CA staffing ratios evoke anger 'tween RNs & LVNs - page 6

Big news on the California nursing ratios front. As California prepares to carry out its first-in-the-nation law telling hospitals how many nurses they must have on hand for patients, a bitter... Read More

  1. by   Youda
    Excellent, excellent post, rncountry! You clarified this problem exactly! Thank you!
  2. by   BBFRN
    Originally posted by RN2B2005
    Hospitals want to call L.P.N.'s "nurses" because these "nurses" earn a fraction of what a graduate R.N.'s earn.

    Not to denigrate L.P.N.'s, but when push comes to shove, I want an R.N. at my bedside.



    If hospitals want to call L.P.N.'s "nurses", fine. Just let them hire TWO L.P.N.'s for every R.N.; after all, an L.P.N's training is one year, half the minimum for an R.N. This will turn the hospital's "cost-saving measures" on their head.
    Wow...when I read this, I was somewhat aghast. Does not the "N" in LPN stand for "Nurse?" Or maybe my little LPN pea-brain didn't get the letters correct. (And for the record, I'm 2 classes away from my RN, so let's get any assumption of RN prejudice out of the way.) So what should be delegated to you, "RN to be in 2005," when you are doing a clinical rotation on the floor. Hmmm, I guess I would rather have an LPN at my bedside than someone who doesn't graduate until 2005. You have had an understandably bad experience as a patient, but let's not try to define MY scope of practice or my ability to perform within it based on that. I ( as well as MANY of my fellow LPN cohorts on my floor) are for the most part greatly appreciated and respected for the jobs we do, which includes a lot more than you seem to be aware of. Try graduating and actually being a nurse before you attempt to paint LPN's into a corner where we aren't considered nurses.
    Last edit by BBFRN on Nov 24, '02
  3. by   rncountry
    lg, first of all every patient, regardless of whether that patient is a nurse, a physician, or Joe Public, has the right to make decisions related to their care. As a patient RN2B has the right to not want an LPN as her nurse if she choose that. And RN2B did not call you or any other LPN pea brained, you called yourself that. What irritates me is that there is an automatic assumption that if someone says ANYTHING related to care from an LPN, than LPN's jump on that person with both feet, shouting and snorting that LPNs are not stupid. Well, duh. Wouldn't have made it through school is you were stupid now would you? Now the mistake that RN2B illustrated may have been done by an RN as well, but her patient experience, not nursing experience was not an RN who made this error, but an LPN who made the error. And to ask a student what things she should be allowed to do is already answered, a student does what they have already been checked off to do, and where they are in their studies. The same process that you went through as a student. Oh, and by the way it is the RN who will ultimately be responsible for the student's care, even though there is an instuctor present. This is reality, not making it up as I go along.
    And the other part of RN2B's post that you qouted. Yes, LPNs are being used to fill the ranks at less pay. And I do mean used. We are all getting screwed but the LPN seems less able to see that. As an LPN you are now being asked to do things that even 10-12 years ago LPNs did not do. But along came managed care who decided that they could push the gray areas of the LPN practice acts, and get a nurse who cost a hellava lot less than an RN. When I graduated in 1991 there was a big push to go to all primary care nursing, to get away from team nursing and to eliminate LPNs from the hospital. The thought behind that was that LPNs were not educated to be able to do what the RN was educated to do and that RNs would give ALL care to their patients, from bedbaths to meds. Then came mergers and downsizing, elimination of RN staff, LPNs starting doing what had traditionally been the provence of RNs and CNAs were also doing "tasks" that had always been done by nurses, both RN and LPN. Do a search on articles in nursing magazines from the early 90's and you will see what I am telling you is the truth. There are articles on how to deal with the new way of doing things. So the hospitals got LPNs to do things that had been done by RNs for less pay, and CNAs for even less pay. Because all they did was focus on the task oriented things that is part of patient care, not the critical thinking that is a major part of being able to understand what is happening or not happening for a patient. Patient loads increased, patients that would have died 10-15 years ago are now the ICU patients, and the old ICU patient became a med-surg patient, and the med-surg patient became a LTC patient, all at the same time that the critically thinking educated team member was being laid off, downsized and plain not hired. And LPNs bought into it with the chant we are not stupid, or Pea Brained as you said, and we are just as good a nurse as an RN. Point is that is not whether an LPN is a good nurse, but that the LPN is a different kind of nurse, with different skills and different education. But you bought what managed care was selling you and decided that RNs were just saying you were stupid. That RNs were the ones who were taking "away" your ability to do what was never yours to begin with. You bought the company line hook, line and sinker and did it for less pay. I just wonder how you would feel is a CNA got on line and argued that they should be able to do what you do as an LPN, to identify themselves as a nurse, and then take offense because you pointed out that they were not licensed to do what you do, and by the way doing it for less pay. And then think about given this scenario just what do you feel your worth to the American Hospital Association, to your corporate, to managed care would be? Maybe the same that I feel they think about me and other RNs. Yea, your being used, screwed without even a kiss, but your not seeing it. Instead all you are choosing to see is an RN or soon to be RN calling you pea brained. And there is a specific study out there that shows an RN caring for too many people does make a difference in outcomes. And instead of supporting the RN the LPN is calling foul. Hell, I thought this was about patient care and outcomes, but oops not really. Instead it is about RNs making LPNs feel stupid. I think I hear the sound of laughter and clapping coming from the AHA.
  4. by   BBFRN
    Whoa!!! Hold on there, please! The only thing I took offense to was that the poster had the audacity to have a problem with an LPN being called a nurse. I just didn't want a bad experience as a patient to be cited as a reason not to consider an LPN as a nurse. And as an LPN, I DO see the RN's being screwed- ON A DAILY BASIS. But some RN"S do need to stop viewing LPN's as a hinderance to their having a quality work environment. LPN's are NOT worsening the nursing shortage. We are not akin to Scabs, coming in to take your jobs. And by the way, I did NOT buy into what was "sold to me." What I did was get a job in a hospital who is PAYING for my RN education. We all win in that scenario. I personally don't think that RN'S are "taking" anything "away" from me. That statement confuses me. ?? If you read my post as being anti RN, I'm sorry- that certainly is NOT the case, but I work very hard on a very tough floor, and I hold my own quite well. I just get tired of LPN bashing on these BB's at times. And yes, I think that statements refering to LPN's not being nurses are provoking, and it's hard not to get offended.
  5. by   rebelwaclause
    RNCountry...

