Are LPNs the Answer to the RN Shortage in Some Locations?

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    AN staffers recently attended the 2017 Emergency Nursing Conference in St Louis. We had some interesting conversations...

    Are LPNs the Answer to the RN Shortage in Some Locations?

    AN had the opportunity to talk with multiple healthcare systems throughout the US at a national conference. Many had the same issue: not enough RNs. Some had sign on bonuses - up to $10,000 for experienced critical care nurses, while others offered tuition reimbursement, high PTO accrual rate, guaranteed days off, self-scheduling, and free meals. Many nurses at the conference were reporting mandated overtime, on-call time - again that was mandated and staffing shortfalls. Several of the nurses were overheard discussing the sheer exhaustion they were experiencing as a result of "always working short." It is a phenomenon that AN hears and reports all the time. So...whats the solution? Decrease the acuity? Doubt that will happen anytime soon - our patients are sicker than ever. Increase the staff? As the hospital recruiters told us, the sign on bonuses are not always the answer.

    However, one healthcare system, Erlanger Health Systems in Chattanooga, TN, spoke to us about how they are meeting the demand for RNs.... by hiring LPNs. Here are some of the guidelines:

    • Obtain a certification to give IV meds within 7 months of hire date
    • Become an RN within 3 years of hire date

    The LPN to RN transition program is about one year in length and they partner with a community college to facilitate clinicals.

    As we all know, healthcare needs ebb and flow. In 2011, Media Health Leaders brought us this news; speaking about primary nursing models, "and in this model, we're going to replace LPNs with more RNs and also more nurse aides. It's a model which, essentially, does not use LPNs."

    From 2007, HC Pro reports; "Kaiser Permanente hospitals in Sacramento and Roseville, CA, are to replace their licensed vocational nurses (LVNs) with registered nurses (RNs) as part of efforts to provide a higher-level of care to patients. A total of 280 Kaiser LVNs will be affected by this change, which was made following negotiation between the health maintenance organization and United Healthcare Workers West, the labor union representing the LVNs."

    And these are just two examples of how over the past few years, LPNs have been moved out of the acute care environment.

    Now, Erlanger Health System in Chattanooga, TN is bringing LPNs back to the hospital. From their website, they have multiple LPN positions available that are inpatient-based.

    When we discussed this trend with the staff from Erlanger at the conference, they welcome LPNs in the hospital and encourage them to continue their education and in fact offer an LPN to RN bridge program. They couple an LPN with an RN and are using a team nursing approach for the ever-increasing acuity of hospitalized patients. This has resulted in higher satisfaction for the RN, LPN and has improved the patient experience as well. LPNs are able to provide nursing care within their scope of practice which far exceeds what an unlicensed person can provide. As licensed staff, they are held to a higher standard but they also have more knowledge and more ability to affect patient outcomes.

    The Institute for Health Improvement recommends a team-based care approach across all domains of care including acute care. They cite the "definition of “team-based care” for all care settings that is most widely accepted and consistent with the World Health Organization."

    ANA published a white paper in 2015 about staffing strategies for nurses and stated; "Over the years a number of nurse staffing strategies and models have been tested and utilized across and within healthcare organizations. Inherent weaknesses in some models present opportunities for improvement that benefit patients, nurses, and healthcare organizations. The underlying discussion essentially involves the contrast between fixed or rigid models and those which include components that allow for the greatest degree of flexibility to ensure staffing needs are met in real time."

    There are many different outlooks on team nursing, primary care nursing or some hybrid type of nursing care. While none of them are perfect, we as nurses need to speak up, voice our opinions and continue to encourage innovative strategies such as the ones at Erlanger Healthcare.

    For more information about Erlanger Healthcare, contact: Careers with Erlanger
    Last edit by Joe V on Oct 12
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  3. by   caliotter3
    Because Erlanger assists the LPNs to obtain RN licenses, I think this is a good program. However, to simply hire LPNs to fill RN slots, at an LPN rate of pay, seems to me, more likely an attempt to get the job done while saving money in wages. Good for the unemployed LPN in the short run, but a detriment to qualified RNs in the long run.
  4. by   rzyzzy
    Lol.. Nice work citing an ANA document in an article about LPN's! The org that won't even take LPN's as members (and actively works against the interests of ADN's!)..

