Good Question

Working outside the area of your expertise and using LVNs to make patient assessments are the topics Ericka Waidley, MSN, RN, tackles in this installment of Good Question.

January 11, 1999

Q: I’m a neonatal ICU nurse. My colleagues and I have a concern about floating out of our area of expertise. Because of a high census and the nursing shortage, we are being asked to float to adult med/surg floors. We think it is unfair and unsafe for the patients because most of us have not worked with adults for many years. What can we do?

A: This is an issue that you need to bring up with your unit supervisor and educator. It is always uncomfortable to have to change, especially if you have been in a specialized role for a long time. However, the healthcare industry has changed, and it’s crucial to be open to new ideas and roles.

Today’s models of care delivery include emphasis on teamwork. There’s a greater focus on cross-training and an expectation that a licensed RN should be able to function, at some level, in any unit. But "some level" needs to be defined when floating occurs.

If you are being asked to float to a med/surg unit, you should be oriented to that unit. This orientation may include a walk-through of the physical layout to see where supplies are kept, a review of the documentation forms and charting system, and an overview of how patient care is delivered on the unit. This orientation might be similar to the one given to registry personnel. After this level of orientation, you should be able to function as a team member, with a unit "regular" as your backup or buddy. Your function on this unit probably would not include giving meds or doing unit-specific treatments.

If your institution expects you to carry a full patient assignment on the unit that you float to, then a more intense cross-training program should be used. Cross-training means that you have been given an opportunity to learn (or relearn) the skills needed to deliver care for a specific patient population. Often, hospitals give their employees a choice of another area that they would like to be cross-trained to. This may mean an emergency room nurse wants to be cross-trained to the ICU/CCU or a radiology technician wants to be able to work in nuclear medicine also. As you can see, this level of cross-training requires a more dedicated educational program (as required by the JCAHO). Cross-training opportunities benefit healthcare workers by providing job security in their current roles and more "marketability" for future employment.

You certainly can be asked to float to other units. You are licensed as a registered nurse, not as a neonatal ICU nurse. As long as you carry your RN license, you can be expected to function within the parameters of that license. However, it is the dual responsibility of you and your institution to maintain the standard of care delivery to your patients. You and your education department should work to achieve a successful floating or cross-training program.

Q: Because we’re trying to cut costs, we’ve been using LVNs in our ICU/CCU. We were told recently that LVNs are not allowed to do any patient assessments. RNs must do initial and periodic shift assessments, and LVNs can only do meds and baths. Is that true?

A: The immediate answer to your question is "yes," mainly because your facility establishes the policies and procedures relating to the functions that different team members can perform. These functions may vary in different units within your organization and are based on the type and acuity of the patients in the different units.

Most vocational nursing programs include the nursing process in their curricula, which means that vocational nurses are taught how to do an assessment, collect data, and document their findings. In many outpatient facilities, clinics, and extended care facilities, the LVN’s role includes more of these functions.

In an ICU/CCU, it is the standard of practice that the LVN works in collaboration with an RN. This teamwork can be beneficial to both the caregiving team and the patient. Although you may feel that the only reason to do team nursing is to "cut costs," many hospitals have found that patient satisfaction ratings actually go up because of the increased availability of caregivers to patients. Often, the LVN can spend more time with the patient when giving baths and medications, which allows the RN to spend more time planning care, implement patient and family teaching, and coordinate the efforts of the multidisciplinary team.

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