been done. The Charge was assigned a group with 2 LVNs and the charge did the initial assessments on the pts. Most of the time the 2 LVNs were assigned the less acute patients, but sometimes they were assigned those with complex IV issues and the Charge handled the IVs. The LVNs ended up being the primary care giver but the charge went in there when needed. They still had a CNA taking the vital signs because the LVN was the primary care giver while the RN was still available as needed. It seemed to work that way and there were no complaints from anybody except for your usual busy busy busy days.

If you ask me, the LVN should be use much like a CNA is used... as a HELP to the RN .... LVN's should not be assigned any one or five patients... they should assist the RN's on the floor ... The problem here is the LVN would need to be given the report on the entire floor (I took a nursing report as a CNA for the entire floor as I wanted to know which were the more critical patients, total care, feeders, etc). I would go as far as saying here that a LVN should replace EMT's and CNA's in the ER and Med Surg floor... as they can do more to help the RN than either the EMT or CNA... but again should not directly be assigned any patient.

I honestly believe this is how a LVN should be utilized in a acute setting and it is a win win for the RN.

One problem i do see, is the LVN will no longer be held to the higher standard than a CNA in the eyes of a RN... another words we will be look at far more inferior to a RN than we currently are. Some of us Nurses can be down right ugly to the CNA's.

[NurseCubanitaRN2b, BSN, RN]

Although I do respect your opinion Weebee, I have to disagree with it. The LVN shouldn't be used just as the CNA. The LVN has a scope of practice that they can function under and it's bigger than that of a CNA. There are many things that we can do as a LVN that a CNA can't do. There are many things that the RN can do that we can't do. The RN is the charge and oversees all the nursing staff from CNAs-RNs. Therefore we are all of HELP to the RN, that's what team nursing is about. I can tell you that a lot of RNs can't function on primary care. Some either refuse to do direct basic bedside nursing care, or they just don't have the time because 5 patients really is a lot for them to care for on their own. They need the LVNs and CNAs to assist them with their work. But the LVN shouldn't be utilized just as a CNA we can do a lot of nursing tasks that CNAs can't do. The LVNs are nurses too, that's why we are LICENSED VOCATIONAL NURSES.

[herring_RN, ASN, BSN]

I know of a step-down/telemetry unit that uses experienced LVNs. The LVN is assigned to one or two RNs to help with tube feedings, suctioning, multiple dressing changes and to share medication administration.

The "team" is on RN to 3 or 4 patients and an LVN OR 2 RNs to 6 or 8 patients and an LVN to help with all patients.

The RN is responsible for ongoung assessments, the care plan, teaching, and such.

If not for the LVN these RNs would not be able to care for the maximum number of patients the ratio allows. These RNs would go as a group to protest the unsafe assignments on behalf of their patients but at least one LVN is scheduled every shift. If no LVN is available a float or registry RN is sent.

It works well because these nurses have been friends for years.

[Music in My Heart]

We have a few LVNs but they were hired back in the "shortage" days. Now, only RNs are hired for m/s, ER, and OR.

I know of a couple of hospitals who still hire LVNs but for the most part, they're moving (or have moved) toward all RNs.

[herring_RN, ASN, BSN]

I think hospitals don't want to pay for an LVN unless they can substitute him or her for an RN. It is unfair to the patients and the nursing staff.

Sometimes they expect an LVN to function as an RN but not the pay of an RN. This risks the LVN license.

[Music in My Heart]

I think hospitals don't want to pay for an LVN unless they can substitute him or her for an RN. It is unfair to the patients and the nursing staff.

Sometimes they expect an LVN to function as an RN but not the pay of an RN. This risks the LVN license.

I occasionally work with the LVNs and I really don't like it. It's not that they're not good nurses - they are. The problem is that their patients are still *my* patients on the record. I have to initial their assessments and sign off on their charting. It's silly, of course, because they are perfectly capable of doing things themselves but given the legalities, I - as the RN - am ultimately responsible. I'm also the one who has to do their pushes, hang their abx, etc.

Overall, I would far prefer to work only with other RNs since they do not add to my responsibilities or liabilities.

Please, everybody, before you flame me, make sure that you're understanding me... I'm not belittling or denigrating the LVNs - I'm simply saying that I don't want to assume responsibility for another nurse, especially one who really doesn't need (or want) my oversight.