What are hospice LPN's NOT allowed to do?

[RN4hospice]

Our hospice is looking into hiring an LPN -mostly to assist with taking call. Does anyone else do this? What are the limitations for an LPN in the hospice setting? If a patient has a PCA pump infusing subcutaneously, can the LPN initiate, or discontinue it? Are they allowed to titrate dosages since it is SubQ if they collaborate with the RN? For the ones that help take call, do the RN's take all the calls and delegate to the LPN? Does the LPN need to have constant contact with the RN?

Thanks!

[EricJRN, MSN, RN]

You may want to pose this question in your state's forum as well. Each state's board of nursing is involved in scope of practice/delegation issues.

[Wildbriar]

We have an LPN/RN team for weekend on-call. Our LPN takes the calls and triages, RN does the admissions and home deaths and they both do visits that need doing. I know in Colorado an LPN cannot do the intake nursing assessment. We don't use PCA's much but the one time we had a pt on a pain pump his primary nurse was an LPN. She would coordinate pain dosages with the MD and our DON. I agree, its best to check your state regs, they can vary widely from state to state.

-Erin

[SkyeOwl]

Sorry to hijack this thread, but Wildbriar, are you the same Erin who wrote a book about hospice nursing two years ago? If so, I just wanted to let you know I loved it! I've been seriously thinking of becoming a hospice nurse and your book was a factor in that, so...thank you!

Melody

[Katillac, RN]

In our hospice, LPNs can do much of what the RNs do. What they can't do is the case management piece, which means they can't do the initial or the mandatory every two week assessment, nor can they initiate or change the plan of care. That means that they don't, for example, assess the patient and then call the docs with recommendations and get the patient on a new med; those kind of issues need to go through the RN Case Manager.

In our residential setting the same is true, with the addition of the fact that the LPNs can't touch central lines, or do any IV pushes which would be very rare in that setting anyway. We also have an agency policy that only the Primary Nurse or her designee can change the CADD pump settings.

[JSCOOBY]

I am a hospice LVN with a primary assignment of crisis/continuous care in the home or other facilities. When our census is low, I perform weekly visits with other patients. My RN case managers trust my judgement to call the physician as needed, the notify them when changes might be needed. We are not allowed to perform admit or recert assessments, nor are we allowed to pronounce death.

I have been a hospice nurse for three months, after 20+ years in administrative/URQA roles. A hospice nurses' role is meaningful and has purpose. I found my niche and don't see myself every going back to any other field of nursing.

[TheCommuter, BSN, RN]

The LVN/LPN scope of practice is entirely dependent on the state in which they are practicing.

I am in Texas, where the LVN scope of practice is wide open. Hospice LVNs do IV pushes, hang and spike IV medications, wound care, and are allowed to perform the initial assessments in any setting other than acute care hospitals.

[a21chdchic]

In AZ, an LPN cannot assess a patient, therefore she cannot do admissions or case management. She can do most tasks, except for IV meds, etc. An Lpn in our Hospice may report her "observations" to both the RN case manager and the MD, but if she reports something to the MD, she had better be reporting it to the case manager also, because the case manager is the RN responsible for the patient. The LPN cannot take call, she may make visits, do general nursing duties such as teaching, wound care, etc. She also cannot 'supervise' care given by a CNA in AZ.

Ana