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

It's so difficult. If there was only one type of nurse (RN's) it would make my life a LOT easier because I wouldnt be running around for all the LPN's to do their pushes. They dont help with my work when I do their pushes. When i'm doing an admission of one of their patients they are not helping me with my patients. I think LPN's should be able to do the same things as an RN. In other words they should become RN's.

ejsn, I think you should ask the LPN's to help you while you are doing things for the patient .

I am happy we are not as restricted where I work, however when I do need to have an RN do something for me . In return I always ask them if they need help with something.

No, it is not universal and I work in a hospital. If you read the many threads of not only this one but others you will realize how different our ability to practice is. It varies not only from state to state but institution to institution. There are some always things such as RN only hangs blood and does the first 10-15 min assessment after blood is hung. The later part has only recently this year changed, prior LPN/s could do that . It is very important that not only LPN stay ontop of changes but also the RN's.

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.

I agree with your statement, lpnflorida; review the policy and procedures of the facility and see what the LPNs can, in fact, do. But one arguement I have with your statement, EJSRN; do you feel the same way about nursing assistants? They are not licensed to do any nursing procedures; they are delegated and the RN is ultimately responsible for the outcomes of their tasks, while an LPN does, in fact, have a license of her own, and is responsible for her/his own practice. I understand your frustration, but to say that we should do the same as an RN would mean that we have to be compensated monetarily the same as the RN. It makes no sense to me to ask someone that has less education, theory and money than you to do what you do. In addition, it is harder to enter into RN programs in many places, so, people applied, graduated and work as LPNs to at least be in the arena. Are you saying that we don't deserve to be employed? Not fair, to me, sorry.

Where I work, we have some weird rules that limit LPNs, but many of us try to work around it. If there is something that I am not allowed to do, I do as much as I can legally do, even work around some of it, in order to assist the RNs, so that all they have to do is focus on the RN-specific tasks. I work in a clinic, and depending on the clinic, there are some things I cannot do. An example of this is that we can't administer Rhogam in OB/GYN. I may not do that, but, I counsel the patient on what it is, why it is being administered, can order the drug, sign off with her and do all of the other teaching and medication administration necessary, so, all she has to do is administer that med. When working on the floors, I can't push certain medications, but, I do get them out for them, give the rest of the meds and save a few steps, as well as do what I am allowed to do when an admission comes. Would you rather have a CNA that can only do bedbaths and fingersticks (not degrading CNAs, mind you all), or a medication aide that has no real legal responsibility towards the outcomes of that administration?

I'll be the first to admit that many of the mentioned situations that RNs encounter are the reasons why I will NOT go for registered nursing. For me, it is too much responsibility for things that are out of their control and I never felt it was fair to assume that just because a person is a registered nurse that they can be thrust into these horrible situations where they can easily sink. But, we can do what we can to make what exists work. It is not the fault of the LPN that these impossible to follow rules exist, but it doesn't mean that we have to feel in the way because we are trying to make an honest living as well.

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.

OP - I see your point as one of a lack of clarity in roles between RN and LPN. In some places, that IS a problem. In other places, it isn't a problem. So, it's not "obvious" that there's a blurring between roles. Could you describe what situation specifically you are thinking of?

In my opinion, the difference is unclear in too many places. I'm not sure what the solution is, though. One thought I've had is to have ALL nurses on the same curriculum and they can "step off" at various points depending on what type of work they want to do or if circumstances demand they can't continue school at that time.

Since I'm making this up, I'll have basic nursing assistant training a pre-req for entry.

Then, the first level of nursing school would prepare nurses for work in LTC, to work with stable home health patients, and perhaps some office environments. All nurses who finish the first level of training would be a "licensed level 1 nurse."

The next level of nursing care would prepare nurses to work in acute care and to take on supervisory roles (such as in LTC). All nurses who finish the second level of training would be a "licensed level 2 nurse." This would be a very clear distinction of what kind of training is required for that type of work. And even better, all level 2 nurses would know exactly what type of training the level 1 nurses has because they all had it, too.

Just thoughts!!!

It's so difficult. If there was only one type of nurse (RN's) it would make my life a LOT easier because I wouldnt be running around for all the LPN's to do their pushes. They dont help with my work when I do their pushes. When i'm doing an admission of one of their patients they are not helping me with my patients. I think LPN's should be able to do the same things as an RN. In other words they should become RN's.

Please Do Not put words in my mouth. I never said you dont deserve to be employed. I feel that there should be less or no LPN schools and all RN schools. There are LPN's that are much smarter and have much more experience than me, and I learn from them all day long. Dont you think its sad that they make so much less than an RN. In the nursing homes LPN's do almost the same exact thing as an RN. So No Proud2bLPN I am not degrading you, just think you should be rewarded a bit more for what you do. Its a couple more months of school.