Eliminating LPNs - are hospitals doing this?

[kalaith]

Hello All,

My mother is an LPN at a major women's and children's medical center in Honolulu. Recently the hospital announced that it may eliminate the LPN position throughout the hopsital in the next 12 months. My understanding is that they will supplement this loss by hiring additional CNAs.

My question to you all is if you have any experience with this. Do you work at a hospital that has done this? Was it a good choice? Was it a bad choice? And what's your personal opinion? Do you think it's a good idea or a bad idea?

While I'm certainly biased for my mother's position, I am honestly curious what others in the field think of this major decision.

Thanks for your time. :)

[Gldngrl]

When I became an LPN in Ma in 1990, I could not get a job in a hospital at all, as jobs were going to RNs only. I then became an RN and started work in a hospital and the LPN's were phased out, then went to work in Boston at an all RN hospital. However, when I moved to Va, I've seen LPN's in a variety of settings, including the ICU so I suppose it depends upon the state and its resources or lack thereof. I personally think it would be easier for nursing education to be stream-lined like all other professions and would elimininate the RN vs. LPN issues, but it is highly unlikely this will come to be.

[GPNANGEL]

I hope that the health care field doesn't do away with LPN's. I just graduated from a two year program to become a LPN. I've worked very hard to get where I am. On Friday I go take the state boards. Right now I'm working in a nursing home as a GPN. I don't see myself conintuing education to become a RN, I'm happy right where I am. This is the first time I've heard of eliminating LPN's. I'm from upstate NY, and their aren't enough LPN's to go around as it is. I take my job very seriously as like all other LPN's.

[kimmicoobug]

I forgot to mention in my last post that the reason behind doing away with the LPN is because of money. The hospital has found it is cheaper to decrease the RN's load by a patient or two and increase the load of the CNA. So, a CNA is under two RNs which I am sure can be hairy, at times.

Our town is in no shortage of nurses. Unfortunately, I am a new grad in this situation of having a difficult time to find a full time job. All that I have at this facility is an on-call float position. Over the next month, I have 5 shifts. This is to help with the OT accrued by the other staffers. We were hired with this purpose in mind even though we didn't seem to understand the situation until after we had been placed on the floor. But, from what I have heard, give this hospital 4 years and they will be utilizing LPN's again because there will be another shortage as people retire or get sick of the crap.

[FlightRN2B]

As an ER Tech, I used to work hand in hand with the nurses and doctors. Once in a while there would be a LPN joining the mix of personal. I would think to my-self, I'm an EMT-II. I can do what there doing (wrong) I didnt have a clue. Then years later I started nursing school and changed my title to apprentice nurse. As an apprentice nurse I was then given the responsibility to take care of a group of patients with the direct supervision (yea right) of the charge RN. Basically I did all the work and they signed my charts. I still did everything I could to stay within my scope of practice so that I didnt jepordize my future nursing lic. At the end of Nursing school, we were told that we now knew about 10% of what we really need to, and that the rest would be learned on the job. Well when your dealing with peoples lives, some how 10% doesnt seem like very good odds, and thats at RN level. I cant immagine knowing less. My point behind writing all of this is that, as an RN I have come to the realization that the work load and truck load of responsibility placed upon us is crazy to begin with, compound this by being held responsible for other peoples active roles in patient care were there is less training then translates to increased work loads for the RN along with all the potential legal problems, after all as RN'S were utimately responsible . The first six months of being an RN was very stressfull. expecially in a critical care arena. I have alot of respect for all medical professionals and therefore do not want to see anyone loose there job, however there has to be a middle ground. Im just not sure where that is.

[TiddlDwink]

Well, this just burns me UP!!! I've lived & worked in 4 states, and in the military... I can tell you that LPNs are indispensible!

As far as what LPNs can do... it differs from state to state, depending on the nurse practice act in each state, and also depending on the policy in each hospital... or may I point out... each NURSING HOME.

In the military, the LPNs ("Charlies") basically run the units and care for the patients. The RNs ("nurses") give some IV push medications and see that everyone gets the care they need. Their main job is usually teaching... teaching the charlies to do stuff like EKGs, IVs, venipunctures, etc.

I haven't seen any argument or comment about LPNs in the nursing home, but how in the world would we run nursing homes without them?!?

Now the hospital... I contend that there is NO RN shortage! I believe (from looking at the thousands of jobs, while looking at the hundreds of thousands of RNs) that the RNs have found something else to do... something that pays more, that offers them more respect, or that has better hours and holidays/nights off to be with their families... not to mention that they can emotionally leave at work and not worry about some patient all the time they're off!

Thanks for letting me vent!!

[healingtouchRN]

how sad, My heart goes out to those LPN's....I have learned alot from some wonderful LPN's in my day!

