CA staffing ratios evoke anger 'tween RNs & LVNs

[NMAguiar]

Big news on the California nursing ratios front. As California prepares to carry out its first-in-the-nation law telling hospitals how many nurses they must have on hand for patients, a bitter dispute has broken out between rival unions over exactly who should count as a nurse.

In separate news, testifying hospitals plead for more time, citing the nursing shortage as a hinderence to nurse-patient ratios.

Both stories in entirety are here.

[SKM-NURSIEPOOH, BSN, RN]

originally posted by youda

...i still cry about a little lady that went into chf and died before we could get her to the hospital. i was an lpn in school for my rn at the time. the very next week, we were doing heart sounds and i knew that if i'd have just known those heart sounds a couple weeks earlier, i would have heard that she was getting into trouble long before she reached a crisis stage. but, to even understand what i was hearing, i had to learn the physiology, the route of blood, the different valves, and practice listening to the sounds . . .

...why shouldn't lpns be taught vital things like heart & lung sounds to the deepest degree??? it used to bother me when my instructors from my lpn program used to say...."this is this...but we won't really worry about that...because it's out of your scope." why not teach it anyway & make it part of the scope???

but i do hear ya youda...i'm currently in school for my rn as well, but i'm having a bit of a different experience than i guess you did though. i'm finding the nursing classes easy as i have the education from my lpn & experience to draw from. sometimes, i'm afraid for some of my classmates whom, no matter how much book knowledge they acquire, just can't seem to connect the theory with their clinical experiences. i help them-out as much as i can...without overstepping any bounderies.

but i guess my point is that rns shouldn't have to co-sign for another licensed nurses' work...that just crazy & i can't understand for the life of me why rns take it!!! if it was passed that rns are no longer are required to co-sign for the lpns, then would they welcome them back into the hospital mainstream???

[MoghraRN]

I'm fairly new to the site and maybe I should be worried about jumping into this "heated" thread but hear it goes-

I'm a RN and worked with LPNs in a tele unit in SC. They were a great group of nurses, a few taught me a thing or two. Having said that, I still had to cosign their assessments, hang blood, and give their IV meds in addition to caring for my own pt load. Surely this must be taken into consideration when considering nurse/pt ratios. I also would like to state that I have worked for 2 non-union hospitals and am currently at a union hospital and I wouldn't go back to the non union hospital. When our contract was negotiated 1 1/2 years ago, the nurses got 19% pay raise over the next 3 years and the charge nurses gained more control over pt flow on the floors ( ablility to close units to admits when staffing can't cover all the pts). I'd also like to add that I enjoy reading the threads and look forward to participating more in the future!

[rebelwaclause, ASN, RN]

originally posted by skm-nursiepooh

...why shouldn't lpns be taught vital things like heart & lung sounds to the deepest degree??? it used to bother me when my instructors from my lpn program used to say...."this is this...but we won't really worry about that...because it's out of your scope." why not teach it anyway & make it part of the scope???

but i do hear ya youda...i'm currently in school for my rn as well, but i'm having a bit of a different experience than i guess you did though. i'm finding the nursing classes easy as i have the education from my lpn & experience to draw from. sometimes, i'm afraid for some of my classmates whom, no matter how much book knowledge they acquire, just can't seem to connect the theory with their clinical experiences. i help them-out as much as i can...without overstepping any boundaries.

but i guess my point is that rns shouldn't have to co-sign for another licensed nurses' work...that just crazy & i can't understand for the life of me why rns take it!!! if it was passed that rns are no longer are required to co-sign for the lpns, then would they welcome them back into the hospital mainstream???

excellent post, skm-nursiepooh!

what type of lvn's have you all been working with?

i understand lvn's scope of practice only allows us to do so much - so i understand some of the frustration's rn's are venting. but for rn's to blame lvn's for something that is totally out of our control - that's just ludicrous. do you get mad at your patient for having a cold? do you get mad at a seven year old for not conversing as a 15 year old? its the same analogy. upset about a limitation. i'm beginning to believe those same rn's who do all the whining (with no solutions or flexibility...of course) about "covering" lvn's would be the same rn's who would find something else to complain about if it wasn't the lvn "monkey-of-the-week" attack.

if an rn takes 5 minutes to hang an abx on a patient i'm assigned to...who's responsible to ensure the patient is tolerating the medication without adverse reactions? as a lvn, i am trained enough to apply my skills and know what treatment is required while i contact the on duty md and update my rn. i am responsible for this.

and fortunate for me, i was trained at a school by a group of rn's who aspired for us to go on to rn school. we where trained above the required curriculum because they new what type of lvn they would want by their side. our class fused about this initially, stating "we are not in rn school", but soon realized the extra education would make us that much more savvy once practicing as a nurse.

the way it is argued on most of these posts - i could take my lvn behind home while you "do all the work". should i start getting mad at cna's scope of practice, since they aren't pulling any medically helpful weight either? (that was a joke...no offense cna's!)

lets get it together, practice some sort of teamwork for each other, and move on. lvn's aren't going anywhere. get over it.

sighhhhh.......

