LPN Scope of Practice

The Nurse is defined by the University of North Carolina as "the leader in supplying caring, quality care, focusing on the distinct requirements of clients and their households." It goes on to specify the Nurse as someone who "collaborates with patients families and other health employee to prepare and offer Nursing care that will attain an ideal level of health and health, or when this is not possible, support the experience of loss and death." I completely concur with these statements.

Deciding to take on the function of a Nurse shows the altruism of the person. It is deciding to put somebody else before one's self. It is the act of transforming from whatever type of individual they are on the beyond the work location, and becoming someone who is non-judgmental, optimistic, positive, caring, empathetic and has the understanding capability to be able to supply care while appreciating the patient's desires and beliefs. I feel as if certain attributes of the Nurse are not taught.

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These are personality type that we are born with and whether or not we utilize them, is up to us. Other Qualities of the Nursing function, I feel are obtained by training and education.

For example, inserting a Foley catheter, or any sterile procedure for this matter, training has to take place for the Nurse to properly insert the catheter.

We have to be trained how to properly open the package, how to move so that sterility isn't broken and know proper techniques to insert the catheter. The Nurse must be trained on how to do this skill but unless she is educated, then the skill is useless. The Nurse is educate on rationales to each step, i.e.: Why am I doing this?, What am I looking for? What do I do If this happens? How will this affect the patient? Nursing is an incredibly interesting field with many doors of opportunity. It is a field that interests me greatly. There are so many different areas of nursing which makes the learning process never ending. While pursuing my Nursing license, I find it extremely comforting to know that if I ever feel "burnt out" on a specific area of the field, I can move on to different areas. I am not obligated to do the same type of Nursing for the rest of my life. My options are endless. While comparing the roles of the Licensed Practical Nurse in North Carolina versus South Carolina, I was a little surprised at some of the differences. I had a very hard time finding specific skills that an LPN in NC could perform.

We are directed straight other pages which don’t necessarily directly state do's and don'ts. Some skills with both North Carolina and South Carolina can be performed by the LPN if, and only if, the employer has documentation of proper training, continuing educations courses, verification of skill competency by at least an RN, and frequent evaluation of the Nurse's competency of completion with the skill being performed, on file. Both states have set rules on how much continuing education is necessary or how frequent the skill competencies should be evaluated. Both States allow the Licensed Practical Nurse to assist in preforming the initial assessment but are not allowed to make nursing diagnoses. They both allow the LPN to verify blood with an RN but LPNs are not allowed to hang blood. Neither state allow the LPN's to do any pulmonary artery pressure or pronounce death. Also, in South Carolina the Licensed Practical Nurse cannot evaluate or stage pressure ulcers, they can only document on the observations of the ulcer once the RN have evaluated and staged it. In North Carolina, the LPN can first assess and size the wound or ulcer or even change the dressing under a specific order and a Registered Nurse will verify the LPN's evaluation.

South Carolina does not allow LPNs to do any arterial punctures, but they can manage the site; LPN's in North Carolina can complete arterial punctures for the collection of blood. The two differences that fascinated me the most dealt with acupuncture and cosmetic procedures. In North Carolina, the LPN, or the RN, cannot practice acupuncture. It is prohibited, unless an individual has completed a 3 year postgraduate acupuncture college or training program verified by the state. In South Carolina, an LPN can practice acupuncture under a Licensed Acupuncturist as long as he/she has been trained under the employer, it is documented, and a request to practice has been approved by the state. With cosmetic procedures, in South Carolina a Licensed Practical Nurse can only apply chemical peels with less than twenty percent acid solutions and they may also do a microdermabrasion under a dermatologist. In North Carolina, a Licensed Practical Nurse can do a broad range of skills in the cosmetology field. He/She may give a microdermabrasion, chemical peels, give Botox, collagen injections and laser hair removal. With Botox and Collagen injections affecting the appearance so greatly, it is hard to believe that this is a skill that an LPN can become properly trained on.

