What my DON said about getting rid of LPN's

[Future LPN Sheryl]

She said, in 1985 she started as an LPN, and when she was in school, they were told they would Graduate without a job! That was 1985, she is now an RN.

She said "LPN's are licensed by the state!! Who's going to get rid of them?? If the state doesn't do it, the hospitals can't. She said there is "talk" of grandfathering LPN's to RN's.... She said she LOVES LPN's she was one, and has LPN's in management. She added there will ALWAYS be work for LPN's.

[ May 04, 2001: Message edited by: Future LPN Sheryl ]

[Brownms46]

ACNP Ouch.. I get the feeling it is that bad in many places. My best friend who works in Portland, OR told me that a local agency is paying $95/hr for critical care nurses.

I'll tell you three brief stories.

Four years ago, a seasoned RN in the hospital in which I worked “accidentally” infused 1500 mg of Demerol within a 20-minute period. Now clearly she is at fault, because it does take only a second to TRIPLE check the drug being given. She thought it was an experimental anti-biotic, which the pharmacy tech who brought it to her said it was. She was so stressed from caring for 15 patients on days, she just hung it quickly and moved on. She’s gone now.

A few months later, I was working ICU when a code was called overhead. The time was at 6:00 a.m. The patient, who was mottled, was lying in a coagulated pool of blood. Early during the night, he apparently pulled out the Swan-Ganz introducer port by accident (possibly confused or while sleeping). Anyway, he was taking Coumadin, and his INR must have been way out. We stared in amazement while the RN pleaded for help. We told her, “Rigor mortis has already set in. There’s not a thing we can do”. He clearly died soon after the shift began. The nurse was so busy, she had not a chance to go into his room until preparing for shift change.

A year later, I was a traveler in Memphis when I was pulled to a general ICU. I received the two sickest patients there. I picked up one of the patients from an RN who had made a lateral shift from the pysch ward. He had never worked ICU in his life, but was in “training”. The patient, who had chronic renal insufficiency, had been on a dopamine gtt at a renal dose of 2mcg/kg/minute. The patient had been dropping her pressure, and thus he called the physician. The physician said, “Okay, titrate the gtt as needed”. The nurse (I swear I’m not kidding) increased the Dopamine from 2mcg/kg/min to 22 mcg/kg/min (2 mcg above the maximum recommended dose) in one shot. Her pressure shot up of course, and I imagine her SVR was through the roof. When the nurse told me what he had done, I thought he was kidding. Then he had a puzzled look on his face and said, “She hasn’t had a drop of urine in her foley since soon after I increased the Dopamine”. At the same time, I was picking up a patient (ventilated) who was in extreme mixed acidosis with hypoxemia. ABGs were 7.26/65/55/19 at the beginning of the shift. I called the pulmonologist who was already irritated with the previous nurse. He gave explicit orders to extubate the patient immediately (in a pissed off tone). I simply made vent changes instead and was going to draw immediate lab, with subsequent ABGs. Yet, the resp tx. took it upon herself to extubate. Needless to say, I had two codes on my hands at the exact same time. While I was attempting to conduct both codes, I had someone call the physician for each patient. Within three minutes, five physicians were on the phone wanting to talk to me at the same time. End result? One patient died (the ARF), and the other lived (after being reintubated and NaHCO3 pushed).

These are a few… sorry they weren’t so brief.

Jason-ACNP You aren't being a pain in the ass. I noticed that after I submitted the post, I needed to clarify a few things. I was waiting for someone to catch the confusion. You are very astute.

The patient WAS NOT in an ICU. I failed to mention that. I was working in the ICU on the 6th floor when this incident happened. The patient was also on the sixth floor, (on a med-surgical floor)

You are absolutely correct to assume that the patient should be monitored continuously if a Swan-Ganz catheter was in place. In addition to my failing to mention that he was on a med-surgical floor, I failed to mention that the actual catheter was already removed. The floors don’t have SVO2 monitors or monitors to read the PA pressures. Thus, the catheter ALWAYS came out before we sent them to the floor. HOWEVER, the physicians always chose to LEAVE the introducer port intact, because it had a single-lumen IV access. (The introducer port we use is a very large bore and is inserted at least 5” into the IJ vein.) Thus, the nurses on the floor could obtain blood samples for lab without having to stick the patient every morning. (I realize that may not be the policy in some, or even most hospitals, but it was there).

