Are LPN's going to be phased back into the hospital settings?

mfigueroa22 · Apr 7, 2014

There is no nursing shortage and while this may work at this facility....many states have limited the LPN's practice so they are not efficient in the acute care setting. This has been cyclical throughout my entire career....35 years...however I have not seen the reintegration of the LPN which I do believe would be a good thing.

I think it all depends on the market you work in. Because there are places where you can't find a job and places you can get a job the first day you pass the boards. So specific to my area there seems to be a shortage of experienced nurses. And a lot of nurses specifically RNs that don't want to go to LTC facilities to get the experience to work in hospitals. Where as LPNs are a main component to LTC. And idk how it is where you live but LPNs and RN's make about the same at LTC facilities if not the exact same, so most new grads aren't willing to take a job making the sane as LPN's to get the experience that hospitals require. Every now and then my med surge floor will hire a new grad RN but it isn't often.

TheCommuter, BSN, RN · Apr 7, 2014

I work at a small, for-profit specialty hospital in Texas that utilizes LVNs and never actually phased them out. However, the facility has not had a job posting for LVN positions in a couple of years. Administration has expressed the desire to hire RNs only from this point forward.

HazelLPN, LPN · Apr 8, 2014

Maybe they would go for the cheaper route if patient outcomes were the same, but it has been proven that there is a higher infection and mortality rate with LPN's compared to RN's.
BMC Health Services Research | Full text | The association between nurse staffing and hospital outcomes in injured patients
"The association between nurse staffing and hospital outcomes in injured patients, 2012.
A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p
https://massnurses.org/files/file/Le...art_Attack.pdf

in-hospital mortality.Results:
From highest to lowest quartile of RN staffing, in-hospital
mortality was 17.8%, 17.4%, 18.5%, and 20.1%, respectively (
P
0.001 for trend). However, from highest to lowest quartile of LPN
staffing, mortality was 20.1%, 18.7%, 17.9%, and 17.2%, respec-
tively
P
0.001). After adjustment for patient demographic and
clinical characteristics, treatment, and for hospital volume, technol-
ogy index, and teaching and urban status, patients treated in envi-
ronments with higher RN staffing were less likely to die in-hospital;
odds ratios (95% confidence intervals) of quartiles 4, 3, and 2 versus
quartile 1 were 0.91 (0.86 - 0.97), 0.94 (0.88 -1.00), and 0.96 (0.90 -
1.02), respectively. Conversely, after adjustment, patients treated in
environments with higher LPN staffing were more likely to die
in-hospital; odds ratios (95% confidence intervals) of quartiles 4, 3,
and 2 versus quartile 1 were 1.07 (1.00 -1.15), 1.02 (0.96 -1.09), and
1.00 (0.94 -1.07), respectively.
Conclusions:
Even after extensive adjustment, higher RN staffing
levels were associated with lower mortality.

This is one ten year old study and to interpret it that "its PROVEN" that LPNs provide inferior care (which is implied by the infection rates/mortality rates etc) is simply mistaken. I read the whole thing. Yes, this old retired LPN knows a thing of two about research. Notice it mentions "this study has several limitations". Certainly more research needs to be done. Bias is always a problem in research, and the fact that LPNs are not researchers but are bedside nurses seems that the conclusion are often known before any such study even begins.

Is this one single point of data what helped some hospitals fire veteran LPNs who have put in years and years of experience? Do nursing students and nurses believe that this is a neat and easy "RNs are good and LPNs are bad"?

