Can an LPN train/precept and RN?

[yfloridanurse]

Where I am presently working I seen some practices that I do not think is beneficial. Have you ever have the experience where an LPN train an RN being their preceptor?

I beleive LPN are an asset to anunit, and they can be very prepared but their Scope of Practice differs a lot from the RN as well as being the RN the delegating part to an LPN. What is your opinion in this type of practice?

[NurseKatie08, MSN]

I'm a new grad RN in subacute rehab (within an LTC facility). I was precepted on days by an RN for five weeks, and then when I switched to evenings (my permanent shift) I was precepted by an LPN. In this setting there is really nothing different that I can do from the LPNs, other than pronounce death with an MD order for RN pronouncement, and given that this is rehab, our patients don't die terribly often, so I've never had to do that. I had no issue being precepted by an LPN...I consider this particular nurse a mentor, and since we both work the exact same schedule, I am always going to her for advice about issues with my patients.

I think it should depend on your setting.

[Brian, ASN, RN]

FYI: I just added a poll to this thread.

[flightnurse2b, LPN]

where i work, there is not much difference between us as far as scope inside the facility. the preceptor on days for new grads is a RN, and on nights, it's a LPN.

the hands down smartest nurse on my floor is the LPN who has been there for like 25 years. she knows everything there is to know about that floor and about telemetry. she precepts 99% of the new grads on night shift... my NM doesn't put up with the concept that the LPN's are the inferior species and has let people go for making nasty comments. i've learned more from her than i have from any other nurse on the floor. even the charge nurses run to her for advice on things.

and to those who think LPN's blindly do things, i'm sorry you feel this way. the misconception that the difference between a LPN and a RN is that "LPN's do things and don't know why they do them" is horse hooves.

[LesMonsterRN, ADN, RN]

As an LPN I've precepted many an RN in LTC but in the vein of facility P&P, routine, etc. It's definitely doable but not always the best approach, depending on the facility or unit.

[pagandeva2000, LPN]

I also say that it depends on the area, situation and circumstance. I have taught agency RNs and RN students the basic, predictable activities that go on in our clinic. There are some things that I do not do, such as administer Rhogam, BLT (bilateral tubal ligation) teaching/obtaining consents or triage. If it is particularly busy, many times, charge nurses have left these people with me and have said with confidence "You are in good hands".

I also have to echo that the comment basically saying that LPNs do without knowing why is insulting; it insinuates that we are licensed trained monkeys. In addition, it takes a bit of time to obtain experience from either level of nursing to comprehend the entire nuts and bolts of a particular practice. Some take the initiative to learn the details, others don't. And, that is not an LPN-RN thing, that is a personality/quality of work ethic thing.

[jjjoy, LPN]

A bit off-topic, but I have a question for some of you.

Why does it seem like quite a few of you believe that LPN's are not taught the rationale behind nursing actions?

I would really like to know where you received this information because where I live, LPN's better know exactly WHY they are doing anything. "This is the way we've always done it" is just not good enough.

My nursing school instructors harped again and again that we, as RN students, were being taught the