There is a lot of talks these days about the changing role of nurses and whether or not licensed practical nurses (LPNS) can work in ICU. On one side are those who believe that LPNS are not qualified to work in such a critical setting, while on the other side are those who argue that with proper training and supervision, LPNS can provide quality care in the ICU. Let’s take a closer look at both sides of this debate.
What is LPNS?
Licensed practical nurses (LPNS) are the term used to refer to the largest segment of the nursing profession in America today. They are nurses who have obtained a practical or vocational degree rather than an academic degree. Unlike registered nurses (RNs), LPNS do not take an exam to become licensed. They simply graduate from an approved practical nurse program and apply for licensure with their state board of nursing.
LPNS work under the direction of RNs and doctors, providing patient care that can vary widely depending on location, setting, and employer. At one end of the spectrum are those LPNS who function as assistants in doctor’s offices or clinics; at the other end are those who provide life support functions in hospitals or other critical care settings.
Like RNs, they perform a wide array of basic care functions, such as taking vital signs, inserting catheters and feeding tubes, changing dressings and bandages, assisting with medical procedures, and administering medications.
Can LPNS work in ICU?
For years, some nurses and nursing organizations have been arguing that if LPNS were given proper training and support, they could provide quality patient care in the intensive care unit (ICU). They point to RNs who routinely perform tasks like inserting central lines and starting IVs on patients in the ICU without having any more formal education than their counterparts.
Why they ask, can’t LPNS do the same? Their argument is that having more people trained in basic ICU skills would increase staffing levels and thus reduce nurse fatigue. There are some nurses who believe that LPNS should not work unless the
Not surprisingly, those who advocate for increased autonomy for LPNS reject this suggestion as unnecessary and overly restrictive. During the last few decades, there has been an evolution in LPN scope of practice, and today they are allowed to provide care unsupervised with only a few exceptions. Some states allow trained LPNs to administer medications, perform EKGs or start intravenous fluids without any supervision at all.
Today many hospitals around the country have adopted this expanded role for LPNs, in which case their level of education would be equivalent to an associate degree in nursing (ADN). However, some states still require that all IV administration be performed by RNs or physicians. If your state is one of them, then it means that you are not qualified to work in ICU as an LPN.
What are the benefits of having LPNs in ICU?
The simple answer is that it saves money. Many studies have shown that patients who are cared for by mid-level providers have fewer complications, stay in the hospital longer, and may even cost the hospital less than if they were cared for by an RN. Furthermore, there has been some evidence that having trained LPNs do certain tasks improves the quality of care while lowering costs.
There are also many benefits to nursing staff themselves when you allow them to work at their full scope of practice. It alleviates some pressure off of nurses, which means they can focus more on direct patient care instead of spending time charting or looking up orders (which often takes time away from directly caring for a patient).
Allowing LPNs to work at their full scope of practice is not a threat to the RN profession, as long as they are supervised properly and there is adequate documentation in the medical record regarding all care provided by mid-level providers.
What are the concerns about having LPNs in ICU?
I understand that many nurses don’t feel comfortable about the idea of expanding roles for LPNs. They feel threatened by it because they believe that allowing LPNS to work unsupervised will lead to substandard care and put patients at risk.
Many also fear that if their employers allowed LPNs to work without direct supervision, then this would be a first step towards abolishing nursing positions or, worse yet, replacing RN with less educated providers such as NAS or Medical Assistants. These fears may seem justified, but only if the nurse providing care is not properly supervised and lacks adequate education and training.
If your state requires registered nurses (RN) to administer IV medications and start IVs, then LPNs should not be allowed to do that without proper supervision. Furthermore, there is a risk that if your hospital allows less educated providers such as NA or MA to work in place of RN, you will miss some important information from the patient’s chart, and this could put him at risk.
As far as quality of care provided by mid-level providers goes, it depends on the facility where you work and how well an individual mid-level provider is supervised. In some places, LPNS are doing a great job, while others have more problems with them. I don’t think that function of being a nurse changes depending on whether they have an RN degree or a diploma from a school of nursing.
I believe that nurses who lack a degree should be supervised very closely, and if they fail to meet your expectations, then you should report them or get rid of them.
I think that LPNs have a place in ICU. They can take care of routine tasks such as blood pressure cuffs, bed making, etc. Some facilities may allow mid-level providers to perform some other tasks while being supervised by an RN (such as starting IV fluids), which is fine too.
However, all medications administration requires RN supervision, and if your facility allows less educated providers to start IVs without direct supervision from an RN, then it’s not safe for patients! If you feel uncomfortable about having LPNs work at their full scope of practice in the unit where you work, suggest the idea to your employer instead of complaining about it.
The nurse who is uncomfortable with allowing LPNs to work at their full scope of practice should consider finding a job in another unit where she doesn’t feel threatened by them or find another line of nursing specialty that does not require her to work with mid-level providers.