    I never didn't understood where RN's are coming from, and have said so in previous posts. I AM NOT an RN. I cannot function as a RN. I know..I am not...A RN.

    I do not have the same training as a RN. I cannot function self sufficiently, as a RN. Yes - I agree, staffing sucks, at times for RN's - Mostly the posts I've seen here from various RN's across the state. I wouldn't put myself in danger for any hospital. I'd find somewhere, anywhere that I can function safely at.

    My point is and always will be - Don't bash LVN's because we aren't the RN you'd prefer to work with, because of "covering" issues. Attack the suits who possibly aren't living up to their end of the bargain, but please, don't blame LVN's because they show up to work as scheduled, instead of another RN. For the most part, on the last few pages of this thread - I haven't felt bashed at all. I have been merely responding to points in various posts.

    By the way - I would NEVER work in an ICU. This is one place I wholeheartedly agree, LVN's are of little help, IMHO.

    Oh...And in regards to RN2B's post, if you are referring to me...I won't debate who called who what, however, "Pea-brain" isn't a word anybody used here...Are you reading posts correctly? No one said RN2B didn't have a right to whoever she wanted to take care of her. I said an RN just as much as a LVN could provide lousy care. I additionally stated the generalized perceptions of LVN's in RN2B's post are unfounded. MANY others took offense to the post, so I do not feel bad for saying so.

