unworthy of an RN

[LisaG21]

Hey guys I have a question. I am an extern at one of the hospitals near my home, and I will be graduating from a BSN program in may. During my time as an extern I have witnessed a lot of acts done to patients that I feel are wrong, but I don't have a better way of handling the problem. I also have a LPN/RN issue if you guys could give me your help on these problems I would greatly appreciate it!

1. There is an LPN who has worked on my floor for probably 20 years. She does stuff that she is not allowed to do (IV push drugs, and so forth) as an LPN. I am new to the floor I have only been there 6 months. How do I handle this?

2. I was waiting to clock out, and I heard an RN ask a tech if she had turned someone in another room. The tech said she couldn't remember, and she went to go see who it was. The RN continued to say to me that she didn't turn the person because she has been in the same position since she came in! SO doesn't that make the RN just as bad?

3. We get a lot of Alzheimer patients. And we get our share of beatings and spitting and cursing at. Is there another way to settle these patients and not use restraints? I mean I understand when someone is hitting you with her cane and trying to break your arm you have to do what you have to do, but I feel that there are other options than to use restraints on some of these poor patients. Anyone have any ideas on how to calm a pt. or help them stay safe without the use of the restraints when they are in a rage?

[Dixiedi]

Thank You guys again!

First off let me say that the LPN is not to push medication. I know for a fact she is not certified to do so. Also it was not a heparin flush it was pain medication on two patients (morphine that was supposed to be put in a syringe pump) and I am not sure of the other medication. On one other occasion the lpn told me if the person was on comfort measures it did not matter if she pushed it or hung it. I didn't question it until I saw the other pushes.

Secondly I know that this cuold mean the end of my externship if I say something, however do I really want to work for a place that allows such behavior to go on?

Thirdly I think I have diecided that I am oging to write a letter annonymously to the nm. I will include everything - I know writting a letter will help me get everything out because if I just talked to the nm I will forget stuff because I would be so nervous. Should I put general ideas, or make it specific and put names and so forth in it?

Lastly I think I am going to start speaking up. When an RN has a problem with the work of another and it is just the RN being lazy. I will say well, she works under your liscense so maybe you should have done it.

Thanks again you made me think on another level about the situation

Oh gees, again, I will say the pts are probably in no danger, however, that LPNs license is!

I would first talk to the charge nurse. The person who is actually responsible for assigning an RN to the LPNs pushes. (Hell, you said the pain med was meant for a pump and she pushed it... yea, they are in danger. Darn, (and that's not what I was thinking, hehehe) you need to take this to the charge nurse immediately.

Keep yourself out of rear approaching bullets by asking a question like, I was unaware of parameters in which we are allowed to push pain meds when the order is for pump, can you point me into the correct direction to read that standing order policy?

Yea, the question itself makes you sound as if you have one of your three heads on upside down but at the same time you aren't attacking anybody or accusing anybody. My guess is somebody (one of the other RNs) is initially that med. Then it's your word against hers. You REALLY don't want to go there.

Years ago I pushed meds (hung in a drained nearly dry piggyback bag - ya got to clear the line of air don't ya? - of NS so they infused in about 3 minutes, technically they were not pushed) also hung TPN and blood and changed the dsgs on central lines all quite legally. But the rules they are a changin' and even if you were dong it at one time the new laws say you can't. Bummer, but that's how it is.

[CHATSDALE]

as an lpn we have in the past reinserted g-tubes and suprapubic catherters...a one point in time we began sending residents to er (from ltc) for these procedures.....i don't know if this was the company policy or if it was mandated from state..recently one of my co-workers has been doing the reinsertions and i am not sure if this is within the scope of what we should be doing...i know how and have done so many times in the past but i don't want to risk my license in doing so now...by the way the ownership of the the ltc is not the same....i do not want to go to don if this will get co-worker in trouble..kind of between a rock and a hard place

[Dixiedi]

as an lpn we have in the past reinserted g-tubes and suprapubic catherters...a one point in time we began sending residents to er (from ltc) for these procedures.....i don't know if this was the company policy or if it was mandated from state..recently one of my co-workers has been doing the reinsertions and i am not sure if this is within the scope of what we should be doing...i know how and have done so many times in the past but i don't want to risk my license in doing so now...by the way the ownership of the the ltc is not the same....i do not want to go to don if this will get co-worker in trouble..kind of between a rock and a hard place

I am still allowed to change G-tubes, trachs (that's bout all I ever run into to) so it may just be a facility policy. I your turn-over rate high? Could be they just got tired of not having anybody on duty with the experience. Ask. Could be they are just waiting for somebody with experience. I read the Ohio Scope of Practice not too long ago and don't remember anything the prohibits us from changing these things.

