Blurred Boundaries: Should we eliminate the distinction between RNs and LPNs?

I am curious how you would "merge" the two when there are things that an LPN can't legally do.....at least here in NY state........like assess, a HUGE part of the job, administer first doses of meds IV or push IV meds, or adminster via any central line, run blood......those are just the things I can think of. Very few LPNs here in any acute settings. I worked on a Respiratory/Medical unit and there were 5 LPNs but it was hard on the RNs, especially the charge RN as all those things had to be done by an RN so all assessments had to be co-signed by an RN (so essentially redone as I'm not signing something I didn't see or do) or done all together by the RN.....and there are a lot of PICCS on that unit. Not to say that those nurses were not wonderful and very good nurses but they were limited in what they could LEGALLY do.
I agree in all nurses having the same title and education--- eliminate the LPN, and require a BSN for all nurses. Even physical therapists have this minimal requirement. Not to say that the AS nurse is less capable........not my point......just to make a more professional standard.

The hands-down smartest nurse in our ED is an LPN. She's the go-to person for everything. But she didn't get the initials and regrets it because she is legally bound to a more limited scope.

The big thing that annoyed me when I was an LPN, and it's the same thing that annoys her, is RN's not wanting you to have an opinion and to know your place.

However. She should be able to bridge for a lot less money than she would have to spend now.

There are differences between an LPN and an RN. I really don't think they can be merged. The only thing I can think of is to totally elliminate the LPN role, require us to obtain an RN degree. Just be ready for the HUGE addition to the Nursing shortage. You will now have to cover LTC, Rehab, Dr's offices, Assisted Living, etc... The problem is not that LPN's don't want to advance to get an RN degree, it's that there are not enough teachers to cover the classes. I was going to go for my RN, but the waitting list is so long (2 to 3 yrs at some schools) that at my age it isn't worth it, plus during the waitting time some of my classes time limit's would expire so I'd have to retake them too. Yes, there are Bridge programs, averaging 12 seats per class, causing a real backlog when compared to the number of working LPN's applying for those 12 seats. I vote for allowing us back into Hospitals, we would be working under an RN, the few things we can't do are outweighed by the amount of things we can.
Just my 2 cents, as an LPN.

Having just had to take the new jurisprudence exam in Texas, I can tell you that here, the line is not blurred at all....and if it is, you won't pass that exam. A huge chunk of that exam is knowing what the scope of practice is for each so that the line is NOT blurred. I think the roles are dramatically different. I don't see how the two can merge without all of the LPNs being educated up to the level of an RN or BSN.

Yang

I believe it might be more helpful if all states allowed LPN's to work up to their Scope of Practice instead of taking away what we are able to do.

There has always been a place for us to continue working. Yes there are things we can no longer do, it does not however mean we are dinosaurs to be put away and forgotten.

The lines are clear in what we are not able to do compared to an RN such as assessments or hanging blood and pushing some drugs.

At this point it more depends on where you work as to what we are able to do. Again I feel badly when RN's see us as a burden rather than a help. I am so greatful that where I work this is not the case.

I don't understand, I work in LTC, I do assessments on every patient on admission, start IV antibiotics, etc... Here in Massachusetts, the only things I can not do is Hang Blood, Push IV Narcotics, and pronounce someone dead. Yes, I agree that I would need to return to school to learn what RN's learn, however, I don't feel LPN would be a burden in a hospital setting. We would talk a major load off RN's allowing them to concentrate on the area's that we can't do.

NY doesn't permit LPN's to do any assessment, push anything, hang first dose of abx, hang blood.

I think in Florida the lines are a bit blurry. The LPNs I work with a relatively indepedent. As a charge nurse I am their "supervisor" and I verify admissions. Other than that they can assess and monitor patients, and pretty much function in the same role as an RN bedside nurse.....for a whole lot less money. I work with some awesome skilled LPNs, when I need help with a wound vac or an IV, I usually ask an LPN because they've been doing it on the unit the longest. The RNs come and go. I think they are taken advantage of because they aren't properly compensated for the responsiblity they have.

I'm not sure the positions should be merged though. I think LPNs have a role to play in LTC, rehab, and other settings. In acute care, at least around here, they are taken advantage of and if I was an LPN I wouldn't work that hard for such little money when an RN with nine more months of school is my boss and makes $10.00 more per hour.

http://www.op.nysed.gov/nurse-lpn-iv-longterm.htm
This link is to the Office of Professions who licenses all nurses in all states RN and LPN........clarifying the laws of practice in a LTC setting. It specifically talks about the IV and that an LPN can administer but that an RN must be on the premisis at all times while the IV is being used and the site assessed by only an RN every shift/q8H. Scope of practice does differ from acute to LTC but not state to state.....the laws are through this agency and are for all states. This is a good reference as it breaks down in a chart the things LPNs can and can't do by law in the LTC setting. As far as pushing meds the law only allows saline and heparin for a flush if that is the protocol....though not really something used for peripheral IVs anymore thus the change in terminology from hep lock to saline lock. The heparin is really only used in central lines which LPNs can't flush. Anyways check out the page I linked to here....helpful.

It is illegal and out of the scope of practice for any LPN in any setting in any state to ASSESS that is not a state by state thing. The supervising RNs are putting their licenses at risk by allowing this to occur, as the RNs are responsible for the LPNs and if he or she allows that LPN to practice outside of the legal scope of practice it is the the RN who will be in trouble and at risk of losing his or her licence. Many facilities ask LPNs to do this and they can get in trouble as well. Just because a facility is not following the law does not make this law non existant.