    RN2B had an opinion - So did I, and several others in response.
  6. by   rebelwaclause
    Originally posted by lgflamini@msn.c
    I personally don't think that RN'S are "taking" anything "away" from me. That statement confuses me. ??
    , Me too..? Unless you're referring if "All RN's" in hospital's pass (which it could), I get the boot and my livelihood does too! But in retrospect, that won't be such a bad thing. I'll go back to school, and upgrade to anything other than nursing. Not that I hate it. I just don't like the political BS that runs amok in it....Like the RN/LVN debates.

    Originally posted by lgflamini@msn.c If you read my post as being anti RN, I'm sorry- that certainly is NOT the case, but I work very hard on a very tough floor, and I hold my own quite well. I just get tired of LPN bashing on these BB's at times. And yes, I think that statements referring to LPN's not being nurses are provoking, and it's hard not to get offended.
    High five and Amen, lgflamini!
  7. by   rncountry
    The part about LPNs feeling that RNs are taking from them, came from a previous post, not yours, sorry for the confusion. While you are tired of LPN bashing, I am tired of LPNs attempting to define their role as the same as RNs, because they play a different role. There are many LPNs on this board that the minute someone says I am tired of having to be responsible for my patients and an LPNs, who come along and start bashing the RN for something that is beyond our control. The RN is responsible ultimately period, and it is not a great feeling to know your job and license can hinge on what someone else is doing, whether you are physically there to see it or not, or even if you know what is happening, which is not likely when busy with your own patient load.
    Yes, an LPN is a nurse and I think it is regrettable that RN2B put the nurse in quotes and sounded as if she/he doesn't feel that LPNs are nurses. It is obvious LPNs are. But a different kind of nurse who cannot do the same things an RN, and it simply is not right to ignore this. And it is also wrong, in my own opinion, for any LPN to pretend those differences are not there.
    You may not have "bought in" but there are an awful lot of LPNs out there that have. I recall a thread from several months ago where an LVN from Texas asked why would she want to be an RN when she could take various certification courses, and could then do what an RN could do. It seemed never to occur to this person that they were still an LVN, that the RN still had to be responsible for whatever she did, certified or not, and that she was doing it all for significantly less pay. And other LPNs chimed in with, well yea, see there, yea. We can be just as good as you pain in the ass RNs. But it isn't about being just as good. It's about giving away what you are worth, it is about crossing boundaires that even hairdressers don't allow to be crossed.
    I hope you get your RN, your right it is a win situation for everyone. I'm sure you work hard, and hold your own. You see RNs getting screwed, so do I. I also see LPNs getting screwed because they have been talked into "you can do it all, except these few task oriented items, don't let the RN tell you otherwise" and they are willing to play that role, do it for less money and perpetuate the LPN vs. RN game. And that is a win situation for the corporate, the AHA, not for the nurses and not for the patients. It is not about whether an LPN can do the same thing as an RN, it is about that they legally can't do it no matter what. And it is about the fact that the education is different in the various realms of nursing, despite some LPNs thought that it makes no difference. It does make a difference. I can't write a script like an NP can because my education is not at a level that would allow it. Yet I am a nurse and so is the NP, with different levels of practice, no different than the levels of practice between LPN and RN.