[rebelwaclause, ASN, RN]

Wow....What type of LVN's have you worked with? I'm totally SERIOUS! You have described them as licensed dum-dum's, and I TOO would be worried working with them - Just as much as I'm worried when I have a registered dum-dum covering me.

Originally posted by -jt

The SEIU plan of a 1:4 ratio is a farce on the public.

FYI: The 1:4 ratio was initiated AND implemented by CNA, California union for RN's. The hoot came about when Kaiser-Permanente - The unions biggest employee base initiated the 1:4 ratio on ALL licensed nurses. Now, CNA and SEIU are battling the word "nurse".

When I give PO/PR medications, insert foley's, monitor labs, hang and monitor blood transfusion's, monitor vital signs and KNOW what they mean in relation to my patient - I AM A NURSE. (Heck - When I took the boards and passed I felt like a nurse!).

I think there's a HUGE difference state-to-state in how LVN's operate. I also think some RN's have experienced LVN's that may not have been very savvy or chose to do the minimum necessary...Which is the "tasks" assigned to their patient load. I'm sorry about that. But don't generalize all LVN's to be beasts of burdens. And before ANYONE says "This is not an LVN/RN thing"...Look back at how many posts put the burden of practicing RN's on LVN's. It becomes an LVN/RN thing because LVN's are continually put in the negative by those RN's who continue to insist we are of no value.

Originally posted by -jt

YOU will have only 4 pts. The RN will have her own 4 PLUS your 4.

Is that how it is in New York? I can understand your frustration, if so.

I work in a small facility, 20 bed med-surg. I understand this makes a difference. I also work NOC's - So this adds to the difference. A usual shift there's 2 or 3 RN's and 1 or 2 LVN's.

Assignments are acuity based, and can look like this:

RN1 = 2 Patients, 1st admit, covering 2 LVN Patient

RN2 = 3 Patients, 2nd admit, covering 1 LVN "

RN3 = 3 Patients, 3rd admit, covering 1 LVN "

LVN = 4 Patients, transfer or 4th admit, 1 patients with no scheduled IV meds, 1 with blood transfusion, 1 with IV abx's Q6

Take into consideration:

Admissions during NOC shift varies, sometimes none.

This is a great night illustrated above!

Sometimes there are no scheduled tasks RN's have to intervene. I

I understand:

Originally posted by -jt There is much more to that than just technical tasks like hanging your pts antibx. There are a lot of implications for me & the Pt's when Im trying to monitor your pts blood transfusions, manage your pts IVs, hang all your pts antibx, assess all your pts for changes and problems, keep ontop of whats happening with the full pt load that youre assigned to, and what you are doing, while Im trying to manage my own full pt load at the same time.

Again...Look's like LVN's in NY practice differently that in California. OF the things mentioned above, you'd hang my abx's. If you trust my skills, you'd trust that I'd notify you if there where ANY changes in the patient at any giving time. I would keep you abreast of things I knew where out of my scope of practice.

Maybe I've stumbled onto a small barrier here.

Of the RN's who have posted here, how many trust the nursing skills of the LVN's you currently work with? Do you feel you need to micro-manage them to assure your license isn't in jeopardy? Do you have control issues...in general?

(Sorry NMA!...Maybe I'll start a new thread with this question!)

[rncountry]

I would like to address a couple things that have come up in this thread.

