2 hospitals to drop licensed practical nurses - page 13

the changes at mercy and unity hospitals are meant to improve care, but unions say the remaining nurses will be stretched too thin. all 90 licensed practical nursing jobs at mercy and unity... Read More

  1. by   tntrn
    About 35 years ago, when I took a statistics class (thinking I wanted to be a statistician), the first thing we learned was that you can prove anything you want to prove with statistics. It depends on how you do it. That is about the only thing from that class that stuck with me: made me really question the validity of any study that gives "statistics."

    I lived and worked in California in the 70's, and I don't remember ever signing off on the LPNs I worked with. We did sign off on the NA's. And I would add that at my very first nursing job, there were two aides, with perhaps 40 years between then, who taught me more than they know. They were gentle with me, but firm, and when I needed to be attending to something, they let me know it. I think of them often, and believe that my experience with them is one of the big reasons why I have always tried to treat all employees as part of a team. Too often I have seen some employees treat others (not in their classification) as less important than themselves.
  2. by   Sheri257
    Quote from Dixiedi
    However, in these two hospitals, one hires only RNs, the other a mix, about 1/2 and 1/2. The all RN hospital discharges folks quicker; what fantastic nursing care they must receive!
    They repeatedly discharges folks quicker with fewer "complications" and other issues ever mentioned in the chart.
    These same patients are frequently admitted to the other hsopital (the one with the happy mix of LPNs and RNs) when the family and/or pt becomes totally disgusted with the lack of comprehense care.
    My impression is the all RN staff is so over worked they focus solely on the reason for admission and too often miss underlying conditions resulting in readmission just days later.
    At the last hospital I worked, patients were discharged quickly also. But that was because management was riding both the doctors and the RN's to discharge quickly. They even threatened to write up the RN's for sitting on discharges if they had a lot of admits waiting in the ER.

    Granted, this was a lousy hospital with lousy care. But, in this case, that's wasn't the RN's fault, it was management's. And, not surprizingly, this hospital also has trouble keeping RN's.

    So ... I'm not sure discharges are an accurate reflection of the quality of nursing care, or the lack thereof, because there's other factors at play in these situations ... namely financial. It may not be the RN's fault, particularly since the doctors ultimately control the discharges, not RN's.

    Last edit by Sheri257 on Dec 4, '05
  3. by   nurse4theplanet
    Quote from tntrn
    About 35 years ago, when I took a statistics class (thinking I wanted to be a statistician), the first thing we learned was that you can prove anything you want to prove with statistics. It depends on how you do it. That is about the only thing from that class that stuck with me: made me really question the validity of any study that gives "statistics."
    You are right on the money with this one! My statistics teacher always said there are lies, damn lies, and statistics
  4. by   Dixiedi
    Quote from lizz
    At the last hospital I worked, patients were discharged quickly also. But that was because management was riding both the doctors and the RN's to discharge quickly. They even threatened to write up the RN's for sitting on discharges if they had a lot of admits waiting in the ER.

    Granted, this was a lousy hospital with lousy care. But, in this case, that's wasn't the RN's fault, it was management's. And, not surprizingly, this hospital also has trouble keeping RN's.

    So ... I'm not sure discharges are an accurate reflection of the quality of nursing care, or the lack thereof, because there's other factors at play in these situations ... namely financial. It may not be the RN's fault, particularly since the doctors ultimately control the discharges, not RN's.

    I didn't imply that RNs give substandard care, I implied that at least this hospital, IMHO is overworking RNs by not providing enough staff, this leads to some things being missed because they are too focused on a single system or too short staffed to take the time to listen to all lobes, front and back as an example.
    This is my theory, it is not proven it is merely an observation. This particular hospital has no more trouble keeping staff than any other in this city. Most hospitals have a revolving door anyway, particularly in larger cities where there are many options.
    I agree that much is also to blame with the administration, they must get the pt out before the insurance time is up, after that there must be exceptional documentation in order to collect from Medicare and Medicaide as well as the multitude of other insurance companies.
    Overall, there are many problems with nursing. But, I think the biggest one is RNs and some LPNs thinking hospitals should have an all RN staff and not believing good LPNs can care for acute pts who actually get well in record time, go home with adequate knowledge to care for themselves and not leave with some obvious problem unaddressed.
    After all, I don't need indepth knowledge of how community health-care works, I only need to know that it is available and who to refer my pts to within my area to help them establish the care they need. This is one of the areas so many BSNs argue makes them a better nurse.

    I won't get into the arguement about who has more education, becuase it's not important to my "little study, personal observation, etc."
  5. by   Dixiedi
    Quote from tntrn
    About 35 years ago, when I took a statistics class (thinking I wanted to be a statistician), the first thing we learned was that you can prove anything you want to prove with statistics. It depends on how you do it. That is about the only thing from that class that stuck with me: made me really question the validity of any study that gives "statistics."

