getting rid of LPN's?

Hellllllo Nurse, BSN, RN · Apr 19, 2005

Really? Wow! Here they paid for my Bro -19,000 for the course and 1000 a month living expenses for the year course plus he had a wife working!....:

Wow. Things sure are different in Canada.

terryalbright · Apr 19, 2005

Hi!
Thanks so much for your reply. You do IV's??? Wow, I didn't know LPNs could do that. That's good though. I'm also curious to know if you are concidered a "nurse" if you aren't an RN? I think here in bathurst they call LPNs "auxiliaires" in French, and not "infirmieres" (which means nurse). I'm very excited about going for my LPN, but then I worry that I will put all that energy into my studies and then work VERY hard as an LPN, and not even be called a "nurse". I asked an RN in Bathurst if LPN's were concidered nurses even though weren't RN's and she replied " no, not really. When a staff memeber sais they want a nurse, they mean an RN". What do you think? I'm still going for my LPN regardless, I just want to be prepared and not be disapointed that's all. The salary went up for LPNs right? I was told $18.00/hr ? Is that about right?
Thanks in advance!!!!

Well, we are not allowed to use the word "nurse" without using the qualifier "practical" in front of it.

I am part of a pilot project using LPNs on the IV team but I have worked in Specimen Collection as an LPN- Phlebotomist for the last 18 months. All of the girls in that clinic are LPNs.

In the sense that we provide nursing care we are indeed nurses. We aren't cooks! But it is true that when a medical personnel asks for a nurse, they mean an RN.

However, to the patient, we are nurses. LPNs are bedside care specialists and a very valuable part of the care team, as are the RNs, the Physios, etc.

Casuals would probably get $18.00/hr but right now full-time and part-time are at $17.06 if at the top pay scale. By the end of the contract, 2007, we will be at $19.08

I believe "en francais" the proper term is infirmiere auxilaire immatricule.

Don't get too hung up on the title. It is what you do, the care that you provide, that is important. Your LPN training will help if you decide to advance to RN later.

T

Tashia · Apr 19, 2005

i have this info that might help you with what the role is of an lpn. keep in mind this is for ontario. it might be different where you are.....take some time to read....it's 3 pgs long................the effective use of registered practical nurses (rpns): addressing a nursing crisis in ontario hospitals [june 28, 2001 08:00 pm] introduction

there is a registered nurse (rn) shortage in our ontario hospitals today. however, this is not the crisis the media may portray it as. there are many registered practical nurses (rpn) working and available to work in ontario. the crisis is that too often rpns are not being allowed to work in the entire hospital or to work within their full scope of practice. the crisis is that rpns have been pushed out of some ontario hospital units (for example, mother-baby units). the crisis in ontario hospitals is this waste of rpn nursing resources. rpns are skilled nurses and their training and nursing resources are being wasted.

this study surveyed more than 2000 rpns and other hospital workers in order to determine:

1) what skills rpns were using and where,

2) how many rpns were working and where.

by using telephone interviews and focus group sessions, we discovered:

1) rpns were not using all of the skills that they were trained to do,

2) rpns were not in every unit in every hospital and that rpns had been pushed out of units they had previously worked in which resulted in a very inefficient nursing team.

rpns are professional and competent nurses

the following statement from the college of nurses of ontario shows the competency of rpns:

"rpns can provide care in complex clinical situations in a variety of practical areas." (college of nurses of ontario: entry to practice competencies for ontario registered practical nurses, september 1999).

the registered practical nurses association of ontario (rpnao) also describes the professionalism of rpns:

"registered practical nurses are nurses and are accountable to the cno. they are educated and regulated for quality care. registered practical nurses are valuable and cost-effective partners of a health team, especially when used to the maximum of their scope of practice." rpnao utilization survey, 1998

instead of wasting valuable health care dollars, ontario hospital administrators should be using an appropriate number of rpns to their full capacity. appropriate ratios of rn:rpns allow all nurses to work to their full scope of practice. in order to improve patient care and working conditions in ontario hospitals, there is room for both rpns and rns. an integrated health care team includes all types of nurses.

section i - rpn skill utilization

our research regarding rpn skill utilization uncovered startling results. rpns are being pushed out of hospital units they have traditionally worked in, have never worked in some hospital units where they are badly needed, and are often not allowed to perform some of the skills they have been trained to do.

rpns are being pushed out of some hospital units. mother-baby units, intensive care, emergency and pediatrics, are all examples of such units. rpns have had a tradition of exemplary service in these units.

rpns are trained to work in every hospital unit. rpns can work in surgery and other acute care units just as they work, for example, in chronic care. at some hospital sites, an ochu/cupe rpn committee member reports, "rpns are on all the medical, surgical and obstetric floors (while at another site of the same hospital) rns are only on these units - go figure and then they tell me we are 20 million over budget...i wonder why?" rpns should be active in every unit and their training allows for this.

rpns are trained to do a wide spectrum of skills which should be fully utilized. we found that in some hospital units, rpns were trained by the hospital or through a college course to do the following skills, but are not being allowed to use them:

- medication (and narcotics), intramuscular injections, packing, irrigation, recording, tube feeds, sq meds, trach. care, dr.'s orders, insulin, sublingual, transcribing of meds, catheterization (intermittent and indwelling), wound irrigation, pack-wound management, suctioning, ivs, sutures, clips and drains.

too often rpns are not allowed to utilize the above skills in acute care hospital units. sometimes, this occurs, in the very same hospitals where rpns are allowed to utilize these skills in chronic care or long term care units. however, rpns in some acute care hospital units are utilizing most of their skills. sometimes skill utilization can even vary from floor to floor within one unit. for instance, within one unit in one hospital, rpns can catheterize whereas on another floor within this same unit, rpns cannot catheterize. a standardization of full skill utilization should occur across all hospital units and throughout all hospitals in ontario.

rpns can perform many of the advance nursing skills within their scope of practice, especially if working with another registered health care professional (ie. doctor, rn). this means, that rpns can be in every hospital unit using all of their training - no matter the predictability of the patient's outcome.

full rpn utilization frees up an rn to use all of their advanced skills. as michael hurley, ontario council of hospital unions (ochu) president indicates; "the hospital should use every member of the health care team responsibly". this means allowing both rns and rpns to use all of the skills that they have been trained to do.

rpns should be using their full scope of practice. however, full rpn skill utilization could lead to excessive workload with the present number of rpns. a staffing change may be important to ensure patient and nurse safety. therefore, in many cases, more rpns may be required. with more nursing staff, utilizing all of their skills, hospital patient care will improve drastically. hospitals will be able to afford such a change, if rn:rpn staffing ratios are altered. as it becomes increasingly difficult to replace rns, full rpn utilization becomes essential and is both a cost effective and healthy direction.

section ii - rpn/rn complement (staffing)

rn heavy staffing complements

when rpns are not allowed to use their full scope of practice, in some cases, rn hours have been increased. consequently, many ontario hospital staffing complements comprise of too many rn hours which is not cost-effective health care. presently, there is "duplication of nursing work", says one of the ochu/cupe rpn committee representatives, "there is such a difference in education levels (four years of university for rns compared to 2 years of college for rpns), would you want duplication between an rn and an rpn? each should be doing the job that she or he was trained to do."

increasing the number of full time rpns

full rpn utilization will mean increased workloads. an increased number of rpns will be needed in order to prevent overwork and excessive rpn workloads. the new staffing complements mean improved patient care and safe working conditions for all nurses since the savings which result can be used to hire more full-time nurses.

the following are the results of our rpn focus group sessions. the rpns were asked about their present hospital staffing complement and how they would like to see this change if rpns were fully utilized. significant hospital cost savings were discovered. there are many hospital units without rpns.

conclusion

patient care in ontario hospitals is diminishing. better patient care means increased hospital staffing. rpns, who are trained professional nurses, are not being fully utilized, which is wasting valuable resources. the rn shortage provides ontario hospitals with the opportunity to implement an appropriate rn:rpn ratio, where rpns are using all of their skills and training.

rpns are trained in a wide variety of skills. rpns should have the opportunity to work to their full scope of practice. hospitals need rpns to work in all hospital units: acute or `active' units, as well as chronic care - consistently throughout ontario.

past hospital accreditation reviews have suggested such changes. many ontario hospitals, however, have not implemented them. the nursing crisis in ontario hospitals today is not necessarily the shortage of rns. the real crisis is the ineffective use and lack of rpns. rpns are key to finding a sustainable solution to the crisis in our ontario hospitals.

appendix 2

the following provides is a "skill list" for registered practical nurses (rpns). a skill list is only one part of the rpn competencies and scope of practice. registered practical nurses are nurses. they have the educational background that provides quality care in diverse settings.

airway management

-deep breathing and coughing -positioning -percussing -vibrating chest -providing postural drainage -collection of sputum specimens -oxygen administration -nasal cannula -face mask -venturi mask -rebreathing mask -oxygen tent

-lung and thoracic assessment -suctioning: -oropharyngeal -nasopharyngeal -pulse oximetry -pulse doppler -care of chest tubes -care of chest drainage system -provide client teaching

elimination management -urinary catheterization -intermittent catheterization -care of indwelling catheter -removal of indwelling catheter -application of condom catheter -urinary catheter irrigation -continuous bladder irrigation management -care of ileal conduit -bladder training -assessment of urinary retention -collection of urinary specimens -provide appropriate client teaching -laxatives -suppositories -enemas -fecal impaction removal -insertion of rectal tube -fecal/stool collection

-ostomy care/stoma management -stomal irrigation

interal feeding management of a kangaroo pump -calculate flow rate -management and maintenance of j - tubes and g - tubes

-provide client teaching

medication management -oral medications -eye medications ear medications -topical medication -inhalation therapy-medications via g - tube -subcutaneous injections -intramuscular injections -oral narcotics -narcotic count -provide client teaching

wound management -provide medical/surgical asepsis wound care -care of drains -removal of sutures/clips/drains -simple/complex wound care -irrigation of wounds -packing of complex/simple wounds