The patient’s heparin had been discontinued the day before. PTTs were discontinued immediately upon discontinuation of the heparin, because heparin has a fairly short half-life. It was said that the patient was placed on Coumadin at that point. I have absolutely no idea what his loading dose was, or if they had even checked a PT/INR that a.m. (Some docs give a loading dose and then titrate based on that (the next day), whereas other docs start low for a couple of days (2-3) and then draw a PTT, which I don’t like. I want to know the INR the next morning).

I only suspected that his INR was way out because of the massive amount of blood (pouring from a major vein of course). The other explanation was that the patient, (who was very large) tore the internal jugular vein (even slightly). He was huge. I’ll be honest. I have no idea if he was confused. I was grasping at straws. The dressings that the hospital uses are EXTREMELY irritating to the skin, causing significant itching. Some patients cannot wait to get rid of the dressing. It drives them crazy. I thought that maybe (unwittingly) pulled at the Swan-Ganz in a light sleep (like shooing away a fly or something irritating), and pulled hard enough to tear the IJ vein when the catheter came loose. The only thing is that you have to pull VERY HARD because the adhesive on the transparent dressing is like glue.

As far as the coagulation question goes, let me explain the scene. There was a MASSIVE amount of blood that, via gravity, pooled to the center of the bed. The HOB was elevated 45°, and the end of the bed was slightly elevated. The massive pool of blood had a gelatin consistency (vs. being a hard, crusty consistency). While I was in nursing school, I worked with the coroner in homicides, suicides, automobile accidents, etc. Anytime the there was massive blood loss that formed a pool, the coroner (an M.D.) referred to it as coagulated, which made sense to me (due to its gelatin consistency) However, I may have used the word (coagulated) out of context.

One more thing, and this are huge. Vital signs are to be taken on that floor every four hours. The CNAs in that hospital are not very efficient, and many are lazy. (That is not an attack on CNAs in general.. I’ve worked with some of the best that have greatly eased my life in the critical care units). The CNA falsified vitals. The nurse was supposedly busy that night with confused patients, dressings, bed baths, etc. She did have 15 patients that night. The CNA admitted to falsifying vitals (so I was told) once the time of death was actually determined.

As a result, (or soon after), head honchos said that vital signs on the floors would be done every four hours by the nurses. Furthermore, they now wear these damn tags that monitor where they are at all times, and how many times they enter a particular patient’s room that shift, and how long much time they spent each time. YES! NOW THAT’S A SOLUTION!!!! I wonder how many hundreds of thousands of dollars the hospital spent on their new toy….it took effect over the entire hospital (except ICUs).

I left the hospital soon after that incident to go traveling. It wasn’t worth the $11.88/hr they were paying me.

I hope that answers your question, but feel free to tell me if anything needs clarification.

By the way, 2.5 to 3 years later, I heard that this case was still in litigation. HUGE LAWSUIT! HUGE! I have no idea if the nurse was suspended. Like I said, I was quick to leave (to go traveling).

I have posted the above, as posted by Jason, as to how critically ALL RNs who are such a distintive difference from LPNs, in the words of the same person who equated LPNs with "highly trained monkeys"!

I have worked ICU/CCU, and have NEVER had an incident...THANK GOD! I also would have never walked into a unit, without, and had the nerve to care for patients out of my realm of expertise! Is it possible, that these "nurses", failed to critically think???

Heaven forbid! Nooooo...tell this isn't so!

Also please note, the disparaging remark about CNAs, as being lazy, ( so he was told...another example of stating information, that maybe or may not be accurate) when the RN in charge of these pts., was just overwhelmed!

How did this nurse chart her assessment on these pts, if she didn't see them??? Did she also falsify her charts??? She had 15 pts., that nite, and how many did the CNAs have?? Oooh no...they were just sitting on their butts watching this hard working RN bust her behind! yeah right!

