LPNs Fight Efforts To Phase Them Out - page 12

by DoGoodThenGo | 24,349 Views | 139 Comments

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. 5
    Quote from Ginger's Mom
    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.
    You will never find a study in favor of LPNs anywhere, because a study is done when someone has a research interest, usually in partial fulfillment of a graduate degree. Generally, graduate students working on MSNs, PhDs etc have a strong interest in an all RN staff because big business would gladly replace them with cheaper, less formally educated people. Noticed I said less "formally" educated. No RN in her right mind would do research that says LPNs are a good thing to have as it is against her professional interests. I would imagine that in ten years or so, you will see studies conducted by graduate students that LPNs are dangerous in LTC once acute care jobs become scarce. I know enough about reseach being the wife of a physician, the mother of a pharmacist and a nurse practioner and the proud grandmother of a fairly new PhD chemist to say that often times the researcher knows their conclusions before they do their study....even in hard sciences bias is a problem. The only ones who have an interest in LPNs in acute are are the LPNs themselves, and they are not researchers. Fudge isn't just a tasty dessert, its used in research all the time.

    Even if a study was done on LPNs in acute care, there are so very few left working that you couldn't do a valid study. The larger your sample, the more valid your data is. At the time of my retirement, there were five LPNs still working in my unit. All five were excellent nurses. Four out of the five were over fifty. I don't have the peer reviewed research to back that up, but they could have been my nurse anyday...and I can't say that about all of the RNs in the unit. Like I said, I live in a state where LPN practice is broad. I was responsible for my own scope of practice. The few things outside of that scope, the RN charge nurse was responsible for. If I screwed up in my own scope, I have a license that can be lost too.

    I understand the need for more formal education. It is good for the profession I suppose. At the same time, I also realize that informal education is often times more powerful than formal education. In the final five years of my career, I took great job in mentoring young nurses......all BSN educated RNs. A common comment was always " I don't know why I even went to school for this, because it didn't help". I graduated from nursing school in 1955. Obviously, most of the technical knowledge I learned is long obsolete. However, we were taught to respect elder nurses. Now, I think the opposite is true. These kids come out thinking that anything less than a BSN is a mindless automation with no 'critical reasoning" skills and "nursing is now so complex that only BSNs can possibly understand it"...reguarless of the years of experience as a nurse. That changes real quick when a veteran LPN or diploma RN from the old days saves your behind because you weren't looking at your patient closely enough.....and the monitor doesn't tell you as much as you think it does.

    Don't wait around for that study...for it will never happen. You might want to get your MSN, however, and do a study on how only graduate educated nurses are needed in LTC to understand the complex needs of our aging population. People are living longer you know...and in todays society there are just so many complexities that we can't trust our old people to ANYONE but a BSN. Critical reasoning comes only with the completion of a BSN, NEVER with 54 years on the job as an LPN...countless conversations ( many over my homecooked meals and even better cocktails) with some of the most brilliant physicians, nurses and therapists who have ever been....and reading and questioning nursing research long before it was fashionable to do so.

    Best to you,
    Mrs H.
  2. 2
    Quote from HazelLPN
    . . . I would imagine that in ten years or so, you will see studies conducted by graduate students that LPNs are dangerous in LTC once acute care jobs become scarce.
    You can put money on it. I spent several years working with a research team comprised of some of the most towering academics in the world doing real research. So when I get knocked around for not accepting at face value a "study" that turns out to be a set of postcards mailed out to members of an RN professional group and based on the results of the returned postcards I get a little testy, too. The dismissive tone of the "BSN prepared" about what is so obviously above my grasp at times is humorous as well. I think it's because BSN programs drill it into their students how elite they will be once they graduate. The most brilliant people I've ever known tend to be the most humble as well. Thanks, Mrs H.
    mama_d and HazelLPN like this.
  3. 0
    Quote from tferdaise
    Like you, I'm on the same route and yes, I have wondered how some of these RNs pass their boards. But again it comes down to the State Board... So what you getting your MSN in? Mine is in leadership

    Family Nurse Practitioner, I will graduate in 2015 (long time, have to work full time while I go to school)
  4. 0
    Quote from GM2RN
    That's a VERY broad statement that does not compare education or experience. A fair comparison would be a new grad LPN with a new grad RN, assuming neither had any prior healthcare experience. In that case, I have to disagree with your statement.

