LPNs Fight Efforts To Phase Them Out - page 11

Licensed Practical Nurses at one hospital are fighting efforts to have them phased out of direct patient care. The hospital intends to go with a different care model calling for expanded use of RNs and UAP staff to replace the... Read More

  1. 0
    You are the on the board of directors of this hospital and see reports like this

    http://www.hospitalcompare.hhs.gov/h...1&lng=-76.189&

    You are below the national and state averages in HCAPS

    http://www.hospitalcompare.hhs.gov/h...&lng=-76.189&#

    You are below in quality.

    Your Medicare funding has been cut, you can not add staff. Unless you improve your scores you are going to loose 2% more if your scores don't improve.


    http://www.afscme.org/docs/LPN-Rep.pdf - while this report is to support the role of LPNS in the hospital.

    It has many telling conclusions:

    One no studies saying the LPNS improve or harm patient care.

    The State Boards can be very restrictive of the LPNs practice.

    LPNs is all states have to work under the direction of the physician or a RN.

    While many posts argue that the LPNs are independent and only have to interrupt the RNs practice very minimally , I have not seen one RN post here welcoming overseeing the LPNS and performing their own assignment. I have worked with very skilled LPNs but I always felt the burden and responsibility for overseeing their patients. I never got paid extra for caring for my patients and the PN's patients. There is no legal way a LPN can take responsibility for their patients totally.

    In my years of practice when LPNs where employed in hospitals, I would often here the following:

    A. The assignments are not fair ( usually they were assigned more patients due to the fact the RN had to over see their patient's care.
    B. I would miss breaks and meals while the LPNs were sitting around, the reason why is there patient needed medications or treatments that their patients needed.
    C. Scheduling would be difficult, if I needed a day off a LPN could not take my shift, while a RN could cover for them.
    D.LPNS could never be in charge or be on the code team, so in addition to over seeing their patients, a RN has to be available to be in charge and cover emergencies.

    So as a Board Member, why would I continue to hire a nurse, who can't be independent in practice and has a track record of providing care below the state and national average ?

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  2. 1
    I must say I am very surprised at the post above. Maybe I shouldn't be. Your conclusion that LPNs are not able to take care of more complex patients is based on what a Board of Directors thinks about customer service surveys that don't appear to differentiate who or how they felt their experience was lacking?

    Before you start offering that sort of thing as the proof of a nurse's safe practice in the workplace, you might want to step back and see how many of rank and file nurses of all degrees feel about the accuracy of such assessments.

    You just don't like LPNs it appears because where you work they were in your way. The idea the "LPNs sat around" on your shifts causes you to believe in a global trait all of us must have? Other than being shocked that this is what you offer as proof, I suppose I should be relieved. I expected better, Ginger's Mom.

    You can relax, though. As Hazel said (and so did Richard Nixon) pretty soon you won't have us to kick around anymore.

    I just want to add a public thanks to Marion, Yoshiko, Berrie, and Corrine who brought me into the fold as a new LVN made me feel I had worth, and the cohesive culture of teamwork you provided so all of us could grow as nurses and as people. I appreciate all of you so much, wherever you are.
    Last edit by nursel56 on Apr 29, '11
    HazelLPN likes this.
  3. 0
    You have no idea my feelings towards LPNs, in fact I have been an instructor in the PN program and loved teaching this group of nurses. I am very proud to see my former students in the workforce. There is a very important these nurses in the US Healthcare system.

    What the PNs are not prepared for is the complexity of nursing care in the acute care hospitals, I am basing this on my personal experience as a floor nurses and an educator.

    As far as government assessments this is way our healthcare system is moving, if you don't like it read the CMS web page when a new measure is proposed it is open for public comment. I would bet the nurses who complain here do not follow what CMS is proposing and never have made a public comment. Easier to complain than to act.

    If LPNs wished to stay in acute care they should have lobbied to have their education modeled after the Canadian Model where they have double the education ( to me if you are going to school for 2 years why not become a RN).
  4. 1
    Your entire post is based on either a conclusion drawn from mid-air, your personal experiences and opinions, or the personal experiences and opinions of people who have worked at your hospital in your state! I can only hope someone else who agrees with you can offer reasoning that is more valid than all of that, and frankly takes more time to use the language in a way that is reflective of their education.