Thank God, I'm just a "highly trained monkey", that couldn't critically think to save my life, but at least I haven't injured anyone else's...:-)!

Brownie

[canoehead, BSN, RN]

I think that whether a job is considered professional or not is more a legal definition than anything. It has to do with whether the group performing the job is self regulating. To take this self regulation thing a little further to the individual level is more what everyone is debating in this thread. That type of professonalism has to do with critical thinking, and accountability for one's own practice. So you are "self regulating" on an individual level. In my experience there are housekeepers that are accountable for their own actions, and there are docs that never think twice about a decision or read an article to advance themselves. So in the debate on whether RN's or LPN's are professionals, if you look at who is considered a professional legally there is no opportunity or reason for debate. If you look at who holds themselves accountable, and who uses critical thinking there are some real professionals, and some real unprofessionals practicing in both capacities. So no one will win this debate.

Maybe we could start a new thread about what a person has to do to be considered to be praticing professionally. What situations have you been in where you saw real accountability, and responsibility for one's own actions- as opposed to someone saying "well, the doctor ordered it"

Look for my new thread.

[Future LPN Sheryl]

Originally posted by Jason-ACNP:

Okay, look. I have not the time, the will, nor the desire to argue

Yet, I find hilarious the number of LPNs who THINK they have what it takes to be an RN. Everyone wants to be considered a professional, BUT VERY FEW are willing to put forth the effort to reach that level. There are DISTINCT DIFFEERNCES in the education of an LPN vs. an ADN. And the BSN? The differences in education are incomparable. Okay, okay…..so you are better at making beds, inserting foleys, or other “technical” duties. So is a highly trained monkey. But can you think critically? Let me answer that for you….NO. 90% of LPNs don’t know the meaning of critical thinking, much less have the ability to apply it. I think that it is safe to say that 99.9% of LPNs CANNOT take a critical situation and apply knowledge learned from physiology, pathophysiology, pharmacology etc. and apply it to that situation. It’s possible to memorize a ton of information, but NOT UNDERSTAND ANY OF IT. That is precisely the reason why your scope of practice is limited, as well as why advanced practice nursing requires the BSN as a prerequisite.

Yet, as always, nursing continues to seek the least common denominator – that which is easiest. What is the easiest and fastest way I can obtain my AND? That is no different than me stating, “How many classes can I skip in medical school? After all, I have eight years of full-time college education (and every prerequisite for medical school). I hold a BSN (4.0 G.P.A.) as well as a Masc. (3.95 G.P.A), in conjunction to years of VALUBLE experience. Don’t forget!!! I already have prescriptive privileges, and I’ve tutored many of your medical students over the past two years in physical assessment skills! That should count for something!!!!! Pu-leeeaassseeee. Do you think they give a damn? Of course not. It is called S-T-A-N-D-A-R-D-S. Get it? One more time…

S-T-A-N-D-A-R-D-S. By all means…pursue an AND (or whatever) in the fast track, but please…PLEASE – don’t whine and moan because you aren’t deemed a professional.

Furthermore, the longstanding conviction that the BSN should be the entry level into nursing will never be adhered to. Thus, I am an advocate of having LPNs join the ANA in a limited capacity. There clearly needs to be unity within this field. But make no mistake. While unity is imperative for nursing to progress, there is a reason for the hierarchy. All nurses ARE NOT the same.

As always, this is not meant to be construed as insensitive or rude. However, the issue has apparently become cloudy, and the need for clarification is quite evident. I am done with this issue. Take care.

Jason, all I can see is that I hope to God that I don't ever work with someone as narrow minded as you!!!

Brownie, you said it all

:) :)

[Chellyse]

CanoeHead started a post on professionalism asking us to define or give examples.I am glad he asked you can find the thread here: https://allnurses.com/bb/cgi/ultimatebb.cgi?ubb=get_topic&f=1&t=002602

We should talk about it,what I said before was about giving respect to one another,when defining professionalism I found this from the Kansas Medical School:

"Respect for others, including patients and their families and other professional colleagues is the essence of humanism, which is both central to professionalism, and fundamental to enhancing collegiality among medical professionals."