First Lois, if you happen to come back to this thread, RNs have not taken a thing from LPNs/LVNs. Secondly the way many LPNs practice now was not the way they practiced years ago. LPNs now have MORE responsibility than they used to have. My grandmother was an LVN in Texas as a young woman, and according to what she told me the duties she had were little more than what CNA's perform today. The only thing she did that was more was to pass PO meds. She did not assess patients, she did nothing with IV lines or drugs, what she did do was most of the hands on care of the physical needs of patients. Perhaps this was a Texas thing, but somehow I don't think so. Not too long ago we had an LPN on our unit that was an agency nurse. She has been an LPN for 32 years. I asked her a very specific question about one of her patients and she told me I would have to ask her nurse. I know I looked at her like she had two heads. I told her that according to the assignments she was the patients nurse. Yes, yes she answered, but she was the LPN not the Nurse. I stood there a bit dumbfounded trying to figure out if she had assessed the patient or what, or was I simply not understanding what she was getting at. So I asked her if she had assessed the patient or not. Yes, she had, however specific questions needed to be addressed to the Nurse that the patient had. It took me sometime to make her understand that she was the patients nurse and that she needed to know specifics about the patient. This nurse was highly uncomfortable with this scenario, she felt that all she was supposed to be doing was doing an inital assessment, giving that information to the RN who was assigned to her and that the RN was to be giving any specific information to whoever needed it. That is not the way my floor works, but trust me that is what this LPN expected. It must be understood that this LPN explained to me that she had been an LPN for 32 years, had not worked actively for awhile and did not feel comfortable having the responsibility for patients that we were giving her. This nurse did not return to our unit. Later I mentioned all this to my mom, who told me that was the way things used to be. The way most LPNs practice now is a new phenomonon, LPNs have the ability to do more than they used to do, there is nothing the RN has taken away. The issue has been muddied by corporates and facilities who have given LPNs more responsiblity because the reality is that the LPN commands less money. Of course it is a good deal to be able to get someone who is willing to do most of the same things that an RN does and be able to pay that person less money.

SKM, if LPNs were educated the same way as RNs than the education they received would make them an RN, not an LPN. There are differences in what is allowed in practice acts, and not only is that difference there, but even the Supreme Court makes RNs supervisors. The other reality to that is it is impossible for an RN to have their own patient load AND be able to adequately supervise what other nurses are or are not doing. Right now this is a real stuggle in my facility because we have a couple new LPNs that are struggling mighty hard as they transition from student to nurse, and it is causing the RN who is supposed to be their supervisor to consistantly fall behind in their own patient care, and yes the charge is helping in the situation, but it is not the only thing the charge has to deal with either.

One can always say there are good and bad, LPNs and RNs, both. I would wager that all of us have worked both LPNs and RNs that fit into either category. I think what too many LPNs don't stop to think is that most RNs are not saying that LPNs are stupid or incompetant because they are LPNs, what is being said is that the reality is that LPNs are to be supervised by an RN and that does increase our workload when an LPN is counted for patient assignments as if they are licensed to do all the same things an RN is licensed to do.

To me I see the problem as one in which the California Hospital Association is attempting to make this a nursing problem, instead of their problem, and unfortunately there are an awful lot of LPNs biting on it. I hear the refrain of, well of course I am a nurse and I am just as capable as the RN, how dare anyone say otherwise? It is not an issue of capability, it is an issue of license and responsiblity. And ultimately it is an issue of patient care. What I don't understand is how LPNs and RNs involved cannot see how the people who do not want to have to comply with this law are using the traditional infighting among ourselves to strengthen their positions. There are differences in the abilities of RNs and LPNs, for LPNs not to want to see that is akin to the physician assistant stating there are no real differences between them and the physician. No one fights about that, and no one has any difficulty in being able to ascertain what the difference is.

And yes, this does have to do with the SEIU. In my state the SEIU is attempting to be able to have techs, CNAs, PCAs, call them by whatever title you want, to be able to do more and more in the guise of it helping the RN in their patient loads. This has resulted in such assine things as LPNs not being able to put in IVs by their practice act, but there are CNA's doing it in the ER's of some hospitals. CNA's are putting in foley's, dropping NG tubes, and giving discharge education in some facilities. And by God this makes me angry! This is not happening in my facility, but I can freely say that if it were, I would quit. I am not going to be responsible for someone who is not educated to do this or licensed to do it either. It goes under the guise of the RN being able to "delegate" and "supervise" the problem is that the RN didn't get to decide if they wanted to "delegate" these things to a CNA. They were told this is the way it is. And the SEIU has been in the forefront of having this happen, at least in my state.

