RPNs/LPNs vs. RNs

[rant]

I know this has probably been discussed a fair amount on this forum, but as a RPN/LPN that is currently bridging to become a RN, I wanted to share my experiences, questions, and conclusions about the inherent differences between the two nursing roles.

I completed my RPN program in June 2007, and immediately enrolled into the bridging program at McMaster University in Ontario, Canada in September 2009. I have since completed my first year of university towards my BScN.

Before I begin, I would like to note that I have not yet experienced a clinical rotation in the RN role (that begins this year). So the viewpoint that I will be representing is purely from an academic perspective, and not a practical one. I realize that this may be severely impacting upon my bridging experience.

It is my belief that there should not be two types of nurses. And when I say this, I do not mean to say that one is better than the other. Upon the contrary, I believe that RPNs and RNs have a similar breadth of knowledge and that there should no longer be a segregation in pay, entitlement or recognition between them.

I acknowledge that this may sound like some sort of "RPN paranoia" against RNs, but please be assured that is the farthest thing from the truth. I am not saying RPNs are "better" than RNs, at all. But I am not, as yet, willing to concede that in their base ACADEMIC knowledge, RNs are very much more superior than RPNs.

Having gone through one year of RN training in the science-based aspects of the discipline, I can honestly and truthfully say that there wasn't much that I learned this year that went beyond the scope of the RPN. Our physical assessment course was identical to that of the one I took in my RPN program. The anatomy and physiology course was identical, as well. Pathophysiology with a pharmacologic inclusion was a new course that I had not taken, but (and perhaps it was because of the professor and her choice of course planning) I do not feel as though I walked out of the course feeling like I had a superior amount of knowledge prior to the amount that I had walked in with. The course material was very basic, and very rushed. I anticipated that I would be learning common and complex disease states for each system of the body, and how to treat them pharmacologically. However, we focused on basic/common concepts like inflammation and common CV/resp diseases. Pharmacology barely came into it, and I felt very disillusioned. I felt, truly, that I had learned much more in the first year of my RPN program than I had in my first of the RN program.

Many of the RPNs that I have worked with have clinical skills that equate that of the RNs. I have been told many times that the only true difference to be found between RNs and RPNs are leadership skills. I am starting to believe this is true. Because although many RNs have superior disease/pharmacology knowledge to RPNs, I believe this only because of exposure. RNs are granted access to more complex and unstable patients, and it is THIS that gives them the superior knowledge. It is, from what I have seen thus far, not because of an inherent difference in their education.

It seems to me that there should no longer be two types of nurses. But I don't know what to do with that feeling. Because to suggest that we should remove RPN education seems ridiculous. And doubly so to say that we should remove RN education. But I feel as though this dichotomy is causing a rift in our profession. RPNs get paid almost 40% less than RNs for the same clinical skills. RNs get replaced with RPNs who don't have as much knowledge simply because institutions can pay them less.

I don't know what to do, or how to feel. And it hurts and saddens me greatly. I would appreciate any thoughts on this matter. It is deeply appreciated.

[2bNurse-88]

I know this has probably been discussed a fair amount on this forum, but as a RPN/LPN that is currently bridging to become a RN, I wanted to share my experiences, questions, and conclusions about the inherent differences between the two nursing roles.

I completed my RPN program in June 2007, and immediately enrolled into the bridging program at McMaster University in Ontario, Canada in September 2009. I have since completed my first year of university towards my BScN.

Before I begin, I would like to note that I have not yet experienced a clinical rotation in the RN role (that begins this year). So the viewpoint that I will be representing is purely from an academic perspective, and not a practical one. I realize that this may be severely impacting upon my bridging experience.

It is my belief that there should not be two types of nurses. And when I say this, I do not mean to say that one is better than the other. Upon the contrary, I believe that RPNs and RNs have a similar breadth of knowledge and that there should no longer be a segregation in pay, entitlement or recognition between them.

I acknowledge that this may sound like some sort of "RPN paranoia" against RNs, but please be assured that is the farthest thing from the truth. I am not saying RPNs are "better" than RNs, at all. But I am not, as yet, willing to concede that in their base ACADEMIC knowledge, RNs are very much more superior than RPNs.