I don't think I will ever get over how much they think we are incapable of these days. Yes, acute care has changed a lot and the pts are far more "ill" than they used to be - in acute care - but changing the above is required routinely in LTC and who do the states think have been changing them for years? Sounds to me like the ANA is simply ensuring the need for RNs and pushing the BON into making us look like idiots who shouldn't do more than empty a bedpan in LTC facilities - you know, after the pt has lots of experience themselves! LOL

[leslie :-D]

i so strongly agree that lpns are underutilized. that would help our shortage right there, if we could extend our responsibilities to lpns.

[Tweety, BSN, RN]

i so strongly agree that lpns are underutilized. that would help our shortage right there, if we could extend our responsibilities to lpns.

And then of course we need to pay them for what they do. :)

[PaulMedik]

As an extern and nursing student, if you witness illegal medical practice you are obligated to file a written report of your observations to your state board of nursing. Before you file such a report, you need to be 100% certain that your assumptions are correct concerning the LPN scope of practice in your facility and in your state.

As an employee of your facility, you are also most likely obligated to notify, in writing, your immediate department manager or the hospital nursing supervisor.

Do keep in mind the fact that your silence may be held against you if the feces hits the orbital air circulator. Make sure you're right then do what's right.

[Drysolong]

i so strongly agree that lpns are underutilized. that would help our shortage right there, if we could extend our responsibilities to lpns.

In my state, there is also a shortage of LPN's

[pickledpepperRN]

as an lpn we have in the past reinserted g-tubes and suprapubic catherters...a one point in time we began sending residents to er (from ltc) for these procedures.....i don't know if this was the company policy or if it was mandated from state..recently one of my co-workers has been doing the reinsertions and i am not sure if this is within the scope of what we should be doing...i know how and have done so many times in the past but i don't want to risk my license in doing so now...by the way the ownership of the the ltc is not the same....i do not want to go to don if this will get co-worker in trouble..kind of between a rock and a hard place

Each state seems to have a different practice act. Here is Louisiana:

http://www.lsbpne.com/scope_of_practice.htm

The practice of practical nursing is defined in Section 961 of Chapter 11, Louisiana Revised Statutes of 1950. According to this law, practical nursing is the performance, for pay, of acts in the care, treatment or observation of the ill and for the maintenance of the health of others and the promotion of health care. Practical nurses may train and/or supervise other nurses, and subordinate personnel. They may also instruct patients.

A licensed practical nurse must practice under the direction of one of the following: licensed physician, optometrist, dentist, psychologist, or registered nurse. A licensed practical nurse may perform duties consistent with his/her educational preparation. The licensed practical nurse may also, with appropriate training (which is approved by this Board, and documented), perform additional specified acts which are authorized by the Board of Practical Nurse Examiners when directed to do so by the licensed physician, optometrist, dentist, psychologist, or registered nurse.

The Louisiana State Board of Practical Nurse Examiners (LSBPNE) has no "laundry list" of tasks/skills an LPN can perform. Such lists tend to limit practice. Scope of practice is a fluid concept. It changes as knowledge and technology expand. LPNs must possess the knowledge, skill, and ability to perform their duties, therefore, scope of practice comes down to the competency of the individual LPN.