I am a firm believer if an LPN wants to have the same responsibilites as an RN than they should become an RN. In the same way that if I wanted to be able to do what a physician does, I would believe I should go back to school and become a physician. And personally I think that if LPN wants to see appropriate patient care than they would support the RNs on this, because the reality is that the RN will end up being responsible for the additional patients. Each LPN here has focused on the task oriented items that the RN has to do for the LPN, hanging IV, pushing the meds, hanging blood. What is not being thought of is that if I am responsible for the LPN patients ultimately, I am also responsible for the ultimate outcome. Just as jt illustrated in her example, the reality is the RN is the last line of responsiblity. It has always been so, it is not new, and it will always be so. Just like it will always be so that that I am required to follow the physician orders, not make up my own. Of course I may not agree with the physician, and twice in my career I have flat refused to follow an order, inviting the physician to come in and do it himself, but I do not have the ability to write my own order instead.

This issue should not be RN vs. LPN, but about patient care, the bills intent. But as long as there are LPNs who believe they have every right to be counted as an RN then there will be RN vs. LPN. I don't have the right to be counted as a physician, or even a physician assistant, and I would never believe I should. But unfortunately there will always be LPNs that believe they should be counted as an RN, despite the limitations of licensure because somehow or another they feel to do otherwise casts doubts on their abilities. The sad truth is that it has nothing to do with abilities but everything to do with license and education. Yes, education. I may have taken an anatomy class, but I sure as hell did not dissect a human being like a physician did, and will never pretend that I have the same intimate knowledge of the human body as the physician.

I am sure that there will be someone who will take offense to this post. Whatever. There is a difference in education, there is a difference in licensure and there is a difference between RN and LPN. Experience has taught me that there are drugs that should not be given together, experience has taught me much as I am sure experience also teaches LPNs. And even though that is the case, I still may not write whatever orders I may think is appropriate for the patient. That is the provence of the physician, not mine. Why should that be a difficult concept between RN and LPN?

[Youda]

Excellent, excellent post, rncountry! You clarified this problem exactly! Thank you!

[BBFRN, BSN, PhD]

Originally posted by RN2B2005

Hospitals want to call L.P.N.'s "nurses" because these "nurses" earn a fraction of what a graduate R.N.'s earn.

Not to denigrate L.P.N.'s, but when push comes to shove, I want an R.N. at my bedside.

If hospitals want to call L.P.N.'s "nurses", fine. Just let them hire TWO L.P.N.'s for every R.N.; after all, an L.P.N's training is one year, half the minimum for an R.N. This will turn the hospital's "cost-saving measures" on their head.

Wow...when I read this, I was somewhat aghast. Does not the "N" in LPN stand for "Nurse?" Or maybe my little LPN pea-brain didn't get the letters correct. (And for the record, I'm 2 classes away from my RN, so let's get any assumption of RN prejudice out of the way.) So what should be delegated to you, "RN to be in 2005," when you are doing a clinical rotation on the floor. Hmmm, I guess I would rather have an LPN at my bedside than someone who doesn't graduate until 2005. You have had an understandably bad experience as a patient, but let's not try to define MY scope of practice or my ability to perform within it based on that. I ( as well as MANY of my fellow LPN cohorts on my floor) are for the most part greatly appreciated and respected for the jobs we do, which includes a lot more than you seem to be aware of. Try graduating and actually being a nurse before you attempt to paint LPN's into a corner where we aren't considered nurses.

[rncountry]

lg, first of all every patient, regardless of whether that patient is a nurse, a physician, or Joe Public, has the right to make decisions related to their care. As a patient RN2B has the right to not want an LPN as her nurse if she choose that. And RN2B did not call you or any other LPN pea brained, you called yourself that. What irritates me is that there is an automatic assumption that if someone says ANYTHING related to care from an LPN, than LPN's jump on that person with both feet, shouting and snorting that LPNs are not stupid. Well, duh. Wouldn't have made it through school is you were stupid now would you? Now the mistake that RN2B illustrated may have been done by an RN as well, but her patient experience, not nursing experience was not an RN who made this error, but an LPN who made the error. And to ask a student what things she should be allowed to do is already answered, a student does what they have already been checked off to do, and where they are in their studies. The same process that you went through as a student. Oh, and by the way it is the RN who will ultimately be responsible for the student's care, even though there is an instuctor present. This is reality, not making it up as I go along.