    I'm not a grammar cop, but it's beginning to really bother me that I'm being told of my deficiencies in education in posts that appear as though the writer doesn't care very much, and it isn't just you who is doing it. But back to content . . .

    When you teach LPN students - do you omit all the information that pertains to anything normally taking place in an acute care hospital? Are they required to take BLS for Healthcare Providers, or would the standard Red Cross CPR course be sufficient? Or do you just tell them they won't need to know that information once they graduate?

    Our customer service scores are down, it must be the LPNs My terminally ill mother sat on a bedpan for almost an hour after she was done* because the RN couldn't find the CNA, but when I went to remind them she was laughing and joking at the nurse's station** and said "Oh? Didn't Judy go in?"

    If Mom gave a lower score on "getting needs met right away" - would you assume that the CNA was providing substandard care? Turns out the nurse told someone else to "go get Judy" and Judy was off the floor someplace. The RN never bothered to check back - and actually said, "ughh. .", followed by -- does this mean all RNs are at fault for lower scores? No!! It is my personal experience on that day with that person.

    Why are you offering the subjective experiences of the lay public as any sort of proof LPNs "have a track record of providing care below the state and national average"?

    I only point that out to illustrate the fallacy of lower scores being blamed on any one job category, or frankly - any one person who kept you from getting you and your fellow RNs from getting your break on time or take the day off of your choosing.

    I'm amazed that you would offer this: I have not seen one RN post here welcoming overseeing the LPNS and performing their own assignment. - to put it bluntly - so what? If there's no post in this thread it's not real?

    This thread does prove that this nurse likes to do this

    If you haven't read the post by HazelLPN - it will give you a fresh look at the situation. Sometime I will write what my experiences have been over the years working in places where it all works fine, and how the litany of problems you have had are not indicative of similar dysfunction everywhere. My hat tip at the bottom of my previous post was an allusion to it. ~~~The End of Part One~~~

    I know what my AN friends are thinking....

    * I didn't take her off myself because she didn't tell me she was on the thing for 1/2 hour!! "Didn't want to be a bother" and she had lots of attached tubing and monitors I didn't want to jeopardize the integrity of ...

    ** no, she was not charting, talking to the doctor, or decompressing after a stressful code. The place was a mausoleum that afternoon and now I know where all the cool TGIF hot spots are in the area.
    Last edit by nursel56 on Apr 30, '11
    HazelLPN likes this.
  5. 0
    LPNs practice in many different venues, office, home care, and skilled nursing, they need the professional level of CPR to attend clinical in ANY clinical rotation ( which can be office based or skilled nursing). Why would a practical nurse do be held to this standard of care? Why would they take a lower level of CPR than a nursing assistant?

    Studies to Support the use of RNs in hospitals:
    http://www.aacn.nche.edu/Media/TalkingPoints2.htm
    " After taking into account all of these other factors, a 10% increase in the proportion of hospital staff nurses with baccalaureate degrees is associated with a 5% decline in mortality following common surgical procedures."

    http://www.ahrq.gov/research/nursest...nursestaff.htm

    In hospitals with high RN staffing, medical patients had lower rates of five adverse patient outcomes (UTIs, pneumonia, shock, upper gastrointestinal bleeding, and longer hospital stay) than patients in hospitals with low RN staffing.

    Major surgery patients in hospitals with high RN staffing had lower rates of two patient outcomes (UTIs and failure to rescue).

    Higher rates of RN staffing were associated with a 3- to 12-percent reduction in adverse outcomes, depending on the outcome.

    Higher staffing at all levels of nursing was associated with a 2- to 25-percent reduction in adverse outcomes, depending on the outcome.


    I can't find any study supporting staffing hospitals with practical nurses. I would be very interested in reading them.

    I have worked with wonderful, smart, gifted, and well versed LPNs. Their only limitation was the lack of class room education, not lack of hands on experience. Unless the system of licensing nurses is changed to "life experience" and not education based the practical nurse ( as well as non degreed RNs) will have to return to school for career advancement.

    In this day of budget cuts if the practical nurse was cost effective hospitals would be hiring LPNs instead of RNs.

