Ask Aunt Agatha: “Share the love” edition

With winter still going strong, we all need to keep in mind comforting thoughts of love…and chocolate. Jim has some questions this month that merit an entire column, and which would benefit from the strategic application of Godiva.

Q: Why do RNs look down on LVNs/LPNs? (We are to work with them, not against them, but it’s not that way where I am.)

A: This varies from place to place. Where I am, the RNs depend heavily on LVNs and don’t tend to look down on them (especially in labor and delivery, where most LVNs work). I would look at what your workplace’s management is doing to foster—or not foster—cooperation between the nursing disciplines.

Q: Why do RNs have organizations like the ANA and others to join, but there are NONE for LPN/LVNs to join and have a voice?

A: I don’t know about where you are, but in my state (Texas), the nursing board not only pays attention to, but welcomes the input of LVNs. We’re a right-to-work state, so no unions to speak of, but LVNs still get representation on the state level on the board. You might want to look into state-level representation, then see if that translates into national-level representation by unions.

Q: Why do I find RNs unable to start IVs? In fact, many times they hand it off to LVNs to start. Then RNs complain when it’s not done right or not charted correctly.

A: Dude, I don’t know. Where I am, RNs and LVNs start IVs, and each charts the IV starts, and each is responsible for charting what they’ve done. Might I suggest a closer look at your facility?

Q: I have seen MDs give orders to LVNs, allowing them to do, say, a suturing of a wound instead of referring it to an RN. This may be beyond LVN scope of practice, but if the MD has verified the LVN can do the suturing procedure, does that allow the LVN to proceed or not? I know scopes of practice are quite different, yet we interact with them daily and get many orders handed off to LVN from RN for no apparent reason other than they don’t want to do it. RNs are not busy, just preoccupied. How can this be resolved?

A: Now you’re playin’ with me. Scope of practice (SoP) doesn’t take into account whether or not an RN is preoccupied or busy with a code or in the bathroom. If it’s in your scope of practice, you can do it. If it’s not, you can’t, no matter how many times a doctor orders it. You want to go outside your SoP and suture that wound, be my guest: It’s your funeral. It doesn’t matter how often a doctor has certified you can do X or Y; if it’s not in your state’s or province’s SoP, you don’t do it. Special dispensation from the Pope does not apply here.

It sounds like, overall, you’re working in a place where you have a whole bunch of people of different disciplines expecting you to clean up messes and no support from management. If you’re truly worried about what LVNs are held responsible for, and your relationship with the RNs, I suggest—and here I am breaking my personal tradition of not going up the ladder—asking management for a clear and decisive delineation of responsibilities, in writing. It wouldn’t absolve you of some of the ickier jobs, but it would protect your license if somebody asked you to practice outside your scope.