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

SWM2009 · Apr 9, 2014

In my area, more and more jobs for LPNs in hospital systems are starting to crop up but it is usually for positions in affiliated medical offices or subacute care. Still, it is LTC/SNF where the need for LPNs is greatest. I am a recent grad and most of my graduating classmates had job offers within a month or less after passing NCLEX.

When I began the journey to become a LPN, I knew without a doubt that LTC/SNF would be my future and I was fine with that. Working as a nurse in an acute care facility means I need not just an RN but likely a BSN as well.

Chica22 · Apr 9, 2014

A staffing increase is welcomed in the hospital environment. I understand what the RN may feel being the only one, however, delegating pill meds dispensing saves time and more staffing often makes for happier patients, contributing to positive outcomes.

CaliBoy760 · Apr 9, 2014

I work at a VA hospital and all outpatient clinics are staffed by LVN's with an RN Nurse Manager. And, there are afew LVN's working the floors, particularly DOU (Step Down) and Telemetry.

Isis Phoenix · Apr 9, 2014

The hiring of LPN's/LVN's is not a bad idea, as long as they are inserviced to specification,and as long as they work along with RN's.

crs1965 · Apr 9, 2014

"Death of the LPN" :unsure: The local hospital in my area phased out LPNs years ago, and now have given new ADN grads until 2020 to get BSN. A trauma center only hires RNs and PACS. I have been looking for new job but am left with LTC, HH, or prison/jail. Office jobs are far and few between. I have been considering a career change but want to remain in medical/nursing field somehow. Not many opportunities and there are fewer every day.

Mwgamble · Apr 10, 2014

I hear they are bringing LPN back into the hospitals because of Medicare and Medicaid

cinlou, BSN, MSN, RN · Apr 10, 2014

I have been around long enough to see the ups and downs. I remember in the early 80's when DRG's came out and hospitals tried to get rid of the aide. Many hospitals went down and out. Some closed. Others quickly rehired the aide because they realized they could not do without them. I started out as an LPN, 10 years in critical care before I went back and got my RN. I did not learn new skills, I was and am awesome with my skills, but I did learn to think a bit more out of the box. Continuing education is not about skills. I agree that you must look closely at the research studies. When they put the first study one out about lower mortality with higher rates of BSN's they failed to tell us anything about the years of experience of the staff. So guess what they are re doing the research with this added information.

The LPN education depends on if it is a pure certificate program versus a degree program.

LPN's are strong bedside nurses they are the true technician, that can develop strong skills and knowledge base that can be taken as far as they want to take it.

My opinion is a new grad is a new grad, no matter their degree, some can move more quickly through the novice stage, others may take longer, much depends on healthcare exposure prior to graduation.

I do think the smartest thing that facilities can do for so many reasons, is bring the LPN back into the hospital, they could be providing that bedside care while the RN is dealing with the critical thinking aspects. The LPN will develop the critical thinking and many are better at it than others no matter the degree level.

We have spattering of LPN's in the rural community hospitals here in northern Arizona, and myself as the Director of an LPN program, I am working my darndest to get them to understand that in this community which is the 5th poorest county in the US, putting the LPN back in to the hospital and helping them grow into RN's is the best they could do. They are more likely to stay in their community and they will give back fully to their community. It is a give and take and we can grow our own, with a better understanding of the abilities, scope and standard of practice that the LPN has.

Also remember that no matter what you are called, the state board will hold you accountable to the full scope of your education, so if an LPN is called a PCT or tech of some sort, they are still going to be looked at as an LPN in the eyes of the state board of nursing.

FranEMTnurse, CNA, LPN, EMT-I · Apr 10, 2014

Many LPNs in my local area now work in home care, assisted living facilities, or nursing homes.

Mortpm1 · Apr 11, 2014

My hospital only used RN/LPN pairs. No CNA's. if my RN did not have me to pass meds, provide bedside care, and monitor the stable patients, she would have been a basket case. My nurse manager had to fight for this staffing model. We had some of the highest JCAHO evaluations in the area. Of course, that didn't stop the health conglomerate that owned this small 100 bed facility from closing...

