LPNs Fight Efforts To Phase Them Out - page 7

by DoGoodThenGo

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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. 4
    Quote from GM2RN
    Maybe, but I think it has more to do with the higher acuity of today's patients, along with higher patient ratios and more responsibility in general.
    What do you mean by that? Just as a completely unscientific guess - as far as I know there is no more acute mutation of the same things people were hospitalized for in the past, only the treatment you will now get for your ailments. So how does "newer" become inherently out of reach of the mental faculties of an LPN?

    In my state ratios are lower than they were in the past due to our ratio laws.

    It's even possible to say that a nurse of the past had to be more on top of things because so many of them-thar new contraptions tell the nurse so very much more accurately what is happening inside of the patient in an instant, and the process a person would go through for surgery has been transformed. People can actually go home from an outpatient center with two 2 inch incisions held together with steri-strips? Jeeze just thinking about what an ordeal a cholecystectomy was back in the day makes me =shudder=.
  2. 0
    Quote from harlee
    I've been an LPN for 2 1/2 years. I currently work in Home Health Care and must say I absolutely love it. My company just recently hired an RN to work at the home I'm at. There were plenty of hours to go around. Enough hours that we each could have 55 hours per week. I've been working about 60 hours per week for quite some time. No complaints from me, not a real physically challenging position. With that being said... I really resent the fact that since the RN was hired, she now works my 60 hours and I have been cut back to 38 hours per week!! When asked why????? Because she is an RN and you are not. Yes, I was truly told that. So my bosses answer was, GO GET YOUR RN LICENSE!!! The really funny part of this story... I had to train her at the patients home. I had to show her that when measuring liquid medicine, that you need to set it on a flat surface because "you are holding the cup in such a way that it looks like you put 5mls in but it's actually 10mls!!!" and then argued with me about it. Also had to show this RN how to prime a Enteral Feeding pump. "What job did you work at before here, I ask?" "Oh, I worked at _______ Hospital for 2 years!"

    I realize that this is very wrong here and by no means saying this to be the case of a typical RN. It's more of a vent because of how my company is treating me.

    Just an LPN (and darn proud of it)!
    I have a few residents on liquid meds, and I use a 10cc syringe to measure these meds. But, if I had no choice but a cup, I for dang sure would put it on a flat and level surface.
  3. 0
    Quote from harlee
    I've been an LPN for 2 1/2 years. I currently work in Home Health Care and must say I absolutely love it. My company just recently hired an RN to work at the home I'm at. There were plenty of hours to go around. Enough hours that we each could have 55 hours per week. I've been working about 60 hours per week for quite some time. No complaints from me, not a real physically challenging position. With that being said... I really resent the fact that since the RN was hired, she now works my 60 hours and I have been cut back to 38 hours per week!! When asked why????? Because she is an RN and you are not. Yes, I was truly told that. So my bosses answer was, GO GET YOUR RN LICENSE!!! The really funny part of this story... I had to train her at the patients home. I had to show her that when measuring liquid medicine, that you need to set it on a flat surface because "you are holding the cup in such a way that it looks like you put 5mls in but it's actually 10mls!!!" and then argued with me about it. Also had to show this RN how to prime a Enteral Feeding pump. "What job did you work at before here, I ask?" "Oh, I worked at _______ Hospital for 2 years!"

    I realize that this is very wrong here and by no means saying this to be the case of a typical RN. It's more of a vent because of how my company is treating me.

    Just an LPN (and darn proud of it)!
    The agencies I have worked for would have kept the nurse who was there first with her hours. First come, first get. RNs who choose to do LPN level home health care are just like everyone else when it comes to assignments, except probably for new cases. I would guess that the RNs get first dibs at new work partly because the agency wants to keep them happy enough so that they don't go elsewhere to work. But I have never heard of an RN bumping an LVN for an existing assignment.
  4. 1
    Quote from nursel56
    What do you mean by that? Just as a completely unscientific guess - as far as I know there is no more acute mutation of the same things people were hospitalized for in the past, only the treatment you will now get for your ailments. So how does "newer" become inherently out of reach of the mental faculties of an LPN?

