The use of LPN's in ICU CCU

[RNParamedic911]

Earlier today I was read some old threads on this site about the use of LPN's in the ICU CCU and I have to say that most of the comments from the R.N.'s were unprofessional and down right rude. I have been an RN for 26 years now along with being a Registered Paramedic. I started out at age 20 as a G.N. on a medical surgical unit working night shift as the only R.N. for 45 patients. I worked with 4 LPN's and 1 NA. I was also a new Paramedic as same time so I had somewhat of clue how to start an IV and give meds, assess patients quickly. The L.P.N.'s taught me how to be an awesome nurse on the medical surgical unit doing Team Nursing. Granted I was the new RN in charge but those LPN's could run circles around any new RN. I went to work in the ICU after two years of med-surg to which had LPN's as well doing Primary Nursing with their own patients. 1990 The LPN's in the ICU were some of the best nurses I ever worked with and they held their own just fine. I was grateful to have some of the LPN's teach me the tricks of the ICU and made me feel right at home. Working in Critical care and the Emergency Dept now for 26 years I can tell you I would take an LPN any day over todays new Grad/RN. LPN's are still taught bedside clinical nursing which is key. The new Grad of today mostly BSN track are the worst nurses on the planet. We need to get back to the bedside and be nurses with a team delivery system where the RN and LPN have their respective roles and display mutual respect nurse to nurse. Kudos to the LPN's in the world and the RN's who support them. We are all Nurses! This nurse is a graduate of a 3 year RN diploma program with additional degrees obtained later along the path. The thread I read today made sick to think the RN's would make such nasty comments about the use of LPN partners in the ICU.

Just felt I needed to give Kudos to those LPN's who are still in the game. If everyone would work together and follow scope of practice issues legally we could deliver high quality care. Respectfully, RNParamedic911, RN,BSN,MS,CEN,CPEN,CCRN,CFRN,NREMT-P, RN-C

[ktwlpn, LPN]

"this is the song that never ends,it goes on and on my friend , some people started singing it not knowing what it was and they'll continue singing it forever just because this is the song that never ends and it goes on and on my friend...."

As an LPN of 25 years experience in acute,long term and home care I am secure within my scope.In my experience it's others who are unfamiliar with the scope of an LPN who have issues. In my state I can't push IV meds so it does not make sense to put me in a critical care area.Unless it's full of folks waiting for beds out on the floors, I can handle them. The BSN v ADN debate will also go on forever......who has the energy?

[TheCommuter, BSN, RN]

I was an LPN/LVN for 4 years prior to becoming an RN. I wouldn't have wanted to work in critical care as an LPN or as an RN because, frankly, high acuity intimidates me. However, I extend my props and respect to all nurses at all levels of licensure who do their jobs well.

[sallyrnrrt, ADN, RN]

i have worked with some great LPNs in ICU, CCU, and ER

[CandiceNTexas]

RnParamedic, I thanked you because you are truly one of few advanced titled nurses who seems to recognize that the value of a nurse can't always be ascertained by the number of letters after their names!

I was a nurses aide for a few months, an LVN for 6 years, currently an RN for the last 12 years, and just now starting my BSN education.

My critical care preceptor was an LVN, and she was the most experienced ccu nurse on the floor at that time, with a total of 30 years of operating room, recovery room, open heart recovery, and critical care experience. Sadly, when our hospital tried for magnet status, she left, only to be replaced by baby BSNs, and it left a gaping hole, as she was a wellspring of information. Physicians would ask HER what to do next!

From this experience, I learned to open up and learn what I can from every nurse, and give freely what I know to anyone who asks.

[delphine22]

LPNs are awesome, and usually very experienced nurses. But in my state at least, the role of assessment belongs to the RN only. So the one or two times I've worked on a floor with an LPN, her team of 5-6 pts would have to be divvied up among the RNs on the floor, and we'd each take a pt, go in the room, and perform and document a full assessment. It was a lot of work -- perhaps that's why I don't see any in the hospital setting anymore here. I know a paramedic who just finished LPN school, and she intends to work home care.