And the other part of RN2B's post that you qouted. Yes, LPNs are being used to fill the ranks at less pay. And I do mean used. We are all getting screwed but the LPN seems less able to see that. As an LPN you are now being asked to do things that even 10-12 years ago LPNs did not do. But along came managed care who decided that they could push the gray areas of the LPN practice acts, and get a nurse who cost a hellava lot less than an RN. When I graduated in 1991 there was a big push to go to all primary care nursing, to get away from team nursing and to eliminate LPNs from the hospital. The thought behind that was that LPNs were not educated to be able to do what the RN was educated to do and that RNs would give ALL care to their patients, from bedbaths to meds. Then came mergers and downsizing, elimination of RN staff, LPNs starting doing what had traditionally been the provence of RNs and CNAs were also doing "tasks" that had always been done by nurses, both RN and LPN. Do a search on articles in nursing magazines from the early 90's and you will see what I am telling you is the truth. There are articles on how to deal with the new way of doing things. So the hospitals got LPNs to do things that had been done by RNs for less pay, and CNAs for even less pay. Because all they did was focus on the task oriented things that is part of patient care, not the critical thinking that is a major part of being able to understand what is happening or not happening for a patient. Patient loads increased, patients that would have died 10-15 years ago are now the ICU patients, and the old ICU patient became a med-surg patient, and the med-surg patient became a LTC patient, all at the same time that the critically thinking educated team member was being laid off, downsized and plain not hired. And LPNs bought into it with the chant we are not stupid, or Pea Brained as you said, and we are just as good a nurse as an RN. Point is that is not whether an LPN is a good nurse, but that the LPN is a different kind of nurse, with different skills and different education. But you bought what managed care was selling you and decided that RNs were just saying you were stupid. That RNs were the ones who were taking "away" your ability to do what was never yours to begin with. You bought the company line hook, line and sinker and did it for less pay. I just wonder how you would feel is a CNA got on line and argued that they should be able to do what you do as an LPN, to identify themselves as a nurse, and then take offense because you pointed out that they were not licensed to do what you do, and by the way doing it for less pay. And then think about given this scenario just what do you feel your worth to the American Hospital Association, to your corporate, to managed care would be? Maybe the same that I feel they think about me and other RNs. Yea, your being used, screwed without even a kiss, but your not seeing it. Instead all you are choosing to see is an RN or soon to be RN calling you pea brained. And there is a specific study out there that shows an RN caring for too many people does make a difference in outcomes. And instead of supporting the RN the LPN is calling foul. Hell, I thought this was about patient care and outcomes, but oops not really. Instead it is about RNs making LPNs feel stupid. I think I hear the sound of laughter and clapping coming from the AHA.

[BBFRN, BSN, PhD]

Whoa!!! Hold on there, please! The only thing I took offense to was that the poster had the audacity to have a problem with an LPN being called a nurse. I just didn't want a bad experience as a patient to be cited as a reason not to consider an LPN as a nurse. And as an LPN, I DO see the RN's being screwed- ON A DAILY BASIS. But some RN"S do need to stop viewing LPN's as a hinderance to their having a quality work environment. LPN's are NOT worsening the nursing shortage. We are not akin to Scabs, coming in to take your jobs. And by the way, I did NOT buy into what was "sold to me." What I did was get a job in a hospital who is PAYING for my RN education. We all win in that scenario. I personally don't think that RN'S are "taking" anything "away" from me. That statement confuses me. ?? If you read my post as being anti RN, I'm sorry- that certainly is NOT the case, but I work very hard on a very tough floor, and I hold my own quite well. I just get tired of LPN bashing on these BB's at times. And yes, I think that statements refering to LPN's not being nurses are provoking, and it's hard not to get offended.

[rebelwaclause, ASN, RN]

RNCountry...

I never didn't understood where RN's are coming from, and have said so in previous posts. I AM NOT an RN. I cannot function as a RN. I know..I am not...A RN.

I do not have the same training as a RN. I cannot function self sufficiently, as a RN. Yes - I agree, staffing sucks, at times for RN's - Mostly the posts I've seen here from various RN's across the state. I wouldn't put myself in danger for any hospital. I'd find somewhere, anywhere that I can function safely at.

My point is and always will be - Don't bash LVN's because we aren't the RN you'd prefer to work with, because of "covering" issues. Attack the suits who possibly aren't living up to their end of the bargain, but please, don't blame LVN's because they show up to work as scheduled, instead of another RN. For the most part, on the last few pages of this thread - I haven't felt bashed at all. I have been merely responding to points in various posts.

By the way - I would NEVER work in an ICU. This is one place I wholeheartedly agree, LVN's are of little help, IMHO.

Oh...And in regards to RN2B's post, if you are referring to me...I won't debate who called who what, however, "Pea-brain" isn't a word anybody used here...Are you reading posts correctly? No one said RN2B didn't have a right to whoever she wanted to take care of her. I said an RN just as much as a LVN could provide lousy care. I additionally stated the generalized perceptions of LVN's in RN2B's post are unfounded. MANY others took offense to the post, so I do not feel bad for saying so.

