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.
Specializes in Community Health, Med-Surg, Home Health.
lpnflorida - clearly you know your scope of practice as an lpn and don't see that there's any blurring between the lpn and rn roles.
i know i've met many an lpn who gripes that they do "almost everything" an rn does but get paid so much less and that it's not fair. i've met many an lpn who boasts that they "know as much as if not more than" rns and argue that they should have all the same rights and responsibilities as rns. i'm by no means saying that all or even most lpns think that way, but i've definitely heard it and wonder what your experience is with and what your perspective is on that attitude.
also, in general, do you (any of you reading this) out there agree with the different scopes of practice? what is the difference in training that allows rns to take orders off but not lpns? or to start ivs? or to do initial assessments? lpns do on-going assessments, so they must have learned some assessment skills, right? many rn programs don't teach how to start ivs. rn programs do teach the basics of fluid therapy. i don't know if lpn programs do or not, but some states do allow lpns to hang iv fluids.
i'm not arguing what should or shouldn't be in the lpn scope of practice. i'm just not sure what the rationale for where the lines have been drawn between the two types of nurses/nursing practice.
first, i want to say, jjjoy, that i always enjoy your posts. you bring up wonderful insights, worth pondering each time!
my observations are that in my experience, school is one thing, the real world is another. there may be some rns that are really respected for their knowledge and expertise, but, not at my end of the universe. i work for a city hospital that is overburdened with too many patients, their needs are endless and no nurse, may it be lpn or rn has any real support. what i noticed with the rn scope of practice is that they are so overburdened with other distractions that it is more difficult for them to remain coherent...seriously. there are many lpns that criticize them, but i have challenged most of them many times by saying to them "what would you do if you had all of these distractors?? " we, as lpns, at least work under their auspice, have them to lean on, but who supports them?? most times, when i see an rn fumble, it is because she has been overwhelmed. by observation, i know that i could not handle this on a daily basis...i would go nuts. i do hang iv fluids, can initiate an iv line. i cannot do initial assessments, but, i am observant enough to know what probably deserves attention. i don't know the rationale behind the two types of nursing, either, really. the bottom line is experience and the competence, confidence and capacity to learn, which is different for everyone.
believe me, i am not bragging, but, i am approached often about returning to school. i am complimented on my organizational skills, observation and independent thinking (as independent as an lpn can be). but, i tell them all that i am this way because i do not have the same distractors they do. and, many times, the best thing i can do in the time of crisis is to maintain the mundane, predictable tasks that an rn has no time for. it is a horrible thing to deal with one situation after another to then, have to rush and still pump out medications, treatments, suctioning, etc...before the end of the shift. this is where mistakes can be made. this is why i am a proponent of keeping lpns, but, having more of a universal (at least within the individual state) scope of practice for lpns to follow. it is silly to me to have a bon of a state widen the scope of an lpn, while the individual institution within that same state limit their lpns. it is a self-defeating situation, in my eye.
what begins to happen is if the role of anyone, may it be lpn or cna is further diminished, it leaves those individuals to think "what interest do i have in initiating this, or doing that? they don't value me, anyhow!" and who is left holding the bag?
maybe it would be easier to free the rn for the acute situations that occur, do assessments and pick up orders and then assign to the lpns and delegate to cnas. who knows? but, i refuse to accept that we lpns need to be thrown in the dust. if the position was created to begin with, schools and education provided, then, use us!
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!!!
in the Uk and Australia a Ist level nurse is a RN
a second level nurse is a Enrolled Nurse (Practical nurse in USA/CAN)
Specializes in Community Health, Med-Surg, Home Health.
It's so difficult. If there was only one type of nurse (RN's) it would make my life a LOT easier because I wouldnt be running around for all the LPN's to do their pushes. They dont help with my work when I do their pushes. When i'm doing an admission of one of their patients they are not helping me with my patients. I think LPN's should be able to do the same things as an RN. In other words they should become RN's.
