Blurred Boundaries: Should we eliminate the distinction between RNs and LPNs?

[ilovechadkrause]

It is becoming increasingly obvious that the roles of an RN and LPN are blurring into one another.

My question is: Should we eliminate this distinction altogether? If so, by what means? We could eliminate the LPN program, so that every nurse would be an RN. We could combine the two titles and come up with an entirely new generation of nurses, that are considered equal in the public and medical eye.

What do you think?

[Jules A, MSN]

I will be honest, LPNs studentsdont study as long or as intense as RN students. The cirriculum is different. Not insulting any LPN either. But I get a little irritated when an LPN tries to compare my classes that I have taken to the 15 month LPN program and then think they understand as much about the needs of a patient. So, no I dont see a blurred boundry, i see it as a oppurtunity for LPNs to progress to RNs

Well no need to be irritated because fwiw my LPN pre-reqs were exactly the same as the RN pre-reqs. Apparently my LPN classes were comparable and in my experience as intense because I managed to join the second year RN students and in two semesters graduate in the top of my class. You are correct in that RNs have more education but it isn't all that different.

[flightnurse2b, LPN]

Well no need to be irritated because fwiw my LPN pre-reqs were exactly the same as the RN pre-reqs. Apparently my LPN classes were comparable and in my experience as intense because I managed to join the second year RN students and in two semesters graduate in the top of my class. You are correct in that RNs have more education but it isn't all that different.

mine too.

i had to have the same pre-reqs, english 1 & 2, anatomy and phys 1 & 2, computers, intermed. or college algebra, chemistry and micro. and pass the same entrance exam.

unfortunately, the waiting list for the RN program, even with an incoming 3.8 GPA on pre-reqs is like 4 years long here. so i did the LPN program and when i start my bridge i only have 4 semesters left (or the 2nd yr of an ADN program, minus traditional peds and OB).

[ilovechadkrause]

Thank you everyone for your insightful ideas and opinions.

I think where some of the confusion regarding my original question of "should we merge the LPN and RN programs" is because the roles are VERY similar where I live. I am being trained to be an LPN in Alberta, Canada.

Regarding scope differences, some of the things people have mentioned include:

- IV meds, initiating IV sites, etc

- Management positions

- Thinking critically

- Assessing clients

The LPN program in Alberta is quite extensive and thorough. On average, it takes about 3 years to complete the program.

In Alberta, IV therapy has just been added to the LPN's scope. As soon as I start working in hospitals, I will be trained on siting IV's, giving IV meds, etc. The whole shebang! :)

In addition, I have been trained to think critically and creatively - to think outside of the box, link symptoms to help determine our patient problems, and so on. In Alberta, LPN's are a vital part of the assessment team! We are trained to think critically and assess our patient's health status, interpret lab results, coordinate with OT, physio, specialists, radiography, research and give medications, and so on.

I am presently being trained to be in leadership and management positions. To be head nurse/charge nurse, unit manager, etc. LPN's in Canada are allowed to have management positions.

Perhaps it isn't this way in the USA yet?

So, being that the gap between the LPN and RN scope in Alberta is starting to close, this is why I propose merging them somehow.

My initial idea would be to eliminate the LPN and RN training programs all together, and begin an entirely new nursing program.

The graduates of this program would no longer be labeled with LPN or RN, but have a new title.

I propose this be done so that future generations of nurses would be considered equal to one another, practice in the same scope, and eliminate confusions re: differences between the two brands of nurse.

I also like the idea of making it easier for LPN's to bridge and become an RN.

[RochesterRN-BSN, BSN, RN]

might we close this thread at this point? I am thinking we are just kind of going in circles on a topic that has been and will probably always be a touchy subject. We have established that there is a difference in the roles of these two titles depandant on the part of the country, what country, what setting, etc......

[jjjoy, LPN]

OP - I see your point as one of a lack of clarity in roles between RN and LPN. In some places, that IS a problem. In other places, it isn't a problem. So, it's not "obvious" that there's a blurring between roles. Could you describe what situation specifically you are thinking of?

In my opinion, the difference is unclear in too many places. I'm not sure what the solution is, though. One thought I've had is to have ALL nurses on the same curriculum and they can "step off" at various points depending on what type of work they want to do or if circumstances demand they can't continue school at that time.

Since I'm making this up, I'll have basic nursing assistant training a pre-req for entry.

Then, the first level of nursing school would prepare nurses for work in LTC, to work with stable home health patients, and perhaps some office environments. All nurses who finish the first level of training would be a "licensed level 1 nurse."

The next level of nursing care would prepare nurses to work in acute care and to take on supervisory roles (such as in LTC). All nurses who finish the second level of training would be a "licensed level 2 nurse." This would be a very clear distinction of what kind of training is required for that type of work. And even better, all level 2 nurses would know exactly what type of training the level 1 nurses has because they all had it, too.

Just thoughts!!!

[Tweety, BSN, RN]

there are many things i can do independently of an RN. please remember i have a license too.

i am not going to be in trouble for changing my patient's diapers by myself. or giving them a g-tube feeding by myself. or starting an IV by myself. or check my patient's vital signs by myself.

the north carolina BON says an RN has to make my assignment for me. there are things i must report to my supervisor and things my supervisor must do for me that are out of my scope, unless i am working in my paramedic capacity outside of the hospital. i have the nurse practice act in my clipboard, actually. i know the rules.

but i have my very own scope that i can do, too.

