Why can't RN take LPN positions?

  1. RN and LPN role differentiation is so confusing! In some areas the LPN does almost everything an RN does but in that case why can't an RN take an LPN position if he/she is willing to take the lower pay? Or at least, why can't an RN also take the NCLEX-PN in addition to the NCLEX-RN?

    I wanted to work at an inpatient hospice but the only RN positions were as charge nurse, the only RN in the building. As a newbie, I wasn't comfortable with shouldering that much responsibility. But they couldn't hire me into any other nursing position there because those were for LPNs.

    Also, if I find team leading with a LPN too difficult to manage along with my own responsibilities, as an RN I don't have the choice of being team-led by another RN.

    On the one hand, I can see where LPNs would want to protect their role, but on the other hand, many LPNs insist that they have just as much responsibility as RNs and almost all the same skills. If I'm willing to accept the same pay as an LPN, why can't I work in that role? It's not like a doctor wanting to work as a nurse. They are very different roles. The doctor won't know all that nurses do in a shift.

    I do know there are reasons... I guess I'm just looking for sympathy over feeling overwhelmed by RN responsibilities and wishing there were more steps to assuming more responsibility as opposed to pushed to the deep end so quickly.
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  2. 32 Comments

  3. by   TrudyRN
    As I understand it, an RN working in any role (title) is still held to the standards of an RN.

    Check with your state licensing board to know why an RN can't take the LPN licensing exam. It seems to me you should be able to do that.

    But why would you want to not work as an RN? As a new grad, you need good orientation, mentoring, and preceptoring to help you feel confident and capable. Don't throw away your education and higher earning ability just because 1 facility doesn't seem to want to help you get a good start. Aren't there other facilities you could work? Or a different field within Nursing? Let the facility know what you need in order to be a great employee for them.
    Last edit by TrudyRN on Feb 16, '07
  4. by   caliotter3
    In my state RNs can work at any level, the BRN has a position paper on the subject though, pointing out that as an RN, you are held to the RN standard of practice. Many RNs work as CNAs, particularly foreign grads who are taking the tests and working as they can pass each level. I asked this question in my BSN program and the answer given was that while possible to work "beneath" your license, it is not advised to do so for legal reasons. The instructor pointed out that you are held to the higher standard. It is possible that if there were a problem, the fac mgmt would take the stance that you were not required to exceed your job description. Sort of darned if you do and darned if you don't. Also there is the issue that your employer, while using you in this capacity, is literally "using" you, expecting you to take RN actions while paying you at the lower rate. I myself worked as a CNA and moved up to licensed status when an opening became avail. It worked fine as far as getting to know my residents (LTC); but did not work out supervising wise as mgmt did not back me up when the CNAs resented me becoming a supervisor. The CNAs wanted me to be their "friend". Mgmt wanted me to suddenly be able to perform miracles supervising my former peers. I was caught in the middle. I would think twice about doing this at the same place of employment again.
  5. by   jjjoy
    Quote from caliotter3
    The instructor pointed out that you are held to the higher standard.
    What does this mean? Could you give an example? One should stay within their job description regardless of particular licensure. Whether you're a CNA or a CNA who also happens to have a nursing license, you should notify the nurse of changes in status and you shouldn't do nurse-only tasks such as IV starts or teaching the patients.

    In regard to LPN and RN there is even less difference between their functions. Aren't they held to the same high standards? An LPN may not be able to hang blood on his/her patient but if they observe the patient is having an adverse reaction they need to take action per hospital policy.
  6. by   WolfpackRed
    Because you hold a license, as an RN, you are help accountable to the standards of that license, even though you may not be in an RN position, i.e. you cant use the defense that "its not in my job description"
  7. by   jjjoy
    Please give an example.

    If I'm on a plane and someone stops breathing, if I don't perform rescue breathing/cpr (and no one else can or does), am I liable for neglect because I do have the training? Good question. If I do, then fine. If a CNA with an RN sees that a patient has stopped breathing, they need to tell the nurse. If the nurse can't be found and no one is running to help, perhaps the person with the RN should then jump in until help arrives. I don't know the legal ramifications.

    What if I were just visiting an inpatient and saw the roommate wasn't breathing and couldn't find any staff to take care of it? Would it be neglect if I didn't perform rescue breathing/cpr because of my RN licensure?
  8. by   WolfpackRed
    Quote from jjjoy
    Please give an example.

    If I'm on a plane and someone stops breathing, if I don't perform rescue breathing/cpr (and no one else can or does), am I liable for neglect because I do have the training? Good question. If I do, then fine. If a CNA with an RN sees that a patient has stopped breathing, they need to tell the nurse. If the nurse can't be found and no one is running to help, perhaps the person with the RN should then jump in until help arrives. I don't know the legal ramifications.

    What if I were just visiting an inpatient and saw the roommate wasn't breathing and couldn't find any staff to take care of it? Would it be neglect if I didn't perform rescue breathing/cpr because of my RN licensure?
    Not sure about these scenarios, I, and others, are just saying that if you are in the LPN position you are still accountable to the standards of your RN license. Therefore, if something happens to a patient under your care that an RN would have the knowledge to deal with, you are obligated to act as an RN eventhough you are in an LPN position. So you can't expect the position of LPN to protect your RN license.