Why no mention of LPN scope of practice? Why no mention of LPNs who have broad scopes of practice who have few restrictions? How can you compare LPNs in one state who's scope is limited to that of another state where the scope is very similar to that of an RN? This wasn't even mentioned in this research article. How is it this study valid if that isn't taken into consideration? There needs to be much more put into this study and its not as cut and dry as many would like to think. What about experience levels of staff? What about patient care ratios? I particularly enjoyed siting a piece of research sited from 1967 stating how important the RN is to physicians because they couldn't be in the unit as much as the RNs could. In my experience, it matters not if an RN or an LPN who tells the doc that they need to come and look at their patient and that X, Y or Z needs to be done. Did this article from 1967 state that LPNs were simply mindless automatons and their patients were always in immanent danger because they wouldn't call the docs?! I was working in the ICU in 1967 and these researchers certainly didn't talk to me or any docs that worked with me or the other LPNs I worked with.

A critical review of the research is in order here before one can jump to the conclusion that this single study PROVES anything. Proves is a very strong word indeed. One needs to look beyond the stats at the methods and reading the discussion for me brought many challenges to light.

I find that bias and misuse of stats to be a huge problem in nursing research. This one is no exception. I wish LPNs would study research in school to help them understand how research is used and often misused and how much simply isn't valid.

Mrs H.

kaydensmom01 · Apr 8, 2014

No I was not taught that LPN's are bad and RN's are good. You seem as if you are trying to assume that about me because I brought up the point that although RN's and LPN's are both NURSES, there is a educational difference that results in a difference in their scopes of practice. I was trying to simply point out that LPN's and RN's are not interchangeable in every role, as the OP tried to assume- NOT inferior (my first study I cited from 2012 was published after a nationwide study of LPN's vs RN's in Level I and II trauma centers). Although more research needs to be performed, why is not appropriate for me to point out that there ARE educational and scope differences between RN's and LPN's that could very well effect care but it is appropriate to assume the educational differences do not add anything to the RN's nursing practice, that the extra year or so of schooling is just "fluff" that doesn't apply to bedside nursing care (my LPN-RN friends would certainly disagree there).

BuckyBadgerRN, ASN, RN · Apr 8, 2014

Upper Midwest chiming in here: hospitals in my area are definitely phasing out LPN's, and clinics haven't been hiring them in several years.

BrandonLPN, LPN · Apr 8, 2014

Reading these comments sure seems to paint a depressing and bleak picture for the future of practical nursing in the USA.

But keep in mind the current trends in healthcare and which areas of the industry are expanding.... and which ones are contracting. Inpatient acute care is contracting. Many patients who once would have lengthly stays on a med/surg unit are being diverted to skilled nursing facilities for longer-term subacute care. And we all know that LPNs are the backbone of SNFs.

Cost-containment measures, cultural shifts towards "treating in place", and an increased emphasis on preventative care are all leading to explosive growth in home health care and assisted living. These are also areas that heavily utilize LPNs.

It is interesting to note that the "few" areas still hiring LPNs also happen to be some of the areas with the biggest projected growth. I don't think the futre of LPNs is quite as dire as some would make it.

T-Bird78 · Apr 8, 2014

The largest hospital system in my area only has LPNs on one med-surg floor in one small, rural hospital. The big hospitals that are trying to get Magnet status don't have LPNs, the LPNs are "nurse techs" and RNs are nurses. Even established LPNs were changed to "nurse tech" status as opposed to being fired.

RyanCarolinaBoy, ADN, BSN, MSN · Apr 8, 2014

I'm not sure what the long term outcome will be. I will say that in my neck of the woods, there is still a shortage of experienced nurses, and the hospital systems are still actively hiring LPN's to work in the acute units. Even into the specialty units-ICU and NICU for example. Will this hiring and trend continue long term? I don't know, honestly.

