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

hi, this isn't a message, but a question. I am a CNA I just graduated from MMTC, I am now a MA. I will be going to Horry-Georgetown Tech for the LPN Program, I can't take the RN program until I complete ENG2. My question is should I keep my job as a CNA, MA for a year or until I can take the RN program, and complete Eng. 2 while I'm waiting. The only problem is I'm not even on the waiting list for the RN, but I have a spot for the LPN and I will be started this Aug.
Please help me

Since you have a place in the LPN program now I'd do that especially if it is a school where you are then eligible to do a LPN to RN bridge program and get some credit for your LPN. Good luck.

flgrant, take the spot you already have. Bird in hand and all that.

And don't post email addresses. It's a TOS violation.

i agree with the advice given here. i'm in (almost) the same boat. if i don't get in to the RN programs in my state i am absolutely heading for LPN... get some work done while I wait for the RN spots to open up. So many people are applying in my state! one state college has 600 applicants...i think there are 40 slots. that's what happens in a nursing shortage i guess!

Just my two cents...I think LPN should be a 2 year degree (like the Associate's RN is now) and RNs should all be BSNs going forth. Then the distinctions might be super clear.

lpnflorida - clearly you know your scope of practice as an LPN and don't see that there's any blurring between the LPN and RN roles.

I know I've met many an LPN who gripes that they do "almost everything" an RN does but get paid so much less and that it's not fair. I've met many an LPN who boasts that they "know as much as if not more than" RNs and argue that they should have all the same rights and responsibilities as RNs. I'm by no means saying that all or even most LPNs think that way, but I've definitely heard it and wonder what your experience is with and what your perspective is on that attitude.

Also, in general, do you (any of you reading this) out there agree with the different scopes of practice? What is the difference in training that allows RNs to take orders off but not LPNs? Or to start IVs? Or to do initial assessments? LPNs do on-going assessments, so they must have learned some assessment skills, right? Many RN programs don't teach how to start IVs. RN programs do teach the basics of fluid therapy. I don't know if LPN programs do or not, but some states do allow LPNs to hang IV fluids.

I'm not arguing what should or shouldn't be in the LPN scope of practice. I'm just not sure what the rationale for where the lines have been drawn between the two types of nurses/nursing practice.

the other problem is the the lines wander from facility to facility, setting to setting and state to state! To me that where a lot of the confusion comes from.

My own hypothesis as to why they are some LPN's who have strong feelings that they desire/deserve to have the same pay some responsibilities as an Rn is as follows:

I might at one time thought the same, except that back when I went to school late 70"s our Scope of Practice was very clearly defined. It was very much stressed at least in my own school what the differences were between the two factions. We were taught how to do full assessments of the patients. I am also from an era which believed we earn what we have worked for. To me as I have not gone on to become an RN why would I be entitled to all that they worked so hard for. It is not to say I personally have not gotten additional education, but it does not entitle me to be an RN nor treated as an Rn with their Scope of Practice. That is fair. Perhaps that is the crux I do not feel entitled to something I did not yet earn, no matter how much I might know, no matter how skilled I might be.

Yes, Lpn's can become IV certified, working in the state of Florida I am able to do much more within my Scope of Practice than I was when I worked in Minnesota. Yet the Scope of Practice I had in Minnesota was further narrowed by the particular facility that I worked at. It was good training, at that time we LPN"S were taught to do full assessments yet at that time we were not allowed to assessed breathe sounds. Imagine lol. They did finally have special classes which taught us how to assess breathe sounds and then magically we could perform those assessments. When I first came to Florida 10 years ago. The current facility I worked at referred to both LPN"S and RN's as professions. There was little distinction beyond beyond the who was the transfusionist on record of blood products. They did not have a list of medications of which we could not give IV push at that time. It has since changed and at least we now have a concrete list of medications we cannot push, partly in thanks to the fact I kept telling my DON an exact list was needed to protect our own licenses.

Having come from a very restrictive environment to one which is less restrictive I believe has helped me to keep my head on straight. I read all policies coming out. The policies of today are very clear that when a patient falls an RN now has to do the assessment. This is a recent change of the last 6 months. I do not have an answer as to why we are able to take telephone Doctors orders yet for the past 5 years have not been able to sign off on orders. I believe it was less of our not being capable and just more of a push giving RN's more responsibility than was truly necessary. Some of it is due to JCAHO requirements, some is simply ANA requirements . The decision tree for what an LPN can or cannot do is made by RN's not by LPN"S this is what in my own estimation has led to so much confusion among our different states as to just exactly what is our Scope of Practice.

I know my writing is rambling, but I write as I think. I hope this clarifies a little bit what you asked.

i have a FL and a NC LPN license and the scopes as far as nurse practice act don't vary too much. florida is however, more willing to let LPN's practice to their full scope and more widely will utilize us in hospitals. the one thing that FL requires is for LPN's to take an IV cert course.

i went to nursing school in NC, we had a very heavy course load and used the same books as the RN program (pharm, med/surg, mental health, peds, OB and patho) except for our fundamentals, acute care and role transition stuff (RN's had to take professional nursing and delegation instead). all same pre-reqs. my program was 18 months and the RN program was 24 months. we took assessment, care planning, fluids and electrolytes and IV therapy. we did our clinicals for the most part in the hospital, we did have a few rotations in nursing homes/rehabs (but i think everyone does). the RN students got to go to L&D, ER and critical care and we did not. but we had the same sites for med/surg, peds, tele, psych and neuro.

my program did a wonderful job in covering everything. that is why when i go to do my bridge i will be able to test out of alot, which i am very grateful for. we did assessments on each other, had multiple sim people to play with including a sim man that codes, a birthing dumby (awesome) and a baby, had IV/phleb lab and did stick both dumby arms and each other.

i think the hardest part for me is not being so independent anymore. i spent the 1st 6 yrs in the medical field as a paramedic. i did not get into the RN program right away due to the waiting list but heard how good the LPN program was so i did it to get a foot into nursing.

my fiance who is an RN had reviewed books in nursing school.... and the med/surg books were the same he used in his BSN program, just newer versions. he said he spent alot of time researching and writing papers. he is not discrediting his education, but he's told me he wishes he had the hands-on time i did. when i worked in the ER as a medic and he was a new grad, i taught him how to start IV's and insert a NGT.

what makes us different is more indepth education in regards to assessment, diagnosis, care planning, delegation. i know my scope of practice and my hospital polices and you bet your butt i abide by them. i do feel like i a second class nurse sometimes having to chase down an RN to just sign their name next to something i did such as check on my patient in restraints q 2 hrs.... but those are the rules.

i am very excited to continue my education and become an RN. being an LPN was never my goal, but when my plans fell apart the LPN program fell into place for me and i am proud to finally be a nurse, even if i am at the bottom of the food chain.

Flightnurse,
I was surprised to read that you were not allowed during your training to go into ER, surgery, or labor and delivery etc. There was no where in the hospital we did not go, well I lied. I never went into the morgue. All of our training was hospital based except our mental health was 4 weeks at the State Mental Health Facility were we had to lived in the dorms on the grounds at that time. We had excellent training with many many clinical hours, We were not taught team leading of course as that was out of our Scope of Practice. My training was in Wi. and at that time outside of New York State we had the highest number of required clinical hours. It was very different then more intense and the student to clinical instructor ratio was much lower than seen today. In peds we could not give medications, that was the only restriction I clearly remember. Going into surgery was awesome.