Why lvn's /lpn's should not work in labor and delivery

PurpleLVN · Dec 31, 2009

I think that the OP should check her state's nurse practice act. That will outline the specifics of what an LPN can or cannot do. In my state, LPNs are not able to care for Laboring patients at all, but they can receive a baby if they have current NRP and it is an expected "well baby".
Side bar: I think that some posters are making this an RN vs LPN/LVN argument. It doesn't appear to me that the OP has a problem with all LPNs, just the one who is causing all the problems. As a previous poster mentioned, your team is only as strong as your weakest link, and if management is doing nothing about an unsafe nurse, I might be looking for another job.

The OP clearly states in her heading "Why LVN's/LPN's should not work in labor and delivery". I take this to mean ALL LVN's/LPN's since she didn't just specify THAT particular one she speaking of...This seems like a generalization of us all to me. :angryfire

nyteshade, BSN · Dec 31, 2009

I need some specifics about why your hospital does not allow LVN's to work in Labor and Delivery. We are having a HUGE problem with the one and only LVN in our unit. She charts very little--even on cases that wind up in stat C-Sections. We changed to all QS computer charting about a year ago. Since then, NO nurses co-sign her assessments or notes. She refuses to wear her badge because she doesn't want the patients to know she is an LVN. She takes care of Mag. Sulfate pts, critical pts.....and on and on. I have addressed this with our manager and the Director Of Nursing to no avail. I have looked up AWHONN guidelines and looked up "Scope of Practice" for LVN's on the BNE site......to no avail. PLEASE HELP ME!!!! I need specific reasons that mandate why this nurse should not work in L&D.

I see very poor delegation skills on whoever is assigning her these critical patients. Rather than try to hurt this nurse, why don't you help her?

TeriEye · Mar 9, 2010

If she is ashamed of people knowing she is an LPN instead of an RN, that says something about her doesn't it?

But then, what is she telling her patients?

While I do agree that the nurse in question should be judged according to her skill and competency.

I disagree that the "level of education is not so different".

If that were true, then why become an RN at all?

Kind of cheapens the entire title doesn't it?

In my place of employment, (I am retired now) LPN's & LVN's were not allowed to work in L&D and OB as well as surgery, as they are limitedly licensed in our state to place or change IVs, and their practice is limited in scope over all. Making their presence in the L&D room awkward.

While it is true that delivery is mostly a simple process, and women all over the world were doing it on their OWN before there were Doctors and Nurses.

It is not the routine easy deliveries we worry about, and get us into trouble. It is the complicated horrific ones that are the problem. Which one will the next one be? :confused:

It also comes down to, who has your back? If you can't trust the woman, because she has proven she can't be trusted, then how can you feel safe while you work?

Do you want to work next to someone without the skill and training to act rightly when it all goes bad?

If she is the ONLY LPN or LVN in your area, something is wrong.

If she is not, then the problem is not LPNs in delivery, it is this person in delivery.

I DO agree, that if you are the person who has to sign off on her activities and reports, you should refuse to do so, until it is done right and competently and be sure that YOUR superiors know why FIRST. Remember, it is not always who is right or why, it is usually who brought it up first.

Following policy, practice and scope, doing paperwork, charting and notes are your best defense in a malpractice complaint or general inquiry. If the people you are responsible for are the ones playing fast and loose with these documents and responsibilities, it could be you who will pay for it. Do you think your organization will support you, if they know they can throw you under the bus to save themselves? Really?? I know otherwise. I have seen it.

And really, most charting is so easy to do as you go through the day, and mostly electronic now, or at least on a central system. SO why not take the time to do it right?

IF the nurse in question is not charting treatments, especially meds, that could endanger your patients life.

Those of you who have said to stay out of it. How would you feel, what would you do, if you found out you had just re medicated someone, because your LPN or LVN did not chart it?

"Sorry that was my fault, I should have been able to read her mind, and know everything." ?????? :confused:

Or found out that the patient has had a fever, irregular resp., and palp for several hours, but your LPN did not record it the last time she checked?

This was brought to your attention by the Doctor who happened to hear it from the patient's family member, on his cell through his exchange. Sound familiar?

How would you like to set up an IV for "413 bed 2", only to find that an LPN had just done it, but THAT LPN wasn't assigned to that room or that bed?

As far as the badge issue, our hospital had high profile & high income patients, and STRICT STRICT STRICT badge policies, and so personell and security would run spot checks.

No Badge?

No Work!

You were on report!

Twice in one month?

You are out of a job!