Having gone through one year of RN training in the science-based aspects of the discipline, I can honestly and truthfully say that there wasn't much that I learned this year that went beyond the scope of the RPN. Our physical assessment course was identical to that of the one I took in my RPN program. The anatomy and physiology course was identical, as well. Pathophysiology with a pharmacologic inclusion was a new course that I had not taken, but (and perhaps it was because of the professor and her choice of course planning) I do not feel as though I walked out of the course feeling like I had a superior amount of knowledge prior to the amount that I had walked in with. The course material was very basic, and very rushed. I anticipated that I would be learning common and complex disease states for each system of the body, and how to treat them pharmacologically. However, we focused on basic/common concepts like inflammation and common CV/resp diseases. Pharmacology barely came into it, and I felt very disillusioned. I felt, truly, that I had learned much more in the first year of my RPN program than I had in my first of the RN program.

Many of the RPNs that I have worked with have clinical skills that equate that of the RNs. I have been told many times that the only true difference to be found between RNs and RPNs are leadership skills. I am starting to believe this is true. Because although many RNs have superior disease/pharmacology knowledge to RPNs, I believe this only because of exposure. RNs are granted access to more complex and unstable patients, and it is THIS that gives them the superior knowledge. It is, from what I have seen thus far, not because of an inherent difference in their education.

It seems to me that there should no longer be two types of nurses. But I don't know what to do with that feeling. Because to suggest that we should remove RPN education seems ridiculous. And doubly so to say that we should remove RN education. But I feel as though this dichotomy is causing a rift in our profession. RPNs get paid almost 40% less than RNs for the same clinical skills. RNs get replaced with RPNs who don't have as much knowledge simply because institutions can pay them less.

I don't know what to do, or how to feel. And it hurts and saddens me greatly. I would appreciate any thoughts on this matter. It is deeply appreciated.

First off, I'd like to say, HATS OFF TO YOU! It is very heart warming to see someone who truly looks at the two professions as equals, rather than thinking one is better than the other, you are GREAT for that!

If becoming an RN is your ultimate goal, then go for it! I initially applied to the RPN-RN bridge as well. I'm going into my 4th semester of RPN at Mo-Mac (same campus you're attending!), but I recently withdrew my application to the bridging program simply because the uncertainty of jobs for RN's right now & I'm sure you're aware of this as well. I have a few friends who, God bless their soul, are new RN grads & are struggling a great deal in finding a job, as well as the gov't likely removing the new-grad initiative for RN's shortly, simply because they are in e deficit, and cannot afford the high max out pays of RN's. Know that throughout most of the GTA, RN's and RPN's start out making almost the same amount. My bestfriend is an RPN in a Toronto hospital, graduated one semester ago, and is making $26/hour + 14% in lieu of benefits, so she's at $28 and some change/hour. Her RN co-workers are at $28/hour, plus their 14%.

The BIG problem the gov't is having with RN's, is not their starting pay, it's the long-run costs, when RN's are maxing out at $50/hour, and RPN's are maxing out at nowhere close to that ($35/hour at most), the gov't sees this as a huge money saving idea, and that's all.

They've started introducing more skills into the RPN program now as well too, blood transfusions & I.V therapy. It's just that in the past, RPN's didn't get to work to their full scope of practice because RN's were doing these things, even though RPN's knew how to do these skills as well, now, they're doing them everywhere, so schools are pushing the skills much harder/stricter than before, when they just skimmed through material. Don't be fooled though, as this trend continues to happen, and more and more RN's are let go, with RPN's being brought in, you can bet RPN's will be demanding a raise in pay. Not equal to RN pay, but they will likely want a bit of a higher max out rate.

It's unfortunate this is happening. My handful of RN's friends I do know, are considering moving a far distance to secure employment, because they cannot find anything here (in the GTA), and it's horrible. My goal was to get my BScN & eventually do a Masters & possibly do the NP program (that would be my ultimate dream!), but I made the decision to finish my RPN now, and get out into the workforce while it's good, and pay off my student loans, and then see where the road takes me from there.