    I believe that RN2B was simply trying to make the point that the hospitals were not making the difference between the two levels of practice between the nursing groups, and were choosing to call both groups simply nurses so they could get around the intent of the bill. I do not believe she was intending to be offensive at all. Just saying that if the hospitals were going to call the LPNs by the same designation without having to make the difference in practice apparent, then they should have to hire two LPNs to make up for the difference they could save in pay by not making the level of practice apparent. Am I making sense here? I sure hope so. I don't believe that there was any intent on RN2Bs part of trying to make it sound like LPNs weren't nurses. Perhaps worded poorly in the post, but I don't believe it was meant rudely.
    I do make those differences, it is not intended to make an LPN angry or offended. My intent is to not allow my profession to continue to be deskilled when the patients we deal with in the hospitals now cannot afford that. LIke every nurse on this board I worked damn hard to get through school. And I am not willing to give away what I worked so hard to have. You think physicians would be willing to have PA's described in the same terminology as themselves? Not damn likely. The RN and LPN terminology should be different for the same reasons. And to not fight a system that is hell bent on simply describing every nurse as simply a nurse is to give away what you and I have worked hard to have. I for one, am not in favor of that and never will be.
  8. by   tiger
    i'm not going to get into the whole rn/lvn thing, although some comments that have been made are dissapointing. i would like to comment on my own experience though if i may. i am an lpn. when i worked in tx i was charge at ltc facilities. took phone and verbal orders, and the whole bit. i have also worked at an md office where i was allowed to do ivp meds.and there you did not even get iv certified. i moved to nv in 1990. started at a hospital and was allowed to do assessments(without any cosig) including initial assessments. i was allowed to start heplocks and hang ivs via heplock or picc.i was never allowed to hang blood or do ivp here in nv. anyways, now this past year, on my floor, which is rehab now, we are not allowed to do assessments. we are given anywhere from 7 to 15 pts. while the rn has 3(depending on whether we have a cna or not). we also have a charge and unit sec. who do all the orders and calling of the doc. these pts are not critical but do need to be monitored. now, it is confusing to me. i have too many pts. to do what i used to be able to. before the staffing was even rn/lpn. yet i feel responsible for doing everything. the rns may come and spend 5 minutes doing an assessment(others just copy what was there the day before) and another 5 documenting it but other than that--i am responsible for everything else that is time consuming like blood sugars, monitoring bps, transferring, toileting/and or ic or scanning the bladder, o2sats,or monitoring for any problems the pt. has.also i am to get the pt dressed and up before breakfast.many times i have had 9 pts with no cna. can you get report starting at 6 a.m., get all your meds, pts dressed and up, not to mention showers and dressing changes by 8 a.m.? if i need an order i am to go to the charge nurse. . i'm also responsible for all meds including iv antibiotics(we very seldom have ivp orders). plus i am supposed to update care plans, do graphics, chart audits, case conference, and document any thing pertinent on the pt. it just seems f%%%%ed up to me that i cannot now give my pts. the care that i want to. i did before. anymore i feel like answering in the same manner the agency lpn did just to get out of more work so i can see my pts. YOU BETTER GO ASK THE NURSE. anyway, i'd like to finish by adding that this is on MY rehab unit.i realize it is different everywhere. and that alot of the rns will help with stuff if they know you are busy, NOT ALL. i have had rns getting my pts up and doing adls or toileting cause i'm too busy with meds or something. and i do agree that lpns probably shoild not be in critical care units due to the restrictions of their liscense. sorry if i rambled. i am frustrated with my job right now. hate to leave my benes behind though.
    Last edit by tiger on Nov 24, '02
  9. by   -jt
    <...why shouldn't LPNs be taught vital things like heart & lung sounds to the deepest degree???
    Why not teach it anyway & make it part of the scope???>