    Back to the topic of this hospital, letting LPNS go, personally they should have allowed time for these nurses to complete schooling to become a RN. It is tough economic times and it will be very hard to them to find similar employment, that is cruel especially if they have devoted many years to this hospital.

    Bigger picture nursing is becoming more complex and more education is needed for all nurses.
  6. 2
    I don't disagree with you at all about all of us needing a higher level of education. You are right. They will probably need to revamp the average LPN/LVN curriculum to reflect an emphasis on nursing in the LTC/SNF arena, both because of the bubble of aging Baby Boomers, and the restriction from acute care hospitals. I see that as a good thing, and it is a place where LPNs are somewhat more independent, sometimes with the RN a phone call away.

    In my acute care hospital experience in California, we had a less restricted scope, so the RNs really did not feel it a burden to work with us, so that was what I was visualizing.

    In my area (unfortunately) because of budget cuts, our skilled nurses in home care are being replaced with all HH aides or caregivers. I think they will likely regret it when there is an appreciable rise in infection and skin breakdown rates - but that is the field I am in now and I really like it.

    Thanks for the links you provided.
    HazelLPN and Ginger's Mom like this.
  7. 1
    If they phase out LPNs next they will phase out ADNs. I have never seen a LPN sit at the desk unless doing paperwork. I was a LPN before a RN and I worked my tail off. Hats off to the people who have courage to become RNs after being a LPN in LTC. It really is courageous.
    frenchfroggyRN likes this.
  8. 6
    Quote from nursel56
    Your entire post is based on either a conclusion drawn from mid-air, your personal experiences and opinions, or the personal experiences and opinions of people who have worked at your hospital in your state! I can only hope someone else who agrees with you can offer reasoning that is more valid than all of that, and frankly takes more time to use the language in a way that is reflective of their education.

    I'm not a grammar cop, but it's beginning to really bother me that I'm being told of my deficiencies in education in posts that appear as though the writer doesn't care very much, and it isn't just you who is doing it. But back to content . . .

    When you teach LPN students - do you omit all the information that pertains to anything normally taking place in an acute care hospital? Are they required to take BLS for Healthcare Providers, or would the standard Red Cross CPR course be sufficient? Or do you just tell them they won't need to know that information once they graduate?

    Our customer service scores are down, it must be the LPNs My terminally ill mother sat on a bedpan for almost an hour after she was done* because the RN couldn't find the CNA, but when I went to remind them she was laughing and joking at the nurse's station** and said "Oh? Didn't Judy go in?"

    If Mom gave a lower score on "getting needs met right away" - would you assume that the CNA was providing substandard care? Turns out the nurse told someone else to "go get Judy" and Judy was off the floor someplace. The RN never bothered to check back - and actually said, "ughh. .", followed by -- does this mean all RNs are at fault for lower scores? No!! It is my personal experience on that day with that person.

    Why are you offering the subjective experiences of the lay public as any sort of proof LPNs "have a track record of providing care below the state and national average"?

    I only point that out to illustrate the fallacy of lower scores being blamed on any one job category, or frankly - any one person who kept you from getting you and your fellow RNs from getting your break on time or take the day off of your choosing.

    I'm amazed that you would offer this: I have not seen one RN post here welcoming overseeing the LPNS and performing their own assignment. - to put it bluntly - so what? If there's no post in this thread it's not real?

    This thread does prove that this nurse likes to do this

    If you haven't read the post by HazelLPN - it will give you a fresh look at the situation. Sometime I will write what my experiences have been over the years working in places where it all works fine, and how the litany of problems you have had are not indicative of similar dysfunction everywhere. My hat tip at the bottom of my previous post was an allusion to it. ~~~The End of Part One~~~

    I know what my AN friends are thinking....

    * I didn't take her off myself because she didn't tell me she was on the thing for 1/2 hour!! "Didn't want to be a bother" and she had lots of attached tubing and monitors I didn't want to jeopardize the integrity of ...

    ** no, she was not charting, talking to the doctor, or decompressing after a stressful code. The place was a mausoleum that afternoon and now I know where all the cool TGIF hot spots are in the area.