RN2B had an opinion - So did I, and several others in response.

[rebelwaclause, ASN, RN]

Originally posted by [email protected]

I personally don't think that RN'S are "taking" anything "away" from me. That statement confuses me. ??

, Me too..? Unless you're referring if "All RN's" in hospital's pass (which it could), I get the boot and my livelihood does too! But in retrospect, that won't be such a bad thing. I'll go back to school, and upgrade to anything other than nursing. Not that I hate it. I just don't like the political BS that runs amok in it....Like the RN/LVN debates.

Originally posted by [email protected] If you read my post as being anti RN, I'm sorry- that certainly is NOT the case, but I work very hard on a very tough floor, and I hold my own quite well. I just get tired of LPN bashing on these BB's at times. And yes, I think that statements referring to LPN's not being nurses are provoking, and it's hard not to get offended.

High five and Amen, lgflamini!

[rncountry]

The part about LPNs feeling that RNs are taking from them, came from a previous post, not yours, sorry for the confusion. While you are tired of LPN bashing, I am tired of LPNs attempting to define their role as the same as RNs, because they play a different role. There are many LPNs on this board that the minute someone says I am tired of having to be responsible for my patients and an LPNs, who come along and start bashing the RN for something that is beyond our control. The RN is responsible ultimately period, and it is not a great feeling to know your job and license can hinge on what someone else is doing, whether you are physically there to see it or not, or even if you know what is happening, which is not likely when busy with your own patient load.

Yes, an LPN is a nurse and I think it is regrettable that RN2B put the nurse in quotes and sounded as if she/he doesn't feel that LPNs are nurses. It is obvious LPNs are. But a different kind of nurse who cannot do the same things an RN, and it simply is not right to ignore this. And it is also wrong, in my own opinion, for any LPN to pretend those differences are not there.

You may not have "bought in" but there are an awful lot of LPNs out there that have. I recall a thread from several months ago where an LVN from Texas asked why would she want to be an RN when she could take various certification courses, and could then do what an RN could do. It seemed never to occur to this person that they were still an LVN, that the RN still had to be responsible for whatever she did, certified or not, and that she was doing it all for significantly less pay. And other LPNs chimed in with, well yea, see there, yea. We can be just as good as you pain in the ass RNs. But it isn't about being just as good. It's about giving away what you are worth, it is about crossing boundaires that even hairdressers don't allow to be crossed.

I hope you get your RN, your right it is a win situation for everyone. I'm sure you work hard, and hold your own. You see RNs getting screwed, so do I. I also see LPNs getting screwed because they have been talked into "you can do it all, except these few task oriented items, don't let the RN tell you otherwise" and they are willing to play that role, do it for less money and perpetuate the LPN vs. RN game. And that is a win situation for the corporate, the AHA, not for the nurses and not for the patients. It is not about whether an LPN can do the same thing as an RN, it is about that they legally can't do it no matter what. And it is about the fact that the education is different in the various realms of nursing, despite some LPNs thought that it makes no difference. It does make a difference. I can't write a script like an NP can because my education is not at a level that would allow it. Yet I am a nurse and so is the NP, with different levels of practice, no different than the levels of practice between LPN and RN.

I believe that RN2B was simply trying to make the point that the hospitals were not making the difference between the two levels of practice between the nursing groups, and were choosing to call both groups simply nurses so they could get around the intent of the bill. I do not believe she was intending to be offensive at all. Just saying that if the hospitals were going to call the LPNs by the same designation without having to make the difference in practice apparent, then they should have to hire two LPNs to make up for the difference they could save in pay by not making the level of practice apparent. Am I making sense here? I sure hope so. I don't believe that there was any intent on RN2Bs part of trying to make it sound like LPNs weren't nurses. Perhaps worded poorly in the post, but I don't believe it was meant rudely.

I do make those differences, it is not intended to make an LPN angry or offended. My intent is to not allow my profession to continue to be deskilled when the patients we deal with in the hospitals now cannot afford that. LIke every nurse on this board I worked damn hard to get through school. And I am not willing to give away what I worked so hard to have. You think physicians would be willing to have PA's described in the same terminology as themselves? Not damn likely. The RN and LPN terminology should be different for the same reasons. And to not fight a system that is hell bent on simply describing every nurse as simply a nurse is to give away what you and I have worked hard to have. I for one, am not in favor of that and never will be.