A Win for the LVN: Enhancing Practice in the Ambulatory Care Setting

A large academic medical center sought to expand internal capabilities of the licensed vocational nurse (LVN) to include intravenous (IV) therapy in the ambulatory care setting. Historically, LVNs were restricted from practicing IV therapy per institutional policy. Feedback from ambulatory care clinics indicated that allowing LVNs to provide IV therapy would offer multiple benefits. First, the change would enable LVNs to initiate an IV in an emergent situation rather than delay care until a registered nurse (RN) arrives. Clinics with limited RN staff would be able to utilize LVNs to start IVs, allowing the RN to focus on other tasks which cannot be delegated, such as telephone triage. Lastly, expanding LVN functionality to encourage height of licensure practice would increase job satisfaction and maximize budgetary resources.

When considering this concept, guidance on practice standards was sought from governing and professional organizations. The state board of nursing (BON) recognizes that LVN educational programs do not mandate instruction on IV principles or techniques. Therefore, the BON recommends that LVNs not engage in IV therapy without successfully completing a knowledge and skills validation course. The state BON does not define or set qualifications for what constitutes a valid training program.

Following a shared governance model, a proposal was presented to an ambulatory care practice council to enhance LVN practice to include peripheral IV therapy. Approval was granted with the stipulation that completion of a comprehensive training course followed by competency validation by an RN preceptor would be required. It was also specified that IV therapy tasks performed by LVNs would be limited to IV initiation, fluid administration, and IV discontinuation and exclude IV medication administration.

The ambulatory care clinical education department developed and implemented an IV therapy training course in accordance with established nursing practice standards. Topics addressed in the training included scope and legalities, infection prevention, anatomy and site selection, contraindications, IV initiation and discontinuation processes, fluid infusion, documentation, potential complications, and patient-specific considerations. To maximize learner outcomes, the evidence-based curriculum included an interactive didactic presentation followed by hands-on skills practice.

A post-course evaluation was utilized to assess the effectiveness of the training. The average pre-course confidence rating with IV therapy skills was 1.83 on a 1-5 Likert scale with 1 indicating “no confidence” and 5 indicating “extremely confident.” Post-course confidence more than doubled to an average rating of 4. Increased confidence was reported as the main benefit of the course, followed by the ability to provide better patient care. 100% of nurses who completed the evaluation reported a significant increase in job satisfaction.

The original intent of the program was to train LVNs to perform IV therapy; however, this course has proven to serve a broader staff population. Ambulatory care RNs have also attended the course to expand their existing knowledge and strengthen their precepting ability. The course implementation was a success, and the goal is to continue offering the course regularly to support quality patient care, increase employee satisfaction, and diversify staff skills.