Now Tim in that definition comparing someone to a trained monkey is way off base and disrespectful....So in essence you were unprofessional in your response.I think you should realize this mistake and the harm done,and apologize.Now that would be a step in the direction of dialogue.

Along with being professionals we are all humans, so sometimes we get too personal in our own defense or passion.But to admit you have that is more important.I know I have even on this BB made some posts I later regretted,I hope this is not one of them.... :)

[Q.]

Ok Jesus Christ people - do we REALLY want a repeat of the LPN/RN debate??????

I really think that what Jason was trying to say, and I think it is fair to concur here, that the educational differences between RNs, LPNs and BSNs are vast. To argue that they are the same with the exception of a history course or two is not a fair statement, and typically is made by someone who hasn't been through the program to come to such a conclusion.

I've always said that standards of nursing is what is needed to at least start to unite our profession. I don't see how raising the bar in any way can be negative - this equates to higher standards for our profession. This does not mean that the LPN is useless, the ADN is an idiot - all this means is that if you take this already skilled LPN, and the already educated ADN, and give them a 4 year college degree, it can only enhance them as a nurse and as a person who now has opened thier mind even further.

I fail to see the downside to that.

[stick]

Originally posted by Susy K:

Ok Jesus Christ people - do we REALLY want a repeat of the LPN/RN debate??????

I really think that what Jason was trying to say, and I think it is fair to concur here, that the educational differences between RNs, LPNs and BSNs are vast. To argue that they are the same with the exception of a history course or two is not a fair statement, and typically is made by someone who hasn't been through the program to come to such a conclusion.

I've always said that standards of nursing is what is needed to at least start to unite our profession. I don't see how raising the bar in any way can be negative - this equates to higher standards for our profession. This does not mean that the LPN is useless, the ADN is an idiot - all this means is that if you take this already skilled LPN, and the already educated ADN, and give them a 4 year college degree, it can only enhance them as a nurse and as a person who now has opened thier mind even further.

I fail to see the downside to that.

SusyK, he could have said it in a more professional manner. To compare an LPN's intellect to that of a trained monkey was VERY UNPROFESSIONAL! I think that is the problem with the post, not the educational differences. With all of his "higher knowledge" he could've got his point across much better if he had chosen more appropriate words.

[stick]

Originally posted by Susy K:

Ok Jesus Christ people - do we REALLY want a repeat of the LPN/RN debate??????

I really think that what Jason was trying to say, and I think it is fair to concur here, that the educational differences between RNs, LPNs and BSNs are vast. To argue that they are the same with the exception of a history course or two is not a fair statement, and typically is made by someone who hasn't been through the program to come to such a conclusion.

I've always said that standards of nursing is what is needed to at least start to unite our profession. I don't see how raising the bar in any way can be negative - this equates to higher standards for our profession. This does not mean that the LPN is useless, the ADN is an idiot - all this means is that if you take this already skilled LPN, and the already educated ADN, and give them a 4 year college degree, it can only enhance them as a nurse and as a person who now has opened thier mind even further.

I fail to see the downside to that.

SusyK, he could have said it in a more professional manner. To compare an LPN's intellect to that of a trained monkey was VERY UNPROFESSIONAL! I think that is the problem with the post, not the educational differences. With all of his "higher knowledge" he could've got his point across much better if he had chosen more appropriate words.

[Q.]

Stick, thanks for your reply - but I think I am speaking accurately when I say that Jason wasn't comparing JUST LPNs to trained monkeys. I think that of ANY nursing psychomotor skill, performed by ANY level of a nurse. It doesn't take a genius to insert a cath, give a shot, change a bed.

[Q.]

Stick, thanks for your reply - but I think I am speaking accurately when I say that Jason wasn't comparing JUST LPNs to trained monkeys. I think that of ANY nursing psychomotor skill, performed by ANY level of a nurse. It doesn't take a genius to insert a cath, give a shot, change a bed.