    What I meant was experienced LPNs who could work circles around some supposedly experienced RNs.
  5. 3
    Quote from nursel56
    You can put money on it. I spent several years working with a research team comprised of some of the most towering academics in the world doing real research. So when I get knocked around for not accepting at face value a "study" that turns out to be a set of postcards mailed out to members of an RN professional group and based on the results of the returned postcards I get a little testy, too. The dismissive tone of the "BSN prepared" about what is so obviously above my grasp at times is humorous as well. I think it's because BSN programs drill it into their students how elite they will be once they graduate. The most brilliant people I've ever known tend to be the most humble as well. Thanks, Mrs H.
    I was lucky that my nurse manager and head intensivist were very supportive of the veteran LPNs who remained in the unit and who knew that our experience and informal education could not easily be replaced by some 22 year old fresh out of college. Human relationships saved my career as a critical care nurse (as well as my home cooked meals and even better cocktail parties...and my sence of humor and competance as an LPN). It was an honor to be an LPN in the unit, as you really had to prove yourself.

    I get it about formal education, really I do. Back in the day, elementary school teachers didn't have BA degrees, they instead went to teacher training school for about 12 to 18 months or so. Of course, to get higher pay and more respect, these training programs were phased out in favor of the four year degree. However, the old school marms were not given the boot. They were allowed to retire and finish their career. Now they are pushing MEd degrees for teachers as a starting point, perhaps nursing will follow suit in a few years. I say do the same with the LPNs. Close the LPN programs, provide assistance for the LPNs to return to school, allow a broad scope of practice for the remaining LPNs and let them finish their careers. But don't pretend that somehow veteran LPNs are a hazzard to patient care because of the "patients are sicker these days" crap while providing biased and poorly designed research and say LPNs somehow are not able to keep up with the changes and do professional development. When I started in nursing, I took care of patients in iron lungs. Then we got pressure vents and volume vents and HFO and ECMO...and who knows what will be next. Somehow I managed to keep up with the changes and adapt. If my knee would allow me, I'd go back to work tomorrow...I loved it..and nobody can ever tell me I didn't belong in the unit because I was an LPN. If this was the case, my old nurse manager wouldn't still ask me if I would come in once a week to do contingent work (she says this after she's had a few cocktails at my still legendary cocktail parties) despite that I'm now 77 years old and still occasionally have to use a cane after knee replacement surgery. Either I was that good...or my cocktails are....you be the judge......
    caliotter3, mama_d, and FranEMTnurse like this.
  6. 3
    I cherish the few retired nurses who hang around here (and I'm not a young'un ) - some were Diploma nurses, some went on to get their BSN or MSN, some went into nursing education . .some remained LPNs. They've been made to feel unwelcome here - I know it because they've told me in private messages. What a travesty. My respect and affection are overwhelming :redpinkhe
  7. 1
    Quote from HazelLPN
    You will never find a study in favor of LPNs anywhere, because a study is done when someone has a research interest, usually in partial fulfillment of a graduate degree. Generally, graduate students working on MSNs, PhDs etc have a strong interest in an all RN staff because big business would gladly replace them with cheaper, less formally educated people. Noticed I said less "formally" educated. No RN in her right mind would do research that says LPNs are a good thing to have as it is against her professional interests. I would imagine that in ten years or so, you will see studies conducted by graduate students that LPNs are dangerous in LTC once acute care jobs become scarce. I know enough about reseach being the wife of a physician, the mother of a pharmacist and a nurse practioner and the proud grandmother of a fairly new PhD chemist to say that often times the researcher knows their conclusions before they do their study....even in hard sciences bias is a problem. The only ones who have an interest in LPNs in acute are are the LPNs themselves, and they are not researchers. Fudge isn't just a tasty dessert, its used in research all the time.