It's the same way here in Florida. An LPN is given an assignment and can carry out that assignment without me having to approve their every move and supervise everything they do. Almost all of their actions can be carried out independently by virtue of the license and the assignment.

In my 17 years of being the RN supervisor of LPNs, not once has an LPN gotten in trouble with the BON for stepping outside their practice, and not once have I ever seen an RN get into any kind of trouble for what an LPN has done "under their license".

[Jules A, MSN]

In my 17 years of being the RN supervisor of LPNs, not once has an LPN gotten in trouble with the BON for stepping outside their practice, and not once have I ever seen an RN get into any kind of trouble for what an LPN has done "under their license".

This is exactly what I was thinking.

[whodunit]

mine too.

i had to have the same pre-reqs, english 1 & 2, anatomy and phys 1 & 2, computers, intermed. or college algebra, chemistry and micro. and pass the same entrance exam.

unfortunately, the waiting list for the RN program, even with an incoming 3.8 GPA on pre-reqs is like 4 years long here. so i did the LPN program and when i start my bridge i only have 4 semesters left (or the 2nd yr of an ADN program, minus traditional peds and OB).

I also know there are excellant LPN nurses out there and have considered myself lucky to have worked with and learned from them but also have a problem with the thinking that we are equal in our knowledge and skills. I don't understand; is there not a standardized program for LPNS as there is for RNS?:confused:The reason I'm asking is because 2 of my youger sisters are LPNS and even their nsg math was not as intense or detailed as Rns, I know this for a fact because when 1 of my sisters attempted to enter the RN program, she found out she would have to take the A&P, Nsg math etc over.This was in an attempt to do the bridge thing where if you have so many years experience as an LPN, and all the preresq. done, you could bridge into 2nd year Rn classes.

[flightnurse2b, LPN]

I also know there are excellant LPN nurses out there and have considered myself lucky to have worked with and learned from them but also have a problem with the thinking that we are equal in our knowledge and skills. I don't understand; is there not a standardized program for LPNS as there is for RNS?:confused:The reason I'm asking is because 2 of my youger sisters are LPNS and even their nsg math was not as intense or detailed as Rns, I know this for a fact because when 1 of my sisters attempted to enter the RN program, she found out she would have to take the A&P, Nsg math etc over.This was in an attempt to do the bridge thing where if you have so many years experience as an LPN, and all the preresq. done, you could bridge into 2nd year Rn classes.

different program have different requirements. my school had pre-reqs and my program was also 18 months. some programs have no pre-reqs and are only 12 months. it depends on where you go to school. there really is not a set standard, i guess.

we had to pass college algebra with a C to get into the program. we also had a math test every other wk that required a grade of 88 or above to pass.

[RN_Canada]

I think where some of the confusion regarding my original question of "should we merge the LPN and RN programs" is because the roles are VERY similar where I live. I am being trained to be an LPN in Alberta, Canada.

You need to look at the Health Professions Act for Alberta. My recent reading of the Act describes the scope of practice for as LPN with the words "when delegated". This means that an LPN cannot work independently with clients. The client must be under the care of another professional in order for the delegation to take place.

Even the LPN association of Canada describes the role of the LPN as a professional that works in partnership with other health care providers. While RN's also work in partnership they are not limited to that role and can enter into a professional relationship with a client as the primary care provider.

This thread has prompted me to undertake a more thorough investigation of "scope of practice" statements for all provinces in Canada and here is what I have found.

Alberta has the most liberal scope of practice. All scope of practice statements limit the practice of an LPN to "under supervision", "when delegated", or as "assisting" other health care providers.

That's the law.

I continue to investigate this................

[jjjoy, LPN]

My recent reading of the Act describes the scope of practice for as LPN with the words "when delegated". This means that an LPN cannot work independently with clients. The client must be under the care of another professional in order for the delegation to take place.

While RN's also work in partnership they are not limited to that role and can enter into a professional relationship with a client as the primary care provider.

I've heard similar interpretations before of various nurse practice acts in Northern America. But we're essentially talking about inpatient bedside nursing here, aren't we? Many hospitals have given LPNs roles that almost duplicate that of RN - that is LPNs are responsible for 90% of all nursing care for their assigned patients (such as everything except for the admission assessment and hanging blood). In cases like that, the distinction between LPN and RN can easily become blurred and contentious.

[lpnflorida]

I've heard similar interpretations before of various nurse practice acts in Northern America. But we're essentially talking about inpatient bedside nursing here, aren't we? Many hospitals have given LPNs roles that almost duplicate that of RN - that is LPNs are responsible for 90% of all nursing care for their assigned patients (such as everything except for the admission assessment and hanging blood). In cases like that, the distinction between LPN and RN can easily become blurred and contentious.

You are correct when you say we carry our own assignment , none the less I am still under the direction of an RN. There is no blurrying of that fact. Yes, I do many many things for which the RN does not need to be next to my side, yet still I am under the direction of an RN. I can not work on the unit without an RN present somewhere on the unit. Nor can any other LPN that I am aware of in this country. Now SNF might be different, but I still believe that an RN is available somewhere in the building.

I do not feel there needs to be contention between us. I as an LPN accept what my role in within my Scope of Practice. I do take offense when the various powers that be try to diminish our roles and our Scope Of Practice as LPN'S.

For those LPN"S who desire returning to school is an option to become an RN.