[calivianya, BSN, RN]

We use LPNs in my ICU as resources, and I think that's fabulous. However, we have had a lot of turnover and LPNs have started taking patient assignments and I don't like it. Call me an awful person or whatever, but that is how I feel. Just last week, the RN assigned to the LPN had two unstable patients. Then, she had to be responsible for assessing the LPN's patient's, too.

Also, my job has these ridiculously time consuming protocols that one RN has to run and another has to verify before they can be implemented. LPNs are not allowed to touch the protocols at all. So, if an RN is taking care of a patient with a lot of protocols, it takes two nurses to get care done. If a LPN is taking care of a patient with protocols, it takes three nurses - one RN to run the protocols, another to check them, and then the LPN to implement. I think it fragments care. At least if the RN runs the protocols, checks them with another RN, and does the care herself, she knows why she is doing what she is doing. If the person who ran the protocols is too busy to go over them with the LPN and the LPN is too busy to go through the protocols independently herself, the LPN may not know how she got where she is in the protocol.

I fully believe LPNs are great nurses, but giving them assignments stretches the RNs really thin. We are talking about critical, unstable patients here - expecting one RN to assess three or four of them instead of two just because LPNs are not allowed to chart assessments themselves is ridiculous. And with LPNs taking the easiest patients (which is the rule here), we have the funny situation happening where the most stable patients have the most eyes on them and the most people assessing them. Isn't that a little backwards? Shouldn't we be giving the sickest patients the most attention instead of taking the RNs away from the sickest patients so they can assess someone else's stable patient? It just seems really unfair to the patients to me.

[Pinky89]

"The new Grad of today mostly BSN track are the worst nurses on the planet."

I find it hypocritical that you start your post expressing your disapproval of RNs who make comments that are "unprofessional" and "rude," then you make a generalized statement about new grad BSN nurses being the worst nurses on the planet. As a graduate from a BSN program, I find your comment offensive and rude. It shouldn't matter what school you went to, whether you have a diploma, ADN, or BSN degree, or how many titles you have following your name, what matters is that the patients get the care they deserve, and that we all work together to make that happen. Isn't that why we chose this profession?

[PacoUSA, BSN, RN]

Your blanket statement about new grad BSNs of today is disgusting. Way to lose some respect on here.

[CamillusRN, BSN]

Lost my vote with your blanket opinion of new-grad BSN's. On the other hand, I agree with your statement that LPN's deserve appreciation. I work with two in particular who are some of the best nurses on the unit, and one of them could easily fill the role of DON if she was willing to get her RN and take the massive pay cut (she makes more as a 20+ year LPN than the majority of the RN staff, including the current DON)

[icuRNmaggie, BSN, RN]

Is anyone here old enough to remember team nursing?

I did it for a year many years ago as a student and then as a new nurse. We had ten patients, an RN, an LPN and an aide. The RN managed everything IV related. The LPN passed all of the po meds and took the less complex patients. The aide answered call lights, took VS and was responsible for meal trays, call lights, water and the I & O. The RN cosigned the LPNs notes and did all of the admission assessments and careplans. It was a good system and the patients received excellent nursing care. Patients were clean, bathed, linens changed, fed, ambulated per orders and skipping the am bath and HS care was unthinkable. The ward clerk handled the phone and transcribing orders.

We had a whole half an hour for a break in the cafeteria too. There was no need for a rapid response team to rescue patients within a hospital. That was when floors were actually run by nurses, now, hospitals are run by everybody but the nurses. The BSN only / primary nursing push was just a ruse to slash staffing costs. I am feeling very jaded right now after reading about some new grad who was thrown to the wolves.

The nurses of twenty five years ago would be appalled at what is expected of a floor nurse in 2015.

I love it when we have an LPN in ICU to help with tasks. Their knowledge base, skill and nursing judgement is always an immense help.

[sallyrnrrt, ADN, RN]

ouch, 43.5 years here, yes I remember "team nursing" & yes we did a good job!