    Even if a study was done on LPNs in acute care, there are so very few left working that you couldn't do a valid study. The larger your sample, the more valid your data is. At the time of my retirement, there were five LPNs still working in my unit. All five were excellent nurses. Four out of the five were over fifty. I don't have the peer reviewed research to back that up, but they could have been my nurse anyday...and I can't say that about all of the RNs in the unit. Like I said, I live in a state where LPN practice is broad. I was responsible for my own scope of practice. The few things outside of that scope, the RN charge nurse was responsible for. If I screwed up in my own scope, I have a license that can be lost too.

    I understand the need for more formal education. It is good for the profession I suppose. At the same time, I also realize that informal education is often times more powerful than formal education. In the final five years of my career, I took great job in mentoring young nurses......all BSN educated RNs. A common comment was always " I don't know why I even went to school for this, because it didn't help". I graduated from nursing school in 1955. Obviously, most of the technical knowledge I learned is long obsolete. However, we were taught to respect elder nurses. Now, I think the opposite is true. These kids come out thinking that anything less than a BSN is a mindless automation with no 'critical reasoning" skills and "nursing is now so complex that only BSNs can possibly understand it"...reguarless of the years of experience as a nurse. That changes real quick when a veteran LPN or diploma RN from the old days saves your behind because you weren't looking at your patient closely enough.....and the monitor doesn't tell you as much as you think it does.

    Don't wait around for that study...for it will never happen. You might want to get your MSN, however, and do a study on how only graduate educated nurses are needed in LTC to understand the complex needs of our aging population. People are living longer you know...and in todays society there are just so many complexities that we can't trust our old people to ANYONE but a BSN. Critical reasoning comes only with the completion of a BSN, NEVER with 54 years on the job as an LPN...countless conversations ( many over my homecooked meals and even better cocktails) with some of the most brilliant physicians, nurses and therapists who have ever been....and reading and questioning nursing research long before it was fashionable to do so.

    Best to you,
    Mrs H.

    I wish I had known that all RNs are crap before I studied so long for my BSN. I could have save myself a lot of time money and had a superior education to boot if I'd stopped at an LPN.
    FranEMTnurse likes this.
  8. 1
    One of the LPNS I work with is in her early 50s she was the last one to be kicked out the door at the local acute care hospital. Been a Nurse since the early 70s. She told me... that back then it was Diploma RNs..the few BSNs around were the ones who ran the units or taught. Then the ADN Nurses came and thought they were the kings and would replace the Diploma RNs (a ton of hospitals in my area still have Diploma RNs working most are in their mid 40s on up)...now its all BSN Only around here for new hires..unless your grandfathered in.

    On the floor of most hospitals no one cares...as long as RN is after your name. Unless your the RN, NP, MD, DO.. no one cares if its ADN, BSN, MSN, Diploma.

    Its not because LPNs are inferior..sadly it is the way things are...

    I have 0 interest in working in a hospital.. I personally see anything relating to home care nursing as the future..Hospital Jobs will still be available just a lot harder to find and with too many nursing schools things will be even worse..

    The only thing future RNs have who want to work in the hospital is retirements (which a whole library of nursing knowledge goes down with it) of the current older RNs..

    My plan is to take my pre-reqs then off to an LPN-RN Bridge Program. Either Excelsior or the one at the local community college that is actually starting to understand that us LPNs actually work full-time and can't quit our jobs to return to school.

    I'm not going to go work in Long-Term Care unless my detox/psych facility closes.. The job market is to dry to try to mess around out here. My full-time job comes first. Plus I am interested in the field of psych/detox nursing always have been and I think I always will be.

    LPNS will be phased out of acute care.. its a game... its sad but true...

    Then eventually the BSNs will see their day when someone determine that a MSN RN has 20% better out comes when it comes to X, Y, Z.

    I usually go to the older nurses and I like to watch them work... because you learn so much just by being around them. Vs. Suzy 25 y/o nurse (note not ALL do this is an example) who got her BS in BS to BSN and is now texting on the phone instead of saying to the Pt. Hi I'm Suzy, RN what brought you to the ER today.......