    In my state ratios are lower than they were in the past due to our ratio laws.

    It's even possible to say that a nurse of the past had to be more on top of things because so many of them-thar new contraptions tell the nurse so very much more accurately what is happening inside of the patient in an instant, and the process a person would go through for surgery has been transformed. People can actually go home from an outpatient center with two 2 inch incisions held together with steri-strips? Jeeze just thinking about what an ordeal a cholecystectomy was back in the day makes me =shudder=.
    By higher acuity I mean 2 things. First, I believe that some people are sicker with the same things when they finally get to the hospital because they haven't gone to the doctor regularly and have let their illnesses progress. Second, I believe that patients admitted to the hospital have more comorbidities than ever before.

    It has nothing to do with the "mental faculties" of a new grad LPN, it has to do with LPN training vs. RN training. I know that many believe LPNs = RNs, but if that is entirely true, then why even have RNs? It would be cheaper to get rid of RNs and keep only LPNs. But that isn't the trend, despite the desire of hospitals to cut their overhead every way they can. I've already stated this in a previous post in this thread, but my hospital has completely done away with LPNs in ED, PCU, and anywhere patients need tele. Plus, they were never allowed to work in the ICU. If hospitals concerned with budgets believed that LPNs = RNs, that certainly wouldn't be the case.

    If you work with lower patient ratios than you used to due to ratio laws, you are in the rare minority. The hospitals that I know of personally, plus evidence of the same in the numerous threads on this forum, have increased patient ratios and aren't likely to decrease them anytime soon.
    lindarn likes this.
  5. 0
    GM2RN --The only issue I was asking about was why you feel patients in acute care hospitals (regardless of how long they've been out of school) are "too complex". It's really an unsupportable claim, as neither of us know for sure who is waiting too long to see their doctor or about co-morbidities - or even if we did that would make the patients too complex for an LPN. If this were true you'd think it would shake up our Boards of Nursing and would call for changes in present LPN/LVN programs and their funding as excluding them only because their education was inadequate would necessitate a wholesale revamping of their curriculum.

    Thank you for responding, though! I know I can get annoying (ahem or so I've been told) when I don't understand the underlying reason someone makes a statement like that -- like when a kid asks "but why?" seventeen thousand times. Thank you for your patience.
  6. 1
    Quote from nursel56
    GM2RN --The only issue I was asking about was why you feel patients in acute care hospitals (regardless of how long they've been out of school) are "too complex". It's really an unsupportable claim, as neither of us know for sure who is waiting too long to see their doctor or about co-morbidities - or even if we did that would make the patients too complex for an LPN. If this were true you'd think it would shake up our Boards of Nursing and would call for changes in present LPN/LVN programs and their funding as excluding them only because their education was inadequate would necessitate a wholesale revamping of their curriculum.

    Thank you for responding, though! I know I can get annoying (ahem or so I've been told) when I don't understand the underlying reason someone makes a statement like that -- like when a kid asks "but why?" seventeen thousand times. Thank you for your patience.
    No problem. And of course that is my subjective opinion. I do think that LPNs with enough experience are equal to the task because they have had on-the-job training.

    Small aside, I had to laugh when you mentioned asking questions like a kid. I have a 3-year-old granddaughter whose questions are incessant, with every answer provided turning into another question! Sometimes it goes on for so long that I bust out laughing and she gets upset with me and tells me "it's not funny Gramma!'
    nursel56 likes this.
  7. 0
    I was wondering when LPNs are or if they are going to be totally phased out. There was a nursing school I was going to apply to and I was told that schools in the area were phasing out LPN programs.
  8. 0
    Quote from mariposabella
    I was wondering when LPNs are or if they are going to be totally phased out. There was a nursing school I was going to apply to and I was told that schools in the area were phasing out LPN programs.

