Question:
Dear Nancy,
I work in a busy ICU with a very high acuity of patient care. We have an LPN working there as a staff member, and because of her job functions, she cannot admit patients or do IV pushes, she can't accompany her patient to CT scan or to any special procedures, among other functions. We have to change or switch our patient assignment just to accommodate her LPN functions in the ICU. We brought our concern to our head nurse and to our director of nursing, and we were told that we as RNs on duty are responsible if something happened to her patient. We were appalled by this, since now our RN license is at stake. We also were told that, as far as the head nurse and DON know, there is no existing policy in the hospital not to hire LPNs in the ICU.
But it is only in our ICU (which has the biggest bed capacity ICU in the hospital) that accommodated this employee after one particular ICU successfully requested for an LPN transfer to another unit. This makes us the only ICU in the hospital with an LPN.
Ruth
Nancy Brent replies:
Dear Ruth,
An employer is free to hire LPNs if it chooses to, as long as the LPN practices within his or her scope of practice, which is defined by the state nurse practice act and rules. It appears in your state that the act or its rules are very specific about what an LPN can and cannot do in regard to specific nursing care. LPNs function in a dependent role (unlike an RN) and must work under the supervision or direction of an RN or other healthcare provider listed in the nurse practice act or rules.
Since it sounds as though the LPN in your unit works under an RN (charge or resource nurse), that RN is responsible for adequate supervision and non-negligent delegation of tasks to the LPN, as examples. The LPN also would be responsible for his or her own negligent care. The LPN does not practice on or under your license, but rather on his or her license.
LPNs can be important team members when they are utilized pursuant to their education, skills and experience. It might be a wise idea to sit down with the LPN, head nurse and director of nursing and establish a workable solution to this problem. The LPN can be a tremendous help when performing those patient care procedures and tasks that do not need to be done by you as the RN.
One last thought. You indicated that one ICU was successful in requesting that the LPN transfer to another unit. If you see this as a solution in your situation, who will replace the LPN? Another LPN? Another RN? Or will your staffing be short by one licensed individual who, with proper utilization and a team approach, can contribute to the overall nursing care in your ICU?
Regards,
Nancy