    As someone mentioned above the facilty wins, as they are getting an RN for the pay and benefits of a LPN.

    After thinking a while, and I could be way off here, but in the scenarios that you describe above, you, as a member of the general public, have no legal obligation to help someone in a crisis. Ethical obligation can be debated. Also, IIRC, if you do intervene in a crisis in public, and it is found out that you have a certain levle of training, then you can be held accountable for your actions. This is why I same at home and monitor these forums.
    Last edit by WolfpackRed on Feb 16, '07 : Reason: Upon further contemplation
  9. by   caliotter3
    It means to cite an example, that you can't sit on your butt in a geri chair sleeping along with the other CNAs when any of your residents require some kind of attention (night shift). Another example: you determine, that a pt requires CPR, (in our facility CNAs are not held to perform CPR), you take steps to initiate CPR, you just don't go to the charge nurse to get her/him to take action. As far as your second paragraph, LPNs are held to the LPN standards of practice in a court of law. They can not exceed them, without incurring liability for exceeding their scope of practice. I repeat that the instructor in this class advised against working at a level lower than your actual license for legal reasons. My post never implied that a CNA would be doing RN tasks (although I have been in facilities where this occurred and the charge nurse got fired for it). However, employers are not stupid. They turn their eyes about a lot of things. The CNA who was giving meds and was caught by a family member, used the excuse that in her native country she is an RN. Her charge nurse was fired. She had been doing this for yrs and getting away with it. Mgmt only disciplined the charge nurse because the family caused a problem. When I worked as a CNA, I did not exceed my job description. The charge nurses liked having me around because I did a better job of keeping them informed about what they needed to know. I was aware that just b/c I was in a CNA position, I could not "slack".
  10. by   caliotter3
    As far as the example citing Good Samaritan laws on an airplane or elsewhere, there have been lawsuits b/c families were unhappy with the efforts/results of the person performing the good deed. Unrealistic expectations.
  11. by   SN bbgrl
    hmmmmm I would be curious as to the answer myself. :yeahthat: Along the same lines, i have a friend who attended medical school in Mexico. She then returned to the US when she finished school but was unable to pass the medical boards. She lives in Miami and the last i heard was that she is working as a PA. Im not sure how this worked out but i find it interesting and am happy that she is able to put her skills and education to use.
  12. by   WolfpackRed
    Quote from SN bbgrl
    hmmmmm I would be curious as to the answer myself. :yeahthat: Along the same lines, i have a friend who attended medical school in Mexico. She then returned to the US when she finished school but was unable to pass the medical boards. She lives in Miami and the last i heard was that she is working as a PA. Im not sure how this worked out but i find it interesting and am happy that she is able to put her skills and education to use.
    But in this scenario, your friend is licensed, and working, as a PA. The OP is licensed as an RN and is thinking of taking a job as an LPN. It would be as if your friend was a licensed physician, but working as the PA.
    Last edit by WolfpackRed on Feb 16, '07 : Reason: what else, spelling
  13. by   jjjoy
    Quote from WolfpackRed
    Not sure about these scenarios, I, and others, are just saying that if you are in the LPN position you are still accountable to the standards of your RN license. Therefore, if something happens to a patient under your care that an RN would have the knowledge to deal with, you are obligated to act as an RN eventhough you are in an LPN position. So you can't expect the position of LPN to protect your RN license.
    So what's an example of something that an LPN could "get away with" (like a CNA not instituting CPR) that an RN couldn't "get away with"?

    If my RN knowledge tells me that the patient needs RN-level care (what exactly is that compared to LPN-level care? hanging blood products?) I'd tell the patient's RN. If the problem is that the facility is understaffed (not uncommon) and the RN can't fulfill all of her responsibilities then the LPN-RN is legally responsible to pick up the rest - such as to finish patient admits (one of the few things extra that RNs do that LPNs don't in most settings)? But if the RN wasn't able to take care of everything during their shift, the priority tasks would be patient care, which the LPN (or LPN-RN) should be pitching in with anyway.

    Please give a concrete example!

    And why shouldn't an MD be able to work in a PA role if they're willing to take the cut in pay and are willing to accept the reduction in autonomy? That's very different than someone trying to change fields completely, such as an MD to RN. Though if an MD wanted to work as a nurse, why couldn't they go to nursing school and do that? Most wouldn't want to, but why if someone wanted to, why not? Aren't some Philipino MDs traing to be RNs in the US?
  14. by   NicoleRN07
    I can't understand why you would want to work as an LPN if you have a license to practice as an RN. If Hospice nursing is what you truly want to do, you should develop nursing skills by working in an acute care setting for a few years and then try Hospice. You shouldn't settle for taking a LPN position and less money!! Remember.....you worked hard to obtain your license to practice as an RN.....use them!

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