    I lived and worked in California in the 70's, and I don't remember ever signing off on the LPNs I worked with. We did sign off on the NA's. And I would add that at my very first nursing job, there were two aides, with perhaps 40 years between then, who taught me more than they know. They were gentle with me, but firm, and when I needed to be attending to something, they let me know it. I think of them often, and believe that my experience with them is one of the big reasons why I have always tried to treat all employees as part of a team. Too often I have seen some employees treat others (not in their classification) as less important than themselves.
    Oh so very true, I also took a statistics course before I decided on nursing, when I actaully thought I wanted to be an accountant. That was a mistake, I love to play with numbers but I hate to sit in one place most of the day! LOL would never have worked for me!
  6. by   Joan1199
    Again. administrations way to save money. Never mind these nurses provided care to the patients. These nurses probably worked extra when needed, just so patients would receive care. Evidently,their loyalty doesn't compare to the $. The R.N.s are swamped with paper work,so the hospitals can collect from insurance companies,medicare, and medicaid. How are they going to hire nurses to replace the L.P.N.s?
  7. by   Q.
    I have a question.

    Over and over I hear how LPNs, RNs, etc are all nurses and that is the point.

    If that is the point, what is the difference if the LPN role goes away and you become something else (an RN, or whatever?) If it's all about taking excellent care of patients and we're all nurses, why does it matter?

    Speaking of the public and LPNs, I heard on our local radio station last week how one of the radio hosts went to a clinic in a supermarket for bronchitis treatment. This person was seen by an NP, but the radio host didn't really know the difference so she called this person an LPN.

    "I was seen by an LPN and she gave me a Rx for biaxin, etc..."

    This demonstrates how confusing our profession is!!!
  8. by   SmilingBluEyes
    So how would you propose to make it clearer Suzy?
  9. by   lindarn
    This is all the more reason that we need to drop the LPN/LVN career field, and clarify our identity with the public, and even ourselves. We need to have a unified level of entry into the profession to eliminate the confusion. I am sorry, but as an RN, with a BSN, I am not interchangeable with an LPN/LVN. There is a reason that there are professional duties that are designated to RN's only. It is a shame that, in an effort to save the almighty bottom line, that hospitals, and other areas where nurses are utilized, blur the line of what is an RN, LPN/LVN, Medical Assistant, Nurses Aide, etc. We are not interchangeable widgets. If hospitals and nursing homes allow LPN/LVNs do the work of an RN, that does not mean that the LPN/LVN is "just as good" as an RN? Again, there are reasons that there are professional duties that require the education, training, and critical thinking of an RN. Yes, there are LPN/LVNs who have excellant critical thinking skills. And yes, they probably should have become RNs. But then, maybe we should just let ANYONE PERFORM THE PROFESSIONAL DUTIES OF AN RN. MAYBE HOUSEKEEPING WOULD DO. Then again I have worked with LPN/LVNs who have gone on to the community college 1 + 1 programs, and become RNs. I could write a book on who should and shouldn't be RNs. I personally have worked with many of these individuals, and their lack of critical thinking skills have killed patients.

    The arguement should be, why aren't the nurses, who now have a heavier workload demanding better patient ratios, going to the public and inform them why the ratios are not safe, and how their life and health are are risk. That is should have happened ten years ago when "care redesign" took over the hospital environment. Did nurses unite, organize, and fight it? No, they just caved in and let it happen. Do the school districts decide to allow unlicensed teachers assistants to take over control of the classrooms? Why not? First, teachers had a bottom line entry level in to practice to the profession.
    Second, they unified with the National Association of Teachers, who made it almost impossible to be able to teach, without being a member. This gave them a national voice, and Political Action Commmittee, who acted as a watchdog on the profession. They fought for, and won, better student-teacher ratios, benefits, pay, etc. including raises with each higher level of education you achieved. There was no bickering about, "who does the same job, and why should I get paid less because I have less college education than the teacher in the next classroom?". They accepted it, and moved on. Unlike nurses, who insist on validating their self worth and self inportance on their statutory, undifferentiated, title, of Registered Nurse. And we wonder no one, including us, knows who we are, how to define what we do to the public, and how to how to show that our presence makes a differance in patient outcomes.

    Differant levels of "nurses" insist on their "piece of the 'nursing care pie' ". All want the prestige, pay, and respect, but without the education to back them up. We will never become the professional equals of other health care professionals, because we insist on remaining, "separate, but equal". It is no more true now than when it was used as an excuse to keep blacks out of the better public schools, and accomplished nothing more than keeping blacks "in their place", in the "back of the bus", and out of sight to white America. It is doing the same thing to nursing. We are being forced to "the back of the bus", professionally, econonmically, and educationally.

    Lindarn, RN, BSN ,CCRN
    Spokane, Washington
  10. by   SmilingBluEyes
    I can't see the example of teacher being so helpful. From where I sit, they are some of the most underpaid and disrespected professionals in the country, today. Who else with a master's degree will get paid sometimes less than 40k a year and have to put up with the same kind of disrespect we nurses do? Teachers dont' get the respect OR pay they deserve, across the board. And they are VERY-well educated.