I do think that LPN's and RN's alike are valuable to healthcare, and that it would be a huge mistake to phase out the LPN role in the USA. Time will tell all. I do hope that this thread doesn't become yet one more RN versus LPN thread tho. I enjoy reading about the various locations in the US and their policies regarding allowing LPN's to work acute care.

kaydensmom01 · Apr 8, 2014

Reading these comments sure seems to paint a depressing and bleak picture for the future of practical nursing in the USA.
But keep in mind the current trends in healthcare and which areas of the industry are expanding.... and which ones are contracting. Inpatient acute care is contracting. Many patients who once would have lengthly stays on a med/surg unit are being diverted to skilled nursing facilities for longer-term subacute care. And we all know that LPNs are the backbone of SNFs.
Cost-containment measures, cultural shifts towards "treating in place", and an increased emphasis on preventative care are all leading to explosive growth in home health care and assisted living. These are also areas that heavily utilize LPNs.
It is interesting to note that the "few" areas still hiring LPNs also happen to be some of the areas with the biggest projected growth. I don't think the futre of LPNs is quite as dire as some would make it.

No one said that LPN's are not needed. The OP specifically asked about hospital systems, and everyone gave their opinion and said what is occurring in their area. No one said that they are being phased out of healthcare altogether. Even though LPN's are not utilized in acute care in my area, as you have said, they are the backbone of LTC/SNFs in my area and are highly needed.

HouTx, BSN, MSN, EdD · Apr 8, 2014

Tx Scope of Practice for LVNs delineates that that they can only work under direct supervision of RN, physician or APRN. Essential differentiated competencies; LVN provides care to patients with predictable needs. This indicates that the most appropriate setting is non-acute - where I am sure we will always have jobs for LVNs.

HazelLPN, LPN · Apr 9, 2014

No I was not taught that LPN's are bad and RN's are good. You seem as if you are trying to assume that about me because I brought up the point that although RN's and LPN's are both NURSES, there is a educational difference that results in a difference in their scopes of practice. I was trying to simply point out that LPN's and RN's are not interchangeable in every role, as the OP tried to assume- NOT inferior (my first study I cited from 2012 was published after a nationwide study of LPN's vs RN's in Level I and II trauma centers). Although more research needs to be performed, why is not appropriate for me to point out that there ARE educational and scope differences between RN's and LPN's that could very well effect care but it is appropriate to assume the educational differences do not add anything to the RN's nursing practice, that the extra year or so of schooling is just "fluff" that doesn't apply to bedside nursing care (my LPN-RN friends would certainly disagree there).

The only challenge that I had with your interpretation...still have as a matter of fact... of this study is where you said "its been proven". One study does not prove anything. Even in the hard sciences, that is mistaken, let alone in nursing research. A critical review of the research is always important and one must look much more deeply into a study that simply take it as fact. The word "proven" seems like a fact set in stone. The researches themselves never used this word, and I respectfully think you need to reconsider if your use of it is accurate.

I had many more challenges with the design of this study and its interpretation and sources after doing a quick critical review and sure I would find more challenges if I were to take more time with it...which I shall not. Been there, done that, now happily retired.

I almost completed my BSN at one point. I learned about other areas of nursing that I hadn't done since I was in LPN school. I learned a lot more about chemistry, physics, biology and math than I knew before (even took the pre med level courses after I completed the nursing ones). The most valuable thing I learned in school for my RN however was nursing research, and that is why I can critically review this piece. They don't teach you this stuff in LPN school and I don't think ADN or diploma RN programs have it either. I had been working in the MICU since the early/mid 60s when I was back in school for my BSN. Did it change the way that I did MICU nursing? Nope. Not one bit. I don't believe for one minute that my mortality rates would magically go down if I would have finished my degree. However, thanks to that training I'm happy to cry foul when I see it in research and how others interpret research.

Best to you,

Mrs H.

Alex Egan, LPN, EMT-B · Apr 9, 2014

The local magnet level one trauma center in my area has started hiring LPNs for radiology and other procedural areas. Also a point to ponder everyone...why are PCAs being used so extensively? Wouldn't it be better to use LPNs in a similar role, taking advantage of their training and skills, rather than taking an untrained person off the street an placing them in a caregiver roll. I roll my eyes at every study that extolles the benefits of higher education and completely ignores that the educational requirements for the assistive staff haven't changed since the 60s.