    Pretty much speechless..

    What's next- using a "KKK study" in reference to African Americans?

    If it sounds extreme, it is extreme - Like ANA's position towards ADN & LPN nurses..
  5. by   Nurse Beth
    Brilliant!
  6. by   traumaRUs
    I started my nursing career as an LPN and if this program was in existence at that time, I would take advantage of it
  7. by   sarolaRN
    RN shortage? Where? If facilities would hire ADNs, there wouldn't be a shortage. This sounds like trying to make the most of a budget to me, which will be at the expense of the RNs already on the job.
  8. by   CluelessNewbie
    Here, it seems. A quick search shows 202 full-time nursing jobs posted from one system and 489 in the other major system. Everything: inpatient, outpatient, home care, LTC, LPN, MSN only... everything. They both hire ADN's.
  9. by   smartnurse1982
    I kind of predicted this would happen.

    It is going to be Bsn Rn's and Lpn's;Adn's will be cut out.

    I guess employers figure why pay for an ADn Rn when you could have either a Bsn for the same price,or an Lpn for cheaper.

    Edit: Tenn has a very broad Nurse Practice scope for Lpn's,and Lpn's and Rn's can do the same tasks.
    It probably won't fly in certain states with a very strict Nurse practice scope,like Nj.
    Last edit by smartnurse1982 on Sep 22
  10. by   GoodDay2017
    I wish there was a list somewhere of all these openings, with sign on bonuses, that will also take new grads. I know many new grads BSN's who would relocate if there was assistance to help them.
  11. by   Horseshoe
    Quote from smartnurse1982
    I kind of predicted this would happen.

    It is going to be Bsn Rn's and Lpn's;Adn's will be cut out.

    I guess employers figure why pay for an ADn Rn when you could have either a Bsn for the same price,or an Lpn for cheaper.

    Edit: Tenn has a very broad Nurse Practice scope for Lpn's,and Lpn's and Rn's can do the same tasks.
    It probably won't fly in certain states with a very strict Nurse practice scope,like Nj.
    That's not true with regard to IV push drugs. LPNs are limited as to which drugs they may give, and they may only push into peripheral lines. Not an issue in certain environments, critical restriction in others.

    Texas also has a very specific, limited scope of practice for LPNs.
  12. by   Archerlpvn
    Texas, while it may have a very "specific" list of what LPNs can and cannot do, still has a very wide scope of practice for LVNs. They can perform focused assessments, IV push certain medications and I believe they can infuse medications into both peripheral and central lines in adult patients when they complete the "IV cert." Don't know about you, but that sounds pretty wide to me considering most restrictions with LPNs/LVNs occur in assessment ability and IV therapy practice.
  13. by   JKL33
    Quote from CluelessNewbie
    Here, it seems. A quick search shows 202 full-time nursing jobs posted from one system and 489 in the other major system. Everything: inpatient, outpatient, home care, LTC, LPN, MSN only... everything. They both hire ADN's.
    There is a difference in "nursing shortage" and a "shortage of nurses willing to work in 'X' conditions for '$X' pay." Calling the latter situation a "nursing shortage" is rather dubious, to put it nicely.

    If I can't buy a nice filet mignon for $5 that doesn't mean my area is facing a critical food shortage.
  14. by   SaltySarcasticSally
    Quote from JKL33
    There is a difference in "nursing shortage" and a "shortage of nurses willing to work in 'X' conditions for '$X' pay." Calling the latter situation a "nursing shortage" is rather dubious, to put it nicely.

    If I can't buy a nice filet mignon for $5 that doesn't mean my area is facing a critical food shortage.
    I agree with you. There is no shortage of nurses, people are just tiring of the work conditions. I would love to be a floor nurse my whole career. But after 3 months on a Tele floor, I can't see doing it beyond a few years. I'm 30 and in good health. I'm dead tired after 13 hours on my feet and a 10 minute lunch. Sorry but hospitals just don't pay enough for people to want to do this long term. That is where this "shortage" comes from.

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