The Charge Nurse role is defined by the North Carolina Board of Nursing as “an RN who supervises and manages patient care delivery settings or groups of clients, usually for designated time periods." It also defines the Nurse-In-Charge role as "the assigned role and responsibility of an LPN who participates in assuming the implementation of established health care plans for a designated number of clients under RN supervision." Basically how I interpreted this was, the LPN can be the Manager when the Manager is away. The Licensed Practical Nurse will continue to work in the appropriate scope of practice and report to the Registered Nurse. The LPN will call to report updates or for guidance in certain situations. If the task at hand is not in the scope of practice for the LPN, the RN will be called to come in to make decisions or perform the tasks. Working in a long term care facility has helped me better understand the difference between the two, although we do not use the term Nurse-In-Charge as often as we should. On weekends we have two specific Nurses who work opposite weekends of each other and are delegated the responsibility of being the Nurse-In-Charge. On Fridays, before our Charge Nurse leaves for the weekend, she will do a quick run through with the Nurse-In-Charge for the weekend.

They go through and talk about the "what if's?" for the weekend, and what to do and not to do. These Nurses also know when a phone call needs to be placed to the Charge Nurse. Throughout the weekend, they call with updates and notify the Charge Nurse of any changes that have or are occurring with any health statuses of the Residents. Depending on the situation, the RN delegates appropriate tasks in the LPN's scope of practice over the phone or, if another RN is not in the building, she will come into work if needed. It is said that we, ourselves, are our biggest critics. For me this is extremely true, so when it came to trying to determine my strengths, it took a while. Based on what others have told me, I've got an abundance of patience and I also have good communication skills. I've always had strong relationships with my residents and their family members. When trying to decide what my strengths were, I had to ask myself "Why do they like me?", "Why do they treat me as if I'm a part of their family?" "Why do they trust me?". What came to mind was the way I talk to them.

I speak to residents and families the way I would hope to be spoken to, if the roles were reversed. I believe that good communication skills, including the ability to listen, would be something positive I could bring to the role of the LPN. I hope to be an influence to other Nurses who come in with bad attitudes and forget that their patients are humans too. To remember that even though they may be a "frequent flyer", they are still human, they still make mistakes, and more than likely are in desperate need of kind words. I hope to influence others when it comes to being open minded and influence them when they go to pass judgment. I hope to bring more compassion, optimism, acceptance and leadership to the LPN Role. My weaknesses are my confidence in my decisions and my abilities.

I second guess myself a lot and I constantly double check myself. This could work both ways, good and bad. I look for reassurance from others to ensure that I am right and I know that I won’t always be in a position where I can be reassured. I want to gain the confidence without becoming "the know it all." A good quality Nurse is one who's always willing to learn. Another weakness I have is my inability to handle the emotions of the family members during the harder times. Times like these are very awkward for me and I would like to get stronger in my ability to be comforting and supportive. I usually try to avoid these situations as much as possible because the wall that holds my emotions in during these times, is very thin. I need to learn how to be emotionally professional while still remaining to be human.

Resources

NURSE–IN-CHARGE ASSIGNMENT TO LPN Position Statement for RN and LPN Practice. (1996, January 2). Retrieved November 23, 2014, from http://www.ncbon.com/myfiles/downloads/position-statements-decision-trees/nur
se-in-charge.pdf

LPN Scope of Practice Clarification. (2010, January 1). Retrieved November 23, 2014, from http://www.ncbon.com/myfiles/downloads/position-statements-decision- trees/lpn-position-statement.pdf

Mission and Philosophy. (n.d.). Retrieved November 23, 2014, from http://nursing.unc.edu/about/philosophy-of-nursing-and-nursing-education/
Infusion Therapy/ Access Procedures. (1998, May 1). Retrieved November 23, 2014, from http://www.ncbon.com/myfiles/downloads/position-statements-decision-trees/infusion-therapy.pdf
South Carolina Board of Nursing. (1989, November 1-Revised 2014, July 1). Retrieved November 23, 2014, from http://www.llr.state.sc.us/pol/nursing/index.asp?file=AdvisoryOp/advisoryop.htm