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Ask Aunt Agatha: “Share the love” edition

Photodisc | Ryan McVay

Photodisc | Ryan McVay

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.

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Agatha Lellis

Agatha Lellis is a nurse whose coffee is brought to her every morning by a chipmunk. Bluebirds help her to dress, and small woodland creatures sing her to sleep each night. She writes a monthly advice column, "Ask Aunt Agatha," here on Scrubs; you can send her questions to be answered at askauntieaggie@gmail.com.
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2 Responses to Ask Aunt Agatha: “Share the love” edition

  1. carolslee1949

    When I became an RN, I had been an LVN for 27 years. Along the way , I learned a lot of skills. I think sometimes that RN’s, especially new or inexperienced RN’s, are intimidated or insecure in their role when they are working with a very experienced LVN. In one hospital I worked as an LVN, the policy had changed for starting IV’s. Even though previously LVN’s could start IV’s, the policy now was that the RN had to attempt to start or restart an IV twice, before the LVN could try. I was working with a new RN who had never started an IV. We had to restart the IV on a frail, elderly woman with horrible veins. So, together, we looked for the best vein and I talked her thru it. She got it! And it survived the rest of the shift! So, I think when LVN’s and RN’s work together, combining their skills, they can teach each other new skills.

  2. ThreePalms

    RNs are no more important than LPNS LVNs or CNA/NACs. Look at your hand. Would you like to be missing one or more fingers? Of course not. We are all fingers and thumbs and cannot work without one another. I started out as a CNA many moons back. Much later I went to school and became an LPN then RN. How could I ever treat differently or look down upon what I once was and worked my hiney end off all those years? I will never forget the kind nurses and appreciate them. The cruel and crazy ones aren’t worth carrying around their issues. There will always be fingers and thumbs that look down on each other. But I figure, they have some serious insecurity issues to take it out on others. And there’s ALWAYS at least ONE of those no matter where we work, right? Like Sean says, “Not everyone will love us or like us.” So hang out with the kinder workmates whenever possible. Signed, part of the “hand.”

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