Following are some of the tasks (those most frequently inquired about) an LPN may perform when the above conditions are met (NOTE: THIS LIST IS NOT INCLUSIVE OF ALL OF LPN PRACTICE AND SHOULD NOT BE USED TO DEFINE OR LIMIT PRACTICE):

Initiate and maintain IV therapy and administer IV medications by IVPB and/or IVP (including hyperalimentation, blood and blood products)

Reinsertion of suprapubic catheters

Accept verbal/phone orders directly from the prescriber (an optometrist, advanced practice registered nurse, physician, dentist, or psychologist)

Perform heparinization during hemodialysis

Serve as first surgical assistant (but may not suture, dissect or cauterize)

Maintain and administer meds via heparin locks

Pap smears/GC cultures/IUD string checks/Fundal heart tones/Leopolds Maneuvers

Apply Unna Boots

Load/monitor PCA machines

Care for clients with external venous catheters (including Hickman, Groshong, Brovia) and specifically: obtain blood specimens/connect and monitor IV fluids/connect IVPB, provide site care (including dressing changes)

Care for clients with internal venous access devices (including port-a-cath, life port) and specifically: access with and/or remove Huber needle/draw blood/connect and monitor IV fluids and provide site care (including dressing changes)

Insert a feeding tube in a neonate

Reinsert a tracheostomy tube in an established tract

Remove sheaths in a cardiac cath lab and later D/C these lines

Perform tasks which promote pulmonary health and hygiene (administer oxygen, aerosol and IPPB treatments, suction, perform CPT, etc.). LPNs MAY NOT HOLD THEMSELVES OUT AS RESPIRATORY THERAPISTS OR RESPIRATORY THERAPY TECHNICIANS.

Perform "head to toe" physical assessments

Please call or write the Board if you require further clarification.

Louisiana State Board of Practical Nurse Examiners

3421 North Causeway Blvd., Suite 505

Metairie, La 70002

[phone] FAX [phone]

[Godswill]

as an lpn we have in the past reinserted g-tubes and suprapubic catherters...a one point in time we began sending residents to er (from ltc) for these procedures.....i don't know if this was the company policy or if it was mandated from state..recently one of my co-workers has been doing the reinsertions and i am not sure if this is within the scope of what we should be doing...i know how and have done so many times in the past but i don't want to risk my license in doing so now...by the way the ownership of the the ltc is not the same....i do not want to go to don if this will get co-worker in trouble..kind of between a rock and a hard place

I am not a LPN yet, (I am 2005 lpn graduate) but i do believe this is allowed in louisiana, since it states that the Practice act is not use to define or limit practice. I am guessing if are truly trained or certified to do the task, u probaly could do it if it's allowed at the place u work.

[Godswill]

as an lpn we have in the past reinserted g-tubes and suprapubic catherters...a one point in time we began sending residents to er (from ltc) for these procedures.....i don't know if this was the company policy or if it was mandated from state..recently one of my co-workers has been doing the reinsertions and i am not sure if this is within the scope of what we should be doing...i know how and have done so many times in the past but i don't want to risk my license in doing so now...by the way the ownership of the the ltc is not the same....i do not want to go to don if this will get co-worker in trouble..kind of between a rock and a hard place

I am not a LPN yet, (I am 2005 lpn graduate) but i do believe this is allowed in louisiana, since it states that the Practice act is not use to define or limit practice. I am guessing if are truly trained or certified to do the task, u probaly could do it if it's allowed at the place u work.

[pickledpepperRN]

I am not a LPN yet, (I am 2005 lpn graduate) but i do believe this is allowed in louisiana, since it states that the Practice act is not use to define or limit practice. I am guessing if are truly trained or certified to do the task, u probaly could do it if it's allowed at the place u work.

I never went to law school but it seems the reasons in Louisiana for an LPN not to perform a procedure are:

1. I not directed to do the task.

2. If the policy at the facility does not allow it.

3. If you are not competent to perform the procedure.

3. If additional certification beyond the LPN license is required. (and you don't have it.)

Don't take my word for it but I think you are right.

[pickledpepperRN]

I am not a LPN yet, (I am 2005 lpn graduate) but i do believe this is allowed in louisiana, since it states that the Practice act is not use to define or limit practice. I am guessing if are truly trained or certified to do the task, u probaly could do it if it's allowed at the place u work.

I never went to law school but it seems the reasons in Louisiana for an LPN not to perform a procedure are:

1. I not directed to do the task.

2. If the policy at the facility does not allow it.

3. If you are not competent to perform the procedure.

3. If additional certification beyond the LPN license is required. (and you don't have it.)

Don't take my word for it but I think you are right.