    That would do away with LPN programs & turn them all into RN programs. Well, at least the staffing ratio issue would be solved.
  10. by   -jt
    <But for RN's to blame LVN's for something that is totally out of our control - That's just ludicrous>

    I didnt see anyone BLAMING the LPN for anything. The issue is the powers that be refusing to recognize that the staffing ratios they say are 1:4 will not be real if LVNs can be used to fill them. The RN will STILL have at least 1:8 - double the amount that the state is advertizing - because of the rules that govern our licenses. Nobody is blaming LPNs for that. We're blaming the big-business administrators who are looking only at the bottom $$$ rather than the reality of our jobs, nature of our professional responsibilities, our working conditions & what it means to the pt when RNs have unsafe, unmanageable pt loads.

    Time and again Ive seen posted that this NOT an RN vs LPN thing.
  11. by   tiger
    why don't we just graduate lpns and then have them have to further their education in the hospital setting?
  12. by   Youda
    tiger, what a load you have at work! Sounds all too familiar, though.

    To make a little more sense of what I believe rncountry is saying, is that although you are certainly capable of doing all the things you do everyday, it is the RN who is responsible for "interpreting" the results. Suppose you did the O2 sats, BS, and VS on a patient. None were really abnormal, but borderline, so you reported it to the RN. The RN would have to take all that data, look at the recent lab, run down the hall to do her OWN assessment (even though you already did one . . . because the RN would be looking for signs you were never taught to see), and then the RN would have to put it all together and decide if the Dr. needed to be called. In my hypothetical scenario, the RN concluded that although BS's were not very high (200's in the afternoon, let's say) and the O2 sat was a little low at 91%, and the last lab showed a high normal K+, and during the RNs assessment, she found a slighly sluggish reflex . . . she concluded that the patient was going into ketoacidosis and called the Dr.

    I don't know any other way to say this than by a hypothetical example. LPNs are most certainly "nurses." But, do also agree that the differences in training make all the difference. Just have the technical abiilty to DO the tasks doesn't make a person the same as an RN. I don't think anyone is saying that an LPN is the same as an RN, but there is definitely a lot of "I can do everything an RN can" thinking. Well, No, an LPN can't do everything an RN can. And, it is VERY difficult to pinpoint and describe what the difference is, because it is NOT the tasks, it's the interpretation of the tasks and data.

    RNs are taught an entirely different way of doing an assessment, for example. Rns don't just look for subjective data, but how to USE that subjective data to make care plans, to foresee problems, to evaluate outcomes, to prevent complications, to recognize the need for interventions, etc.

    Maybe all I'm trying to say is that the differences can't be SEEN, because the difference between an RN and a LPN is what happens between the ears, not on the floor performing tasks.

    And, that is the problem with this messing with the law that was passed. rncountry is quite correct. The hospitals are trying to lump EVERY nurse into the same category, under the big umbrella called "NURSE" and refusing to recognize that one nurse is not the identical twin of another.
  13. by   NurseAngie
    Originally posted by LoisJean
    As California goes so goes the Nation. I suggest all LPN/LVNs hold on to their azzes, because the big blow is going to blow even harder. Cripes- the nursing shortage/crisis or whatever spin anyone wants to put on it, is just that because LPNs/LVNs ARE NOT counted as nurses in the mix of numbers. Somewhere along the line it was taken away from us--by bean counters. You RNs bring in big bucks to health care institutions--they charge for your services and pay you back in chump change. For the sake of those big bucks, someone took the autonomy and skills of the Licensed Nurse away--(never mind that it was you, the RN, who taught us and utilized us in those skills) -little by little by little until the very defination of an Licensed Nurse became muddied and murky nation wide. We were not allowed to use what we had been educated to do and were made to become the registered nurse's dependent, rather than her Assistant. And now you are complaining because you have to be responsible for us...!? Go figure. You are getting what you asked for.

    I vow to all that's holy right here and now that I will not ever, never, while I am still breathing, consider myself less worthy of rightful recognition as a NURSE because I am an LPN--and don't any of you try to tell me that worthiness is not the issue. It is. If there were any recognition at all of the prime role of the LPN as a viable member of the nursing community it would not be necessary to belabor this subject. It is PRIMARILY because of this denigeration of the LPN/LVN over the past few decades that I do not any longer grace the halls of any hospital or other institution as a nurse and believe me, that is your loss not mine. I work for myself and that is what keeps me very satisfied within my nursing role. I damn well know who I am and what I am and I am damn good! And as for you, Canada--well, sorry for your experience...but you are a litigeous person--short-sighted, narrow minded people usually are.

    No Peace on this one, Folks-
    Lois Jean
    AMEN Lois Jean.....EVERYTHING you said is right on target. It is OUR loss that you no longer grace the halls any hospital/institution! I am in awe of the strength of your character on this matter.

    ~Angie

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