Please Do Not put words in my mouth. I never said you dont deserve to be employed. I feel that there should be less or no LPN schools and all RN schools. There are LPN's that are much smarter and have much more experience than me, and I learn from them all day long. Dont you think its sad that they make so much less than an RN. In the nursing homes LPN's do almost the same exact thing as an RN. So No Proud2bLPN I am not degrading you, just think you should be rewarded a bit more for what you do. Its a couple more months of school.
If I made you believe that I was starting an arguement, let me be the first to say that this was not what I intended. And, I thank you for acknowledging that many LPNs are, in fact, worth their salt. I do believe that ALL nurses should be paid better. My personal observation, however, is that the RN is not given their due regarding respect or pay, either, so, no nurse is being acknowledged for their worth...not just LPNs. What I have done is observed the two types of nurses and was able to make a clear decision that RN nursing is not for me because I cannot handle the constant stress that I see them encounter. Some days, I can't even handle my own situation...to be in theirs would drive me instantly to the nuthouse. I guess, for me, it is easier to forgo the money for a few less headaches, and for some LPNs (not all) may feel that they don't want it, even if the opportunity is there (at least that is a fact for me).
One of the things you mentioned is that it would make your life easier if you didn't have to do LPN pushes and they don't help you with your work while doing admissions. If we cannot do the same as RNs and this continues to cause stress, what else is going to happen? They will take us out of the equation, period (as they have in many states, already)! They have already removed LPNs from acute care in many areas, and the LTC situation in most cases is even worse. 40-60 patients on a floor with one nurse (LPN) to be responsible for them. I would like to see where a facility that has decided to use both disciplines of nursing make it more collaborative than antagonistic. What I really want to see is that we, as nurses, decide to try and work this out amongest ourselves so that we can contribute to care, and gain respect, no matter what the position is.
pagandeva2000, LPN
7,984 Posts
first, i want to say, jjjoy, that i always enjoy your posts. you bring up wonderful insights, worth pondering each time!
my observations are that in my experience, school is one thing, the real world is another. there may be some rns that are really respected for their knowledge and expertise, but, not at my end of the universe. i work for a city hospital that is overburdened with too many patients, their needs are endless and no nurse, may it be lpn or rn has any real support. what i noticed with the rn scope of practice is that they are so overburdened with other distractions that it is more difficult for them to remain coherent...seriously. there are many lpns that criticize them, but i have challenged most of them many times by saying to them "what would you do if you had all of these distractors?? " we, as lpns, at least work under their auspice, have them to lean on, but who supports them?? most times, when i see an rn fumble, it is because she has been overwhelmed. by observation, i know that i could not handle this on a daily basis...i would go nuts. i do hang iv fluids, can initiate an iv line. i cannot do initial assessments, but, i am observant enough to know what probably deserves attention. i don't know the rationale behind the two types of nursing, either, really. the bottom line is experience and the competence, confidence and capacity to learn, which is different for everyone.
believe me, i am not bragging, but, i am approached often about returning to school. i am complimented on my organizational skills, observation and independent thinking (as independent as an lpn can be). but, i tell them all that i am this way because i do not have the same distractors they do. and, many times, the best thing i can do in the time of crisis is to maintain the mundane, predictable tasks that an rn has no time for. it is a horrible thing to deal with one situation after another to then, have to rush and still pump out medications, treatments, suctioning, etc...before the end of the shift. this is where mistakes can be made. this is why i am a proponent of keeping lpns, but, having more of a universal (at least within the individual state) scope of practice for lpns to follow. it is silly to me to have a bon of a state widen the scope of an lpn, while the individual institution within that same state limit their lpns. it is a self-defeating situation, in my eye.
what begins to happen is if the role of anyone, may it be lpn or cna is further diminished, it leaves those individuals to think "what interest do i have in initiating this, or doing that? they don't value me, anyhow!" and who is left holding the bag?
maybe it would be easier to free the rn for the acute situations that occur, do assessments and pick up orders and then assign to the lpns and delegate to cnas. who knows? but, i refuse to accept that we lpns need to be thrown in the dust. if the position was created to begin with, schools and education provided, then, use us!