    And the public can't even be sure NP's are "safe" (reading the other thread assures me they are not sure or know even what they do)---the confusion they experience is not just based on the fact there are RN's, LPNs and NP's....they don't the differences at all. Even if we go to all-BSN RN presence in the field, they still won't understand what all an RN does---let alone an NP.

    I do agree, RN's and LPNs at all levels, need to be better-educated to the policital and business aspects of nursing...that is the way to earn respect from our administrators, managers AND the public---to become more business-savvy and politically-active is key.
    Last edit by SmilingBluEyes on Dec 5, '05
  11. by   Q.
    Quote from SmilingBluEyes
    So how would you propose to make it clearer Suzy?

    How about losing the LPN/LVN/ADN/ASN/RN/BSN distinctions of a nurse. That is 6 distinctions right there. That is insane.

    ONE standard entry for a professional nurse. If you are a nurse, then you have (example: RN, BSN, at the least) and nothing else.

    Advanced practice nurses would be on a completely different level.
  12. by   Q.
    Quote from lindarn
    Differant levels of "nurses" insist on their "piece of the 'nursing care pie' ". All want the prestige, pay, and respect, but without the education to back them up. We will never become the professional equals of other health care professionals, because we insist on remaining, "separate, but equal". It is no more true now than when it was used as an excuse to keep blacks out of the better public schools, and accomplished nothing more than keeping blacks "in their place", in the "back of the bus", and out of sight to white America. It is doing the same thing to nursing. We are being forced to "the back of the bus", professionally, econonmically, and educationally.

    Lindarn, RN, BSN ,CCRN
    Spokane, Washington
    Excellent paragraph.
  13. by   Marie_LPN, RN
    Quote from lindarn
    This is all the more reason that we need to drop the LPN/LVN career field, and clarify our identity with the public, and even ourselves. We need to have a unified level of entry into the profession to eliminate the confusion. I am sorry, but as an RN, with a BSN, I am not interchangeable with an LPN/LVN. There is a reason that there are professional duties that are designated to RN's only. It is a shame that, in an effort to save the almighty bottom line, that hospitals, and other areas where nurses are utilized, blur the line of what is an RN, LPN/LVN, Medical Assistant, Nurses Aide, etc. We are not interchangeable widgets. If hospitals and nursing homes allow LPN/LVNs do the work of an RN, that does not mean that the LPN/LVN is "just as good" as an RN? Again, there are reasons that there are professional duties that require the education, training, and critical thinking of an RN. Yes, there are LPN/LVNs who have excellant critical thinking skills. And yes, they probably should have become RNs. But then, maybe we should just let ANYONE PERFORM THE PROFESSIONAL DUTIES OF AN RN. MAYBE HOUSEKEEPING WOULD DO. Then again I have worked with LPN/LVNs who have gone on to the community college 1 + 1 programs, and become RNs. I could write a book on who should and shouldn't be RNs. I personally have worked with many of these individuals, and their lack of critical thinking skills have killed patients.

    The arguement should be, why aren't the nurses, who now have a heavier workload demanding better patient ratios, going to the public and inform them why the ratios are not safe, and how their life and health are are risk. That is should have happened ten years ago when "care redesign" took over the hospital environment. Did nurses unite, organize, and fight it? No, they just caved in and let it happen. Do the school districts decide to allow unlicensed teachers assistants to take over control of the classrooms? Why not? First, teachers had a bottom line entry level in to practice to the profession.
    Second, they unified with the National Association of Teachers, who made it almost impossible to be able to teach, without being a member. This gave them a national voice, and Political Action Commmittee, who acted as a watchdog on the profession. They fought for, and won, better student-teacher ratios, benefits, pay, etc. including raises with each higher level of education you achieved. There was no bickering about, "who does the same job, and why should I get paid less because I have less college education than the teacher in the next classroom?". They accepted it, and moved on. Unlike nurses, who insist on validating their self worth and self inportance on their statutory, undifferentiated, title, of Registered Nurse. And we wonder no one, including us, knows who we are, how to define what we do to the public, and how to how to show that our presence makes a differance in patient outcomes.

    Differant levels of "nurses" insist on their "piece of the 'nursing care pie' ". All want the prestige, pay, and respect, but without the education to back them up. We will never become the professional equals of other health care professionals, because we insist on remaining, "separate, but equal". It is no more true now than when it was used as an excuse to keep blacks out of the better public schools, and accomplished nothing more than keeping blacks "in their place", in the "back of the bus", and out of sight to white America. It is doing the same thing to nursing. We are being forced to "the back of the bus", professionally, econonmically, and educationally.

    Lindarn, RN, BSN ,CCRN
    Spokane, Washington
    Thanks for the support.

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