California has enacted a law (AB 394) that will change nurse-to-patient ratios. Because I work in Critical Care, Title 22 already mandates that I must only have 1-2 patients in CCU at any time. Even if my patient has transfer orders to a stepdown unit or med/surg floor, I still must only have 1-2 patients, because I am working in a critical care setting.
Henceforth, I’m not sure what the current working ratios for med/surg are. I floated once to telemetry and had 5 patients. I thought that was okay, but one in particular took up a LOT of my time, thus leaving less time to deal with the other 4. AB 394 puts forth minimum staffing ratios. Critical Care will remain 1:1-2, but most other floors (excluding nursery, ante- and post-partum) will eventually phase to 1 licensed nurse to 4 patients. I believe this to be fair.
However… did you notice I said licensed nurses, not registered? There are two classifications of nurses – RN’s and LVN’s. LVN’s (or LPN’s – they’re the same thing) are Licensed Vocational (Practical) Nurses. I have searched for quite awhile tonight to find out just exactly what the difference is between RN’s and LVN’s and haven’t really come up with anything concrete.
From what I’ve heard over the years, LPN’s can’t do as much clinically as an RN. I’ve read sources saying that LPN’s cannot assess patients, and sources saying that they can. Most LPN’s cannot give IV medications, but some can if they are specifically trained to do so. As a rule, an RN is to thoroughly assess their patients and formulate a nursing diagnosis for each, devise a plan, implement the plan, then evaluate the outcome and change the plan as needed. Nursing care plans are the bane of a nurse’s life. But more on that another time :-) It is my understanding that LPN’s may assess patients in more of a “fact gathering” capacity than an “assessment” capacity and are not able to formulate a nursing diagnosis. Big deal, I say. Nursing care plans are overrated!
Unfortunately, I’m also getting the idea that LPN’s can only work under the supervision of an RN. THAT is distressing to me. Say that AB 394 is implemented in January 2004, and hospitals must then staff their floors at 1 RN for 4 patients (1:4). Theoretically, this means that hospitals can hire LPN’s – after all, an RN’s scope of practice is wider than that of an LPN, so RN’s cost more. Hiring LPN’s to pick up the staffing slack would make a lot of sense. However, this also means that because an LVN works under an RN, it is possible to assign one RN to 10 patients, if the LVN takes 5 of them. This would meet staffing ratios, but would then require the RN to care for her own 5 patients and supervise the care of the LVN’s patients as well.
Most RN’s I know hate supervising anything. After all, if you want it done and done correctly, you do it yourself! Certified Nursing Assistants are invaluable to nurses in helping them turn and clean up patients, empty foley bags, and check fingerstick blood sugars. Other than that, it’s Me RN who will be control freaking on every other aspect of my patient’s care. If I had to o.k. an assessment that an LPN under me does, or determine that one of their patients can have some IV pain medication and then have to go give it, what is the point? It still takes up my time.
I know that there are many areas that are perfect for an LPN/LVN. CCU will never be one of these, but I doubt that that would happen anyway – I’m more concerned about the above happening on med/surg and telemetry floors. There is also a raging debate going on regarding how RN’s treat LPN’s (as though they aren’t “real nurses.”) Regarding LPN’s, I say go for it – use them if that’s the best fit. Just don’t ask me to supervise.