HazelLPN, LPN · Apr 11, 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.

Most of my years in acute care nursing were spent in critical care and my patients were not usually stable with predictable outcomes....otherwise they would not be in the unit. Nowhere in my state scope of practice does it say that I was limited to taking care of stable patients with predictable outcomes. It was not uncommon for me to take the sickest patient on the unit. The RN charge nurse covered what was outside of my scope of practice, which was very little as I worked in a state and hospital where the LPN scope is very broad.

As far as the NCLEX is concerned, the RN, no matter how inexperienced or how much lack of talent she/he has, is the only one supposed to be assigned to an unstable patient. This is rooted in an ideal world, but not the real world.

An NCLEX question may read " A 17 y/o meningococcemia is admitted to the PICU by direct admit from the pediatrician's office at 1700. The patient's condition is rapidly deteriorating with drips needing frequent titration, gasses and laws drawn q 30, has coded twice since admisssion etc. Who is the most qualified staff member to take this patient on nights?

A. An LPN with a full scope of practice who has been working in the unit for 50 years. Has presented at critical care conventions for nursing interventions with patients suffering from various strains of bacterial meningitis. Has received exceptional performance evaluations from the start and is limited in scope in that she can not take admissions, take charge, and requires an RN to cosign for all blood products and certain IVP meds, and can not train to be an ECMO tech or give IV chemo products. Awarded " critical care nurse of the year" by the hospital last week, 40 years in a row. Can be sarcastic at times, but is otherwise fun to work with unless crossed by an excessively stupid and stubborn individual.

B. A new graduate RN just out of orientation to the PICU who is excessively stupid and is extremely stubborn. She was recently written up for giving the wrong IV med to the wrong patient and giving it PO. Has a tendency to suction patients until they are the border of coding. This will be her last shift before she takes a job in pharmaceutical sales. She's young and very pretty and has undergone plastic surgery to help with the qualifications of the sales job.

C. The unit clerk who is also covering the NICU, because this will save money for the hospital in the long run making more money for the CEO.

D. An RN who normally works in the admitting office doing patient placement. She hasn't started an IV since 1983 and can't give any critical care drugs or titrate drips. She is great at folding linen and feeding babies who PO well, and will change diapers if needed, but grudgingly. However, she is going on vacation and needs the money and knows that other nurses will cover for what she isn't comfortable doing (75% of the care of her patients).

E. An RN of ten years experience who is great with heart patients who would rather take care of the Norwood that just came out of surgery an hour ago. Cries if she does not get the assignment she wants. Complains about her assignment all night even if its what she wants. Is the second best open heart nurse in the unit, after the nurse mentioned above in example A.

According to NCLEX, the correct answer is E. Just put up with her whining and tune her out. She'll keep the kid alive. Answers D and B would be the second best choices as they are RNs after all. Answers C and A are just plain silly....because unit clerks don't take patients and LPNs only take care of stable patients with predictable outcomes.

I'm actually not sure if there will always be jobs for LPNs in LTC. Once acute care positions become scarce, we may start to see "research" done by MSN and PhD candidates indicating that only BSNs should be caring for our aging population and then give a bunch of statistics as to why.

Best to you,

Mrs H.

colter517 · Apr 16, 2014

I interviewed at a Boston Hospital last year. The interviewer told me that LPN's are being increased in Boston Hospitals. I work for a VNA on the south coast as the clinical liaison. I am on site at a hospital in this area, they just phased out LPN's. There are some but they are in an administrative capacity.

smartnurse1982 · Apr 17, 2014

A staffing increase is welcomed in the hospital environment. I understand what the RN may feel being the only one, however, delegating pill meds dispensing saves time and more staffing often makes for happier patients, contributing to positive outcomes.

I guess you guys did not get the memo that if something happens the Rn is responsible for what the lpn does wrong?

Say if the lpn makes a med error....the Rn goes down with her too.