We also had secure lockers, and we did NOT wear our badges home.

I know that is not how it is everywhere. So don't flame me.

If we saw someone working in areas where a badge was required, with no badge on, and security or admin found out we knew, then we could be wrote up as well. If it was really bad, we could be fired.

If policy requires a badge to be worn, point it out to the appropriate person.

It comes down to POLICY, POLICY, POLICY. If policy demands answers, report the questions.

IF she is not under your authority, talk to the one who has that authority.

If she is taking over patients not assigned to her, BE SURE to report it.

Otherwise why assign patients?

Let's just scramble for the ones we want!

Let Anarchy reign!

If nothing is done, be sure to keep your own records, privately, explain what you said, to whom, and when, to protect yourself if the wall comes down.

But don't carry a personal grudge. That will eat you up, and do nothing to correct the situation.

SmilingBluEyes · Mar 10, 2010

We have not had LPNs for years not because they are not "good enough" but due to scope of practice. We don't have time to push IV meds for them, do their assessments, etc. and the myriad other things that are not in their scope for them. So that is why our unit is an all RN unit. I have learned so much from amazing LPNs. Their knowledge bases were huge. But their scope of practice where I am now, not so.

IF what you are saying is true, there are issues with this NURSE, not the LPN issue. Not charting well, causing dangerous medication errors, and refusing to wear clearly seen ID are huge issues, period. It's not personal, it's safely we are talking about here. And your manager is not doing his or her job IF these things are happening and nothing is being done about it. Not sure what her being an LPN has to do with this however.

PNCC2001 · Mar 11, 2010

The Bureau of Labor Statistics lists among the tasks of LPNs; assist in the DELIVERY, care and feeding of infants. So why does she not belong in L&D?

SmilingBluEyes · Mar 11, 2010

Because we don't have time for that. Again, RNs can and do assist in deliveries already.That is a very small part of our job. We assume total responsibility for the care of the patient, from head to toe.We don't have time to do their assessments and deliver their medications on our unit. Any time an LPN was floated to our unit, a lot of time was spent doing her assessments and cosigning charts as well as hanging certain drugs, blood, and giving IVP meds. That takes a lot of time from our patient care on our own assignments. It's not an issue in general against LPNs ---again, it is about scope of practice. The Bureau of Statistics does not have to handle the workload on our units when there is a mix like this; we do.

The scope of practice for LPNs, no doubt, varies from state to state. Where I am, it's not productive to have LPNs assigned to our L/D unit.

And if you read the original post, the title is very misleading.

This is not about whether an LPN should work on L/D, but what THIS LPN is doing that is so dangerous!

That is my concern here. Since the OP was over 3 months ago, I hope there is resolution and the manager is taking action because THIS LPN is dangerous and would be if she were an RN as well. The issue in this thread is not LPN versus RN but safety of practice and the OP should report what she is seeing and get something done about it, before someone is hurt or worse.

jctiabecerra · Mar 20, 2010

Some of our best l&d nurses are lvn's and in fact our most experienced nurse is an lvn and she orients all new nurses to l&d. I have my bsn and have worked in l&d for 8 years I still go to her with question ect.

Daisy Child · Apr 28, 2010

I have known LPN's who are better Nurses than many RN's. Sitting in a class room isn't where you learn to be a Nurse. You learn on the floor. LPN's are just as capable of doing anything that an RN can do. They used to run the hospitals years ago, before people like yourself, decided they weren't good enough.

If this NURSE (yes, she is a NURSE) isn't doing her job then it isn't because she is "only" an LPN. As far as the skills she is allowed to perform- that is up to the state board. It varies from state to state...

OhioMTCRN07 · Apr 28, 2010

I would wonder how the state board of nursing defines the LPN's scope of practice. Whatever issues the OP has with the LPN are not the issue. In our state, LPNs handle "routine" or low risk cases. In no way can L&D be considered routine or low risk due to the dynamic changes that occur during the labor and delivery process. I know a wonderful LPN that does postpartum nursing and I have learned much from her. That said, her assessments must be "signed off" by an RN in our state. LPNs are valuable members of the healthcare team although they cannot push IV medications in our state as well. As for hanging magnesium, I was cringing when I heard that. Is there a state where the type of work the OP describes this LPN doing is legal? Again, it is my understanding that LPNs are assigned to low risk (dare I say) routine patients. Frankly if this were happening in Ohio, I would worry about my own license (as well as all those on the floor) and the hospital's risk as well. :twocents: As for wearing a badge, all nurses must identify themselves with a photo ID, no exceptions here.