[lpnandloveit1]

O.K. I'll jump in I love RNs I love LPNs when talk of "grandfathering" LPN first started years ago there was talk of revamping the entire nursing system . Exp. Lpn would become Rn Rn would would become PN (proffessional Nurse) and so on. this plan also included the closing of all Lpn schools. I believe at the time any nurse with less than a BSN would be an RN. NOW let me tell you Most LPNS at the time (EVEN now ) concidered this plan much the same as an Urban legened. Along the same line. An RN was found stealing narcotics at the hospital I worked at her school had "pinned wings" on their caps. the hospital told her to continue working she had to unpin her cap and sighn charthing with LPN afetr her name!!!! the implication was that RNS wouldn't steal drugs but LPNs....... Needless to say we "lost our minds" she was not allowed to do this as LPN is a Legal title and she had not passed our boards.(yes we take boards)

[lpnandloveit1]

O.K. I'll jump in I love RNs I love LPNs when talk of "grandfathering" LPN first started years ago there was talk of revamping the entire nursing system . Exp. Lpn would become Rn Rn would would become PN (proffessional Nurse) and so on. this plan also included the closing of all Lpn schools. I believe at the time any nurse with less than a BSN would be an RN. NOW let me tell you Most LPNS at the time (EVEN now ) concidered this plan much the same as an Urban legened. Along the same line. An RN was found stealing narcotics at the hospital I worked at her school had "pinned wings" on their caps. the hospital told her to continue working she had to unpin her cap and sighn charthing with LPN afetr her name!!!! the implication was that RNS wouldn't steal drugs but LPNs....... Needless to say we "lost our minds" she was not allowed to do this as LPN is a Legal title and she had not passed our boards.(yes we take boards)

[Brownms46]

Originally posted by Susy K:

Stick, thanks for your reply - but I think I am speaking accurately when I say that Jason wasn't comparing JUST LPNs to trained monkeys. I think that of ANY nursing psychomotor skill, performed by ANY level of a nurse. It doesn't take a genius to insert a cath, give a shot, change a bed.

No it doesn't Susk, and it doesn't take a genius to see that jason's post was insensitive, inaccurate, belittling, degrading, and downright ignorant..period! I don't care what his point was, he lost it, when he lowering his communication to trying to elevate his "superior" knowledge, and make wild generalizations for which he has NO basis! LPN can't think critically?? Is that your assumption also?? Please enlighten us all as to how, the above "RNs", were critcally thinking in the stories he related in one his own posts? How he belittle, and without an actually knowledge of the situation, except for second hand information, label all the CNAs in that story, on that unit, as lazy, and spoke of how "they" falsified vital signs! Tell me how fair, and accurate he was when he labeled the RN's incompetence as being overloaded, that a patient in the story was never check ALL nite!!! His words not mine! How a "seasoned" RN, titated a Dopamine drip to 22mcgs??? Where was this persons critically thinking?? I get sooooo tired of this whose better than who crap! If an LPN has made those statements, it would have been..."see how these LPNs disrespect us RNs!! Awwww why bother...it's an age old discussion, that will continue as long as there are those who feel the need to degrade others for their shortcomings! I pray that one day, the infestation, that infects some with degrees, will one day be inoculated with a little respect for themselves, and then for those they interacte with! Until then...no amount of RNs with BSNs, or MSN, or anything else will unite this field we call nursing. There will always be those, who will go a little further to prove how much better than are, than someone else!

It has to start within the person, before they ever start their education! It has to be ingrain into their hearts, why they are in this "profession"! Not to elevate themselves, but to elevate others, with a little humility, and the ability to inspire others, not bashed them on the head, with who, and what they are!

No post on here ever stated, that LPNs were better than RNs, but if you read the prior posts, there were concerning a long ago suppose to happen thing, that had nothing to do with LPNs thinking they were RNs, as if they was such a lofty goal to achieve, that it was beyond our ability to aspire to! It wasn't just his misconception about LPNs being equated with monkeys, but his entire response ..period!

Brownie