Uphold Clinical Standards

Check your institution for guidelines and policies. The facility might restrict the LPN/LVN’s role to less than the NPA allows, but no employer can give nurses permission to do what their license says they cannot do.

The National Association for Practical Nurse Education and Service, Inc. (NAPNES) and the National Federation of Licensed Practical Nurses, Inc. (NFLPN) are practical/vocational nursing organizations that provide standards to guide the role of the LPN/LVN (see Appendices E and F on Evolve and the Online Resources at the end of this chapter). These standards of practice—which echo the values and priorities of the profession and provide guidelines for safe and competent nursing care—may be used as a basis of prosecution or defense in a court of law.

Provide Safe Patient Care

In the hospital acute care setting, the LPN/LVN may be engaged in total care for assigned patients, under the supervision of a registered nurse (RN). Total care duties involve being responsible for meeting patients’ basic needs, with the goal of making patients as independent as possible to preserve their ability to care for themselves. LPN/LVNs cannot assume the role of the professional (registered) nurse, but they do participate in the nursing process by assisting the RN to assess (gather data on) patients and to plan and evaluate patient care. The LPN/LVN assists with personal hygiene, performs ordered treatments, initiates nursing interventions, and administers drugs. In other situations, the LPN/LVN might be used as a medication and treatment nurse for all patients on a team. If asked to do a procedure or treatment that was not taught in the educational program but is allowed by the NPA (e.g., monitoring blood transfusions), LPN/LVNs can obtain further training and have their new proficiency recorded in their personnel file.

Teach Patients

An important aspect of nursing care is to teach patients and families to care for themselves or loved ones to prevent complications, restore health, and prevent further illness. LPN/LVNs also teach basic hygiene and nutrition in the context of health promotion. Examples of teaching include reinforcing what the registered nurse or physician advises regarding scheduled diagnostic tests, upcoming surgery, how to treat a wound, or how to change a dressing. Other teaching activities concern how to take prescribed medication, what side effects to report, and the self-care activities and lifestyle changes required to promote rehabilitation and independence. LPN/LVNs contribute to the discharge plan by reinforcing discharge instructions and providing information to patients about community resources and self-help groups.

Communicate Effectively

Therapeutic communication from the medical professional helps the patient develop trust in the quality of care and decreases anxiety about the medical situation. Therapeutic communication is also used when communicating with staff, especially when making requests. Call staff by name, to ensure their attention, and explain the purpose of the communication. Present requirements of a request and give a time line for completion. Obtain feedback that the request was understood, and provide appreciation for cooperation. Loudspeaker noise from paging systems is annoying to patients. Some agencies try to cut down on noise with wireless communication devices that clip on clothing and allow staff to contact each other, other departments, and physicians.

LPN/LVNs give objective and thorough end-of-shift reports and maintain objective documentation about the care given and the status of patients. Nursing documentation is used to receive approval for length of stay, and reimbursement of facility charges from insuring agencies.

Work as a Collaborative Member of the Health Care Team

LPN/LVNs work with other members of the health care team (e.g., physician, RN, physical therapist, respiratory therapist, dietitian, pastoral care team, pharmacy personnel, and unlicensed assistive personnel [UAP]) to provide the patient with an integrated, comprehensive plan of care.

Advocate for the Patient

Facility and unit routine can lead to an impersonal health care system that loses its focus on patients’ rights. The American Hospital Association (AHA) has published The Patient Care Partnership: Understanding Expectations, Rights and Responsibilities (2003) (Appendix G). LPN/LVNs advocate for patients by standing up for patients’ rights and ensuring that their needs are met.

Advocating for a patient could be as simple as making arrangements for special food or meals at times other than those within the facility routine, or it may entail informing the physician of a patient concern.

Charge Nurse/Manager of Care

The most common site of employment for the LPN/LVN is the nursing home or long-term care unit. In this setting, LPN/LVNs frequently assume the role of charge nurse. Many NPAs specifically state that the LPN/LVN charge nurse functions in a nursing home under the general supervision of an RN, who is either on site or is available by phone.

Health Insurance

Health insurance, like any type of insurance, spreads risk among the whole group of insureds. The young and the healthy generally do not claim as much as the elderly for health care, and (if the fee structure is equivalent for all) the young and healthy subsidize (support) the sick and older persons covered by the insurance provider.

The cost of health care services today generally makes payment directly by the patient (private pay) impossible. The traditional method of financing health care services, fee-for-service, involves direct reimbursement by an insurance company to a provider (a licensed health care person such as a physician, dentist, or nurse practitioner) whose health care services are covered by a health insurance plan. To improve their profit, insurance providers charge a deductible (the yearly amount an insured person must spend out-of-pocket for health care services before the insurance provider will begin to pay for services), a copayment (the amount an insured person must pay at the time of an office visit, prescription, or hospital service), and co-insurance (once a deductible is met, the percentage of the total bill paid by the insured person). The insurance company subtracts the amount the patient has paid from the total bill, and then pays the remainder.

Capitation, an alternative for fee-for-service payment, involves a set monthly fee charged by the provider of health care services for each member of the insurance group for a specific set of health care services. If services cost more than the monthly fee, the provider absorbs the cost of those services. At the end of the year, if any money is left over from the unused portions of monthly fees, the health care provider keeps this remainder as a profit.