LPNs Fight Efforts To Phase Them Out - page 9

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... Read More

  1. Visit  Ginger's Mom profile page
    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.
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  3. Visit  nursel56 profile page
    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.
  4. Visit  nurse.sandi profile page
    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.
  5. Visit  nurse.sandi profile page
    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
  6. Visit  mama_d profile page
    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.
  7. Visit  Ginger's Mom profile page
    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.
  8. Visit  HazelLPN profile page
    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.
  9. Visit  nursel56 profile page
    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.
  10. Visit  frenchfroggyRN profile page
    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)
  11. Visit  frenchfroggyRN profile page
    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.
  12. Visit  HazelLPN profile page
    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.
  13. Visit  nursel56 profile page
    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
  14. Visit  GM2RN profile page
    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.


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