    No one can tell you that with any real authority. My GUESS would be that LPNs will never be phased out totally, but the types of jobs available will likely continue to shift from hospitals to LTC. However, you need to pay attention to what is happening in your area, especially if moving is not an option, but because I also think that it's dependent on the region you are talking about, at least for now. So if schools are phasing out LPN programs where you live, you should probably consider other options.
  9. 2
    Quote from mama_d
    I guess it all depends on what setting you work in.

    I'd have to respectfully disagree with the assertion that pts in the hospital are too complex for LPNs to deal with. I've been in a supportive environment where I've been encouraged for years to push myself and learn all I can. I regularly get medically complex pts...those ones that are teetering on the edge of needing ICU or step-down care...b/c I can handle the complexity. It's also no big thing on my floor for the BSNs to ask me my advice when they have more critical pts; there's a recognition there that I often have more experience than they do, regardless of the level of formal nursing education any of us have. And I can guarantee you that if something goes down, it's gonna be my butt in the office. I run my own team as independently as any of the RNs do, and have the same accountability. There are plenty of times when it's me in there teaching how to do procedures...CAPD, dropping a NG, NT suctioning most recently...and plenty of times that I'm asked to explain the thinking process behind why docs ordered one med vs another, or certain procedures, etc.

    I realize that not all LPNs have the opportunities or environment I do, and that seems like a waste to me. How can people be expected to excel if they are in a setting that is constantly setting limits based on a skewed misperception of their abilities? I'm not talking about operating beyond scope of practice, of course...just that all too common misconception that "LPNs do tasks and RNs do the thinking".


    I have no doubt that you can perform all those functions, in my state you would not be allowed to the functions you cited below.
    Also in most hospitals it is the chain of command, in my state and Joint Commission Regulation mandates a RN has the oversight of the floor hence the call to the charge nurse. This does not mean you don't provide excellent nursing care, but you did not have the theory a RN has the knowledge you have comes for the practical experience you have gained. I have worked with some CNA who were brighter and provide care better than a PN or RN, but that does not make them qualified to be a licensed nurse.

    The hospital in this article has all patient outcomes lower than the State and National average. That is a fact, I am guessing management is trying to improve care based on evidence based practices that outcomes improve with better educated nurses.

    I also have taught on the PN level and RN programs, I know the theory the PN is taught and tested on. The PN is intense but it only one year long but a PN is does not have the theory the RNs have. that has been taught in the classroom which the state mandates.

    Since you are so bright and skilled in one year can get your RN, it should be a piece of cake for you since you already know the theory,
    Is you hospital a top provide in patient outcomes?


    Also can you point me to an evidence based article that cites patient outcomes improve with a Rn/lpn staff mix, the research I see is an all RN staff improves outcomes. The LPNs in this hospital can not state their care is superior since there public patient outcomes are sub par, that is a fact.
    lindarn and Mrs. SnowStormRN like this.
  10. 2
    Quote from nursel56
    What specifically do you feel is the reason acute care is too complex for an LPN? Or to put it a different way, what would a new RN be doing (including thinking) that a new LPN would be unable to grasp?

    Many LPN programs can't get placements in hospitals for clinical, they graduate without working in a hospital. LPN are not taught the nursing assessment as extensively as RN. LPN can not learn the theory in half the time of a RN.

    LPN are not taught delegation like a RN program. Pharmcology is scaled down.

    Does this diminish the an individual experiences a LPN may have, no but the system we have in based on nursing education not experience. I know my assessment skills are superior to a new MD, but does this make me a MD since I can assess, diagnosis, and provide the proper orders for a patient, of course. Not.

    If LPN via experience can work at the RN level, smart RN should be able to practice on the MD level.
    lindarn and Mrs. SnowStormRN like this.


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