    The older RNs (ones that got BSNs when it wasn't "cool" to get BSNs back in the early 70s) I have learned so much from and their will be a crisis in the next 5-10 years of older nurses both RN and LPN in all environments to precept newer grads. At least the grads who care.. and I hope to be one of them.
    nursel56 likes this.
  9. 8
    Quote from GM2RN
    I wish I had known that all RNs are crap before I studied so long for my BSN. I could have save myself a lot of time money and had a superior education to boot if I'd stopped at an LPN.
    With all due respect, RNs on our unit years ago worked side by side with LPNs. The difference was that as an RN we needed to cover certain tasks that the LPN was not allowed to do in the scope of their license.

    The LPN was viewed as a peer, and was respected as such. The levels of education for RNs on the unit ranged from Diploma,ADN,BSN, and MSN.

    Never did I hear a nurse showboat what level of education he or she had.

    They gave input per patient to the team related to their experience
    knowledge, and role.

    It has only been recently that nursing itself has created a division in regard to nursing education.

    What appears to be missing for some today is respect. Respect for the fact that there would be no BSN programs without the nurses who have gone before you.

    ....It was diploma nurses who started the initiation for a BSN program
    in my area and many of them started as LPNs. This is true in many areas
    of the USA.

    Education is a plus, but without the respect to listen and learn from others who have gone before you ,you are only getting a partial education no matter what degree...


    What LPNs , Diploma nurses, and ADNs can tell you, is that years ago nursing was no easy job.

    Many of the benefits and other job perks nurses enjoy today were advocated by assertive, professional nurses who had the education that
    was cutting edge at that time, that includes LPNs.

    You can dismiss them, but you can not dismiss their influence to make nursing better for all nurses...
    Last edit by jahra on May 8, '11
  10. 1
    Quote from jahra
    With all due respect, RNs on our unit years ago worked side by side with LPNs. The difference was that as an RN we needed to cover certain tasks that the LPN was not allowed to do in the scope of their license.

    The LPN was viewed as a peer, and was respected as such. The levels of education for RNs on the unit ranged from Diploma,ADN,BSN, and MSN.

    Never did I hear a nurse showboat what level of education he or she had.

    They gave input per patient to the team related to their experience
    knowledge, and role.

    It has only been recently that nursing itself has created a division in regard to nursing education.

    What appears to be missing for some today is respect. Respect for the fact that there would be no BSN programs without the nurses who have gone before you.

    ....It was diploma nurses who started the initiation for a BSN program
    in my area and many of them started as LPNs. This is true in many areas
    of the USA.

    Education is a plus, but without the respect to listen and learn from others who have gone before you ,you are only getting a partial education no matter what degree...


    What LPNs , Diploma nurses, and ADNs can tell you, is that years ago nursing was no easy job.

    Many of the benefits and other job perks nurses enjoy today were advocated by assertive, professional nurses who had the education that
    was cutting edge at that time, that includes LPNs.

    You can dismiss them, but you can not dismiss their influence to make nursing better for all nurses...

    This thread is not about the different levels of RNs; it's about LPN vs RN. As for education, LPN does not equal RN, regardless of what LPNs would like to believe. I'm sorry, but I don't care how good an LPN's IV and foley skills are--techs can be better at those skills than some nurses--eight months of experience as an LPN does not equate to an RN.

    Many of the RNs posting in this thread have agreed that enough experience can overcome the education difference, but some of the LPNs posting have been blind to this and have posted negative comments about RNs. So I agree, there's a lack of respect.

    There's also a lack of acknowledgement that not ALL LPNs are fantastic nurses and not ALL RNs are dimwits, but you'd never know it listening to some of the LPNs from this thread.

    What LPNs are missing is that the RNs here are not making the decisions to phase out LPNs, but some are acting as though we are. That decision comes from higher up and we have no control over that. We are just stating the facts and our opinions as we see them.
    Last edit by GM2RN on May 8, '11
    FranEMTnurse likes this.


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