    I have had no problems in the hospital when they sent a pool LPN to work. I gladly did her pushes and never asked her to do a thing for me, but maybe answer the phone that kept ringing and everyone was ignoring. I was the charge nurse. Thank God the LPN was there. The trick is for whoever is making their assignment to try and find the patients who do not have a lot of pushes. Also, try to keep the patients grouped close together. Come on...lets not run her or him to death. Be kind, have compassion. And be thankful that the RNs did not have to take on part of the extra assignment.

    Shame on any nurse who goes to find a CNA to get someone off the bedpan!! To me, this is totally unacceptable unless I have someone who can not breathe or chest pain. That is just simple prioritization. I always took patients to the restroom. I did not want them to fall. SAFETY 101.

    What upsets me is when a LPN cuts RNs down..making stereotyped angry accusations that most of the time the ones I heard were just not true.

    In every job there will always be slackers and always be the ones who pick up the slack.

    Nurses in general need to get it together and stick together!!:redpinkhe
    Last edit by nurse.sandi on Apr 30, '11 : Reason: addedum
  9. 6
    Ginger's Mom, not sure what state you're in, so it's entirely possible that the limits placed by you BON on LPNs does make it difficult for them to function adequately in the hospital.

    As far as my scope of practice goes, the only limitation that really matters on my floor (tele) is that I cannot push IV meds, so the charge (who does not have any pts) takes care of it. I have to have my charge sign off on admits, which consists of clicking a box on the chart, no more no less. I can't spike the blood, but I can monitor the first fifteen minutes, and since two nurses have to check at the bedside anyway I really can't see the difference.

    I can work with lines, titrate drips, and I'm required to be ACLS certified. In a code situation, I am allowed to do pushes. There are two of us LPNs on nights, and we're among the go-to people if a pt starts crashing, as we've been on our floor for over five years and many of the other nurses have less than three years experience under their belt. We also have had the dubious pleasure of being hand picked by some of our docs to care for their family members when they were on our floor...now those were some entitled-feeling pts!

    I'm in a bridge program now, and can't wait to get that next step of my education done as my goal is to have my NP before my kids finish college.
    nursel56, frenchfroggyRN, HazelLPN, and 3 others like this.
  10. 2
    Quote from mama_d
    Ginger's Mom, not sure what state you're in, so it's entirely possible that the limits placed by you BON on LPNs does make it difficult for them to function adequately in the hospital.

    As far as my scope of practice goes, the only limitation that really matters on my floor (tele) is that I cannot push IV meds, so the charge (who does not have any pts) takes care of it. I have to have my charge sign off on admits, which consists of clicking a box on the chart, no more no less. I can't spike the blood, but I can monitor the first fifteen minutes, and since two nurses have to check at the bedside anyway I really can't see the difference.

    I can work with lines, titrate drips, and I'm required to be ACLS certified. In a code situation, I am allowed to do pushes. There are two of us LPNs on nights, and we're among the go-to people if a pt starts crashing, as we've been on our floor for over five years and many of the other nurses have less than three years experience under their belt. We also have had the dubious pleasure of being hand picked by some of our docs to care for their family members when they were on our floor...now those were some entitled-feeling pts!

    I'm in a bridge program now, and can't wait to get that next step of my education done as my goal is to have my NP before my kids finish college.
    As you are learning in your bridge program that check the RN does is verifying the information is correct, you must an awesome nurse to inspire blind trust. it also sounds like you are practicing at the RN level and glad to hear you are back in school to get your RN. With your experience you must bb finding it a breeze.

    As far as "spiking Blood" that is only a task, in the hospitals I have worked in there is an elaborate process to ensure the correct blood is chosen.

    It saddens me to think SNFS are eliminating LPNs since they are the life blood in that facility. It has also been my personal observation through HEDIS audits, that clinics that have LPNs instead of MA have much better outcomes. My guess since this is only personal and bias information is that having a nurse in the clinic allows for patient teaching and success.

    Most patients I observe in the hospital are on drips and IV pushes, years ago all pain medication and anti nausea medication was IM now IV. Since these doses are unpredictable unpredictable it makes it difficult for the RN who is covering the LPN.

    Once again, I am so sorry for the group of LPNs, who have lost their positions. It is so sad since this hospital seems to have a school of nursing. For short money they could have had a bridge program( paid for by the hospital) and had very loyal nurses for the rest of their career.
    mama_d and FranEMTnurse like this.


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