-provide client teaching

infusion management -assess client with iv therapy -maintain peripheral venous lines -calculate flow rate -set-up of iv lines -hang non-medicated solutions/infusions -discontinue an iv -document rate/solution of an iv -monitor blood transfusion therapy

-monitor rate of blood transfusion -co-sign blood transfusion administration -provide client teaching

assessment skills -abdomen -cardiovascular system -head, eyes, ear, nose, throat -integumentary system -musculoskeletal system -neck, lymph nodes, breast -neurologic system -peripheral vascular system -respiratory system -elder assessment

-obsterical -mental health -pediatric assessment -pain assessment -documentation and client teaching

additional competencies blood glucose monitoring -renal dialysis -operating room -scrub nurse -circulating nurse

responsibilites -taking physician orders over the phone -transcribe physician orders -transcribe medication orders

registered practical nurses are educated and regulated for quality care.

Tashia · Apr 19, 2005

Let me know your thoughts on this paper. I think I got it off the rpano website.....

Fiona59 · Apr 20, 2005

Your preaching to the choir here. Agree with every word you typed!!

I recently had nearly a year in BC and couldn't find a job to save my life. I work full scope in Alberta, but in BC the units where I had experience in were designated for RN's only. Thats really effective use of an LPN.:angryfire One health authority in BC hasn't hired an LPN in over a year, but is offering every new grad RN a full time job upon graduation.

Sometimes, I think the RN professional associations enjoy fostering the myth that only an RN can care for all patients. It can be used to keep their wages up and gives them bargaining clout. They are also in middle management and its middle management that is resistive to utilizing an LPN to her full worth.

terryalbright · Apr 20, 2005

Your preaching to the choir here. Agree with every word you typed!!
I recently had nearly a year in BC and couldn't find a job to save my life. I work full scope in Alberta, but in BC the units where I had experience in were designated for RN's only. Thats really effective use of an LPN.:angryfire One health authority in BC hasn't hired an LPN in over a year, but is offering every new grad RN a full time job upon graduation.
Sometimes, I think the RN professional associations enjoy fostering the myth that only an RN can care for all patients. It can be used to keep their wages up and gives them bargaining clout. They are also in middle management and its middle management that is resistive to utilizing an LPN to her full worth.

In some areas where I work there is still a real "turf war" going on but I also see growing acceptance as the RNs learn we are not out to replace them, rather to complement them in a way that is in keeping with our training.

When I was first hired full time I was the second LPN to get full time employment at my hospital in over 13 years and many, many more have followed.

Personally, I have no desire to be an RN. If I had, I would have gone back to school when I had the chance. I see more and more RNs tied up with paperwork, studies, etc. and less at the bedside, which is where I want to be.

T

Fiona59 · Apr 20, 2005

Those are exactly the reasons that I won't do the bridge either. I enjoy bedside nursing (have no desire to be a charge in active treatment), don't enjoy paperwork or the increasing politics I see the RN staff become involved in.

Education if lifelong. I take classes via Athabasca that could be used in the bridge if I ever chose that route, but Psych courses and Sociology courses are so useful. I'm about two semesters away from getting my BA.

terryalbright · Apr 20, 2005

Those are exactly the reasons that I won't do the bridge either. I enjoy bedside nursing (have no desire to be a charge in active treatment), don't enjoy paperwork or the increasing politics I see the RN staff become involved in.
Education if lifelong. I take classes via Athabasca that could be used in the bridge if I ever chose that route, but Psych courses and Sociology courses are so useful. I'm about two semesters away from getting my BA.

I guess the other reason I wouldn't go back to school was the fact that we didn't ( and still don't) have a bridge programme here in N.B.

I think now that the entry to practice is Bn, you may be able to challenge some labs but that is about it.

At the time when I was considering, I could have gone to a diploma programme. I was sitting and writing entrance exams and thinking "you really don't want to do this, start all over again. Moreover, my marriage was falling apart so that really clinched it. When I got the call saying I was accepted I felt that I couldn't take the chance even if I wanted to do so.

UNB has been working on a ladder programme for awhile but nothing yet, as far as I know. Now, at 52, I am not inclined to look into it anyway. I like what I am doing and have gone into other interests. (politics)

carlom · Oct 30, 2005

Hi,

Just to reply to Char1976, in Quebec they do hire LPN's however, in Quebec we are called nursing assistants. There are many oppurtunities in Quebec.

Kataclismic · Nov 13, 2005

Hi, I know this is an old topic, but I wanted to address it, since it applies to me.

I'm an LPN student in Manitoba, and all the information about LPN's and the job market at this time is very positive. LPN's are aquiring more information at every class intake and program revisions are constantly happening.

In Manitoba, we are given the training to preform all the skills than an RN would do, as we added in Central Lines into our program just this year.

It's a good time to be a Nurse!!!

A good website to check out is... http://www.jobfutures.ca/en/home.shtml

**RosesrReder, BSN, MSN, RN** · Nov 14, 2005

I have been hearing about this too but I have yet to see it happen. Be happy and good luck :)

Kataclismic · Nov 14, 2005

I have been hearing about this too but I have yet to see it happen. Be happy and good luck :)

See what happen?