Never give up on your dream though! I applaud you for going through the bridge, and wish you the best! I hope to be in your shoes one day soon :)

[2bNurse-88]

I am an RPN and I am responsible for my patients, not the RN on the floor. I work under my license, not hers.

Yes, exactly. We're all responsible for our own patients. Not sure what hospital he/she works at, but most hospitals don't have one RN who's liable for the whole ward, we all work under our OWN license, RN's & RPN's. It's a legal issue as well, why would one RN be responsible for 100 patients, when 80% of them aren't even hers? Makes no sense, if a legal issue were to ever come of a situation.

[2bNurse-88]

From what I've seen, there are some areas of work that seem to be restricted to RNs. I don't doubt the fact that RPNs are being used more as a cost cutting measure (2 RNs @ $30/hr = 3 RPNs @ $20/hr - more people to spread the work around to). In some settings, RNs seem to hae more of an administrative roll.

I don't agree with the segregation of the different levels of nursing. They have to be able to work together and the segregation doesn't help when there seeems to be so much bitterness betwee the 2 groups.

Nowhere in the GTA do RPN's make $20/hour. Where I work our HCA (or PSW's make that pay), and RPN's get $25/hour + 14% in lieu of benefits. The reason for the cutting of RN's is because of the long-term savings the hospitals will benefit from. The max out rate for RPN's is much lower than the $50 max out rate for RN's. It's the long-term effects that are the base of these cuts, not the starting pay, because the starting pay is very similar, with a difference of $1.50 where I work, from RN's to RPN's.

Not sure where you live, but that's how it is here in the GTA (Canada).

[kb14]

Did the job title RPN existed before the RN diploma program became a BScN degree? I'm just wondering because maybe that is where the difference lies. Diploma Nurses are obviously grandfathered in the whole new system, but the change from Diploma to Degree sort of legitimately turned the Nursing profession into a "real" (and I say this lightly because I lack a better word for it) science and art. I agree with you that there should no longer be two types of nurses. Maybe nursing in the future should be strictly BScN? I don't know how other people would feel about that as some people go into RPN because the schooling is fast, there is job security and pays okay. However, I feel turning nursing into a Degree program was a good move because I feel it validates nursing as a true profession (not that it was not a worthy profession before but it sort of helped change society's perception of nursing).

I think Advance Practice Nursing does not alter or negatively affect holistic care, in fact I think it enhances it. Professionalizing nursing allowed nurses in areas that were closed to them in the past. Having Nurse researchers let nurses be part of the academic realm where they can take part in discourse regarding health and society. They are able to research, conceptualize and change nursing practice to enhance care. Having specialty in a specific medical areas allows nurses to learn about a disease or illness in depth so that they can provide holistic interventions to a certain population; all in all it is still meeting patients needs. Another point I would like to add is that, socioeconomically the world is dynamic. The nursing profession need to be able to adapt to the present and future socioeconomic times and nurses cannot do that if they do not have an academic background. Nowadays you won't find someone who has a college diploma getting their Masters or PhDs, that's just not how academic advancement works in other professions; why should nursing be any different?

Anyway, I guess what I'm trying to get at is the ACADEMIC part of (BScN) nursing IS important in differentiating between the two types of nursing, especially in this decade.

Lastly, I agree with the other nursing student/grad that said that they want to be justly compensated for the amount of time/money they've put through 4 years in nursing school; it's only fair! lol

[Fiona59]

kb14:

You need to do some research on the history of nursing in Canada. Practical nurses (only Ontario uses the designation RPN) have been around for over 60 years. We were introduced to assist in the nursing shortage brought about by WWII.

PN skills, scope, and education have continued to expand over the decades just as the RNs has.

The BScN education started to gain more acceptance in Canada in the mid-1970s. I remember UBC started theirs around 1977 or 78. I believe the U of A has one of the oldest programmes in Canada (for some reason 1923 sticks in my mind). Many hospital trained nurses feel the degree has developed the wrong way. One year of the education is in Arts (English, Soc, Psych all worthwhile courses in their own right but nurses should come prepared to write a simple short essay).

I've had several friends do the degree after their PN here in Alberta and all have agreed that far too much time was spent writing essays. I even remember tutoring a couple of them on their first year English essays and electives.

[kb14]

Fiona59:

If you feel that there is something viscerally wrong about the difference in treatment of the two types of nursing then maybe RPNs (this includes LPNs as well, just in case others get offended again) should create solidarity; you know, challenge the system instead of yowling how unfair it is. I'm not saying that sarcastically, I'm being genuine. To me, there is a difference, maybe not long ago in the time of WWII but there has been changes in the last decade or two. There is a purpose as to why RN nursing has become a degree (especially in the present) and that is to introduce nurses in the academic circles. Today, RNs are expected to be adept to BOTH technical and academic skills. Yes, there are essay writing in the BScN programs but that's part of all academic programs. Are you saying that nurses do not have a place in academia because this is not what nurses "naturally" do, and that nursing has to be all technical? I believe the technical skills and knowledge in nursing can be gained through experience and exposure while in the work force. However, some people want to pursue further top positions in nursing and the only way to do that is through university and higher education. Again, I argue that you won't find someone who has a college diploma getting their Masters or PhDs in any profession--inside or outside of the health system. The only way nurses can gain influence in a top-bottom approach of the health care system is to be in with the "in crowd;" if that means pursuing a degree to be accepted in a graduate program and therefore leading to jobs at the top, then so be it. The system is not saying that RPNs/LPNs/hospital taught RNs (note: I'm talking about the individual who hold these titles) are not adequate academics, they just need to get the qualifications (i.e, become an BScN RN). If you don't want to, then by all means, don't become an RN but don't hold it against Degree holding RNs for getting paid more for the "same" work. Sadly, the truth is that qualifications weighs heavily in this society whether we like it or not, that's just how the cookie crumbles. Anyway, this is my last post for this forum. Thanks for reading.

P.S. Maybe the older generation of nurses (those who were trained in the hospital) that you speak of need to be more open minded and supportive of the new generation of nurses instead of concentrating on how poorly the new nurses are doing in the workforce. There is a difference between constructive feedback and criticism; the latter impedes learning and creates hostility.

[Fiona59]

Actually there are three types of nursing professionals in Canada (the practical nurse, psychiatric nurse and registered nurse).

Very little (if any) consultation has been with actual working nurses on how their eduation should change. The Registered Psychiatric Nurses (RPN) are being told their education has to become a degree programme to fall in line with the RN education. This has led to a scramble to get into the Psychiatric Nursing field because not all students can afford four years at University. There are some fantastic RPNs working the surgical and medical units in my hospital (their education allows for experiences in all areas of care but their primary focus is on Mental Health).

Nobody consulted the working RPNs to see if they felt their patients would be better served by a degree based nurse.

The provincial colleges very rarely consult their membership on how we feel that our next generation should be educated. I remember when the Practical Nursing programme was changed to include all the first year university Arts courses. Nobody consulted with the working nurses. The strange thing was that many working LPNs already had these courses under their belt prior to taking their nursing education. The new grads are no different from the "old" grads, they just have a bigger student loan.

For the BScN grads, what we constantly see in the workplace is new grads that are very unsure of themselves and their skills. They don't spend enough time on the units learning their craft/trade. When we precept the university students, we have to virtually drag them into rooms for the hands on stuff (yes, I know you've already done a this procedure once and had it checked off BUT the more often you do it, the easier it becomes). They have no experience of working shifts because most clinicals are over by 22hr. So finding that first job and facing reality becomes a major slap in the face.

Profiles of kb14 and a couple of the other posters don't give us much info on where they are in their nursing career. But once they've walked a few hundred shifts in our white shoes, maybe they will understand where the "older generation" of nurses are coming from.

The average nurse will never go into management or do research. Those spots are few and far between. Instead they will hospital nurse until burnout, retirement or a better non-nursing opportunity hits them in the face.

[linzz]

I can say that I have heard time and time again from the charge RN's that I am related to, of whom have taken many courses over the years to upgrade themselves so they are on par with the newer grads, that they find that some new grads just are a long way from being floor ready. Interestingly, I have also heard numerous complaints about lousy people skills with patients and staff members.

I don't think that these nurses are being mean, I just think they expect a new nurse to work hard at the job and at fitting in with the staff. I formerly worked in Human Resources and most companies expect this of new hires.

[kb14]

I know I said that my previous message was going to be the last but I just want to respond to your retort.

We obviously don't see eye to eye and that's fine but if you want to spend a great deal of time complaining how superior RPNs/LPNs are to the new BScN RNs then so be it but do so in an environment where it can be changed--LOBBY it and get Political! Amass a group of PNs and march to those provincial colleges and demand change. The reality of today is RNs are required to get a BScN, end of discussion. Society is dynamic; we can't rely on the old ways and expect everything will fall into place. Nursing cannot be stagnant; if we want other professions to take us seriously we must take the adequate steps to reach the levels where we can be part of the current discourse. That cannot happen when nurses have diplomas.

You're asking new grads to be perfect nurses on their first day of work, and that's not how it goes (maybe in your time, but I highly doubt that). Learning is a process not an end to anything. Are you saying that nurses in the past knew EVERYTHING that they needn't learn anything new after they received their titles? That’s just arrogance, if it’s a “yes”! As some people argued earlier in this forum, skills and knowledge are gained through exposure so whether you learn it in school or the workforce, what’s the difference when you’re still focusing on patient care. Just because an RPN has more bedside experience than a New Grad it doesn’t mean that they should get higher pay considering there is a small yet very significant difference in their education and training. Yes, there is a difference between “old” grads (trained in the hospital) and new grads and it’s academia. As to salary (at least in ON), min. wages for new nurses always increase by some sort of percentage (I think about 1-3%) every few years or so. So what “older” nurses were making when they were new to the profession is not similar to what the new grads are making today. Moreover, it’s a different GENERATION that means different issues and increasing technology. When arguing my point, I’m thinking about the current situation right now, not what happened in the past.

Attitudes such as “the average nurse will never go into management or do research,” are so discouraging for those who want to pursue those types of nursing careers and there are many who do! Advance practice nursing does not necessarily equate to research or management. How about Nurse Practitioners, Clinical Nurse Specialists, Nurse Educators in Schools? I’m looking through job posting right now at different hospitals here in my city, and it seems like the current openings are for those positions mentioned above. Furthermore, I feel your arguments concentrate highly on the mechanical bed-side part of nursing. Nursing is so broad and to centralize your defense at just one skill aspect of nursing totally undermines those who work in the community, governments, occupational health, etc. What if these nurses in the future decided to go back to bed-side and they fail to remember ALL their required bed-side nursing skills, should they be looked down upon like the current New Grads? Should they get paid as much as an RPN even if they hold a BScN?

I DO NOT claim that BScN RNs are better than “older” nurses/RPNs/LPNs, that’s not my main argument. My main argument is that there IS a DIFFERENCE between the two or three or four or five etc. types of nurses (or however many nurses you claim because I always seem to miss one, my bad lol) and that is the reason for the contrast in pay (more specifically RPNs/LPNs). Keyword: DIFFERENCE but I do not contend that it is necessarily better.

[NotReady4PrimeTime, RN]

This debate is deteriorating into a bit of a rant. Might we tone down the rhetoric a bit please?

Just a comment: The need for "the mechanical bed-side part of nursing" is growing and will always be the largest proportion of nursing jobs. Not everyone is suited to nor wants to provide hands-on nursing care, in the same way that not everyone is suited to manage or participate in advanced practice. (Indeed, I can think of more than a few people who should NOT be managers... but they aren't good at the bedside either, so where does that leave them?) Stating the obvious, that the average nurse will spend their entire career providing front-line care, in and of itself is not discouraging to anyone who wants something different from their nursing career.

[Fiona59]

Got to love students. They are so idealistic.

[kb14]

How patronizing and pessimistic gotta love the older nurses! lol