What role can LPNs play in the recovery room?
An administrator of a freestanding surgery center in Florida hired a bright, licensed practical nurse (LPN) with experience working in a local hospital’s critical care unit. The LPN was eager to help the RNs on staff, and the administrator knew they needed assistance in the recovery room. But when the administrator contacted state authorities and trade associations for directions on what LPNs can and cannot do in the recovery room, she got bogged down by legal definitions of nursing that failed to offer any practical guidance.
So what is the answer?
While experts agree that LPNs can play a supporting role in the progressive, or second-stage, recovery room, they aren’t in unison on the LPN’s place in the post-anesthesia care unit (PACU), or first-stage recovery room. In fact, some think there is no real place for LPNs in the PACU at all.
"An LPN in a PACU is not a good match," says Susan Kizirian, RN, BSN, MBA, executive director of the Southeastern Urological Center in Tallahassee, FL. "The PACU is a high-tech area where you are constantly assessing patients’ cardiopulmonary functions as they wake up from general anesthesia. And during the 30 minutes or so that patients are in the PACU, this assessment can only be conducted by a registered nurse, not an LPN."
States define the boundaries
Kizirian says most states prohibit ambulatory surgery centers from using LPNs in any area that requires assessment, and most areas in surgery centers demand some kind of assessment skill. For example, RNs should have the primary responsibility for giving patients discharge instructions, she says.
A registered nurse is trained and educated to assess patient care, while an LPN is not, says Deborah G. Spratt, RN, MPA, CNOR, CNAA, chairwoman of the Ambulatory Surgery Specialty Assembly of the Association of Operating Room Nurses (AORN) in Denver.
"The difference is that as registered nurses review documentation and speak to patients, they assess the patients’ level of understanding and how ready they are to receive the instructions," says Spratt, nurse manager in the OR at Strong Memorial Hospital in Rochester, NY, and former clinical director of a New York surgery center.
Registered nurses assess whether patients have someone to care for them at home, and they assess the patients’ levels of pain, nausea, and vomiting, she says. "If patients are nauseated, the RN can tell the LPN to give them medication. Later, the RN will assess whether the medication worked to treat the nausea."
Providing support to RNs and patients
Others insist that stating LPNs offer little value in the PACU is not accurate or realistic, given recent nursing shortages and the fact that LPNs have worked for more than 35 years in recovery rooms at hospitals. For example, the American Society of Perianesthesia Nurses (ASPAN) of Thorofare, NJ, and the Orlando-based Florida Hospital Association say LPNs can be helpful in the PACU — they just have to be under the supervision of an RN.
"Depending on the state and the institution, some LPNs can do limited care [in the PACU], such as checking blood pressure and giving meds," says Cathy Allman, RN, MSN, vice president of the Florida Hospital Association’s Center for Nursing.
Despite these differing opinions, the experts seem to agree that LPNs can support RNs by taking over some of the technical aspects of patient care in the second-stage recovery room. LPNs can draw blood, change dressings, take vital signs, and report on blood loss or urine output. In Florida and some other states, LPNs also can administer IV medications if they are certified to do so. Registered nurses don’t have to be in the same room at all times as the LPN, but they do need to be in the vicinity.
Because there’s no industry consensus on the issue, experts suggest that managers and administrators who are unsure about LPNs’ scope of practice contact their state board of nursing and review their facility licensing regulations to see what the statutes dictate.
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