Scenario
Debra is a 72-year-old patient who was admitted to a medical-surgical floor with a diagnosis of dehydration from vomiting. The nurse practitioner, Jose, prescribed intravenous hydration with normal saline at 100 mL/hour. Debra has a peripheral IV in the forearm.
Serenity, an LPN, was assigned to Debra. Before IV therapy began, the RN, Lyle, completed a comprehensive assessment of the patient. He verified that IV hydration was appropriate, documented the assessment, and directed the IV therapy to Serenity.
Serenity successfully inserted a peripheral IV catheter into the patient's forearm and initiated the prescribed normal saline infusion. Throughout the shift, she monitored the infusion site for signs of infiltration, verified the infusion rate, and documented the patient's response to treatment.
Several hours later, Jose ordered an IV push dose of ondansetron for nausea. Serenity questioned whether she could administer the medication, but did not have time to review the facility policy and Ohio law. As she was preparing to administer ondansetron, Lyle came into the room and stopped Serenity. After Lyle administered the medication, he talked to Serenity about the rules of IV therapy. She recognized that LPNs are prohibited from administering medications via direct IV push and planned to review more on what is allowed and prohibited
Later during the shift, another patient required a blood transfusion. A newly hired staff member asked Serenity if she could start the transfusion. She correctly explained that Ohio law prohibits LPNs from initiating blood or blood component administration and that an RN would need to assume responsibility for the transfusion.
At the end of the shift, Debra's condition improved, and the IV fluids were discontinued. Serenity removed the peripheral IV catheter, assessed the site, and documented the procedure in accordance with facility policy.
Discussion of Outcomes
Luckily, Lyle, the RN, demonstrated knowledge of Ohio nursing regulations and scope.
Patient safety was maintained through appropriate direction and supervision. Lyle completed the required patient assessment before starting IV therapy. Second, Serenity's recognition of her limitations with the blood products prevented violations of nursing and facility policies. However, when faced with the order for an IV push medication, she did not appropriately consult the RN and nearly attempted to administer the medication herself.
Third, the patient's treatment goals were achieved. Debra received IV hydration without complications, resulting in improved hydration status and symptom relief. Proper monitoring by the staff contributed to patient safety.
Finally, Serenity served as an advocate for safe practice by educating her coworker about the restrictions on her performing blood transfusions. This promoted a culture of safety and regulatory compliance within the healthcare team.
Strengths
Effective Collaboration: The case highlights communication and collaboration between the LPN and RN. Lyle fulfilled the assessment requirement, while Serenity carried out tasks competently. This teamwork optimized patient care.
Patient Safety Focus: Serenity prioritized patient safety. She monitored the IV site appropriately, maintained the prescribed infusion rate, and welcomed assistance when procedures exceeded her scope of practice.
Professional Accountability: Accountability is demonstrated when nurses recognize the limitations of their scope and ask for help when necessary. Serenity displayed accountability by declining to perform blood transfusions.
Weaknesses
Complexity of Regulations: Without ongoing education, there is the potential for accidental scope-of-practice violations.
Staffing Challenges: Healthcare organizations that rely heavily on LPN staffing may encounter workflow challenges because certain procedures, like IV therapy, may require RN involvement. For example, blood transfusions, IV push medications, and central line management cannot be directed to LPNs. In busy clinical environments, nurses may feel pressured to perform tasks outside their authorized role. Without strong professional boundaries and organizational support, patient safety and licensure protection may be jeopardized.
Ethical and Legal Considerations
The ethical principle of nonmaleficence, or "do no harm," was demonstrated in this case study. By declining to administer blood products, Serenity protected the patient from potential harm associated with any unauthorized practice. Legally, nurses are accountable for understanding and adhering to state nursing regulations. Performing prohibited IV therapy procedures could result in disciplinary action by the Ohio Board of Nursing, including license suspension or revocation.
The case also reflects the ethical principle of fidelity, as the team honored their professional obligations and maintained trust within the healthcare team. Their actions demonstrate integrity and commitment to evidence-based, legally compliant care.
Conclusion
This case study illustrates the importance of understanding Ohio's regulations governing LPN IV therapy practice. The team's actions demonstrate appropriate direction, adherence to scope-of-practice requirements, and commitment to patient safety. Through collaboration with the RN, Serenity successfully provided IV hydration. Ultimately, they avoided prohibited procedures, such as an LPN performing IV push medication administration and initiating blood transfusions. The case emphasizes that knowledge of legal requirements, professional accountability, and effective teamwork are essential for safe and effective nursing practice. Healthcare organizations should continue to provide education regarding IV therapy regulations to ensure compliance, protect patient safety, and support high-quality nursing care.