[rdhdnrs]

We did it on the L&D unit I work on....and now we're getting ready to phase in LPNs as techs instead of the unlicensed personnel we have now. We have one long-time employee who is an LPN and the extra knowledge is very helpful to her in her job as a tech. I'm looking forward to having them.

[Marie_LPN, RN, LPN, RN]

Originally posted by rdhdnrs

We did it on the L&D unit I work on....and now we're getting ready to phase in LPNs as techs instead of the unlicensed personnel we have now. We have one long-time employee who is an LPN and the extra knowledge is very helpful to her in her job as a tech. I'm looking forward to having them.

So are they actually called "techs"?

[fergus51]

I work in an all RN hospital now. They stopped employing LPNs years ago. Being that I have always worked in OB, I never saw many LPNs anyways, but it seems to work well. A lot of the RNs on the medical and surgical wards like to practice primary nursing where they are solely responsible for their patients. It makes organization easier and keeps them doing the hands on chores that let them get to know their patients.

[Kashia, ASN, LVN]

The LVN situation in California is a bit more promising, it sounds like, than in some other states. To reply to some of the things I've read.

As an LVN I am trained and lic to do many things on an acute care floor. Perhaps it is not an issue of how little an LVN can do , rather an issue of them being allowed, encouraged and supported to function within the scope of their practice.

There was a trend in California to reduce or eliminate LVN's however in lieu of the nrsg shortage the trend reversed.

An LVN with experience on an acute med surg unit is hard to discern from an RN.

Lastly, in perspective of what liabilites an RN has covering an LVN. I spoke with several malpractice insurance companies and asked if there was a run on RN's losing their lic behind an LVN.

They said no, not at all. However, it is another story for the "charge nurses" who are responsible ( in the way RN's believe they are for LVN's) for ALL the nurses on the unit. So, for an RN to believe that LVN's are threatenng their careers is as relative as the argument that floor nurses are threatening the career of charge nurses.

Hey...thanks for listening...or reading as it were.

[jjjoy, LPN]

I don't know about you all, but it was thumped home to us RN/BSN students over and over again in school that our license was on the line in regard to those working under our supervision and "under your license", especially LVNs who pass meds, do assessments and treatments. What the reality is, I don't really know.

I really had no idea the extent of some LVN responsibilities until after I graduated and started working. Before that, I thought they just did only routine stuff like passing stool softeners and changing dressings on long-healing wounds. Or working closely paired with an RN, taking care of the routine tasks so the RN could focus on any changes in status or emergent situations. So I was surprised to find LVNs with full patients loads "under the supervision" of an RN with her own full patient load. And in LTC, to find LVNs almost completely responsible for 30+ patients day-to-day. All that with just a year of formal training?

I'm really not clear on the differences in preparation between LVN and RN except of course the LVN course is shorter. It was clear in nursing school when we were covering the functions usually carried out by CNAs. But other than IVs and some assessment & documentation, what more are RNs trained for? What does that extra year or two of instruction cover? (I know in my BSN program, the extra included things like public health and research as well as general ed requirements.)

If LVNs don't have the same extensive background of pharmacology, pathophysiology and the like, what are they doing on acute care hospital units providing essentially all nursing care? On the other hand, what extra training is it that RNs have that prepares them for the wider job responsibilities for which they are qualified?

Certainly, an RN ought to be able to carry out all LVN (and CNA) functions, yet as I understand it, an RN cannot apply for an LVN position due to different license requirements. Correct me if I'm wrong. Perhaps RNs are just needed so badly that if you've got one, they won't let you work as 'just' an LVN.

I'd certainly appreciate any clarification on these issues.

[Sekar]

YAWN! Not the "LPNs are being phased out" line again! RNs vs LPNs, the differences have been throughly discussed many times on this board, to no avail. The problem in defining the differences boils down to what falls into your Scope of Practice for your state. Many states don't allow LPNs to start IVs, some states allow them to push IV meds. In NC suturing wounds is within the Scope of Practice of a LPN, but inserting a fetal scalp monitor is not. The scope of a nurse's (RN or LPN) practice is dynamic and constantly changing. One should avoid blanket statements like "LPNs can't start IVs or LPNs can't make assessments" as this may or may not be true depending on your state's scope of practice. How much direct supervision a LPN/LVN also varies from state to state. The more progressive states have expanded the Scope of Practice for LPNs/LVNs in recent years, while less progressive states have limited them.

One might think that education makes the difference...The training I had in pharmacology, pathophysiology, Nursing theory, etc...were virtually identical in my LPN training vs my RN training. Others have had different experiences I'm sure, but my RN training was a dull re-hashing of what I already had been trained in. That is the flaw in American Academia. College Education is a business concerned primarily with making the almighty buck. That is the core of the reason why LPN credits are not accepted for RN programs.

Sorry but I sure don't have the answer to this RN vs LPN thing, I don't really think there is a solid one. Opinion seems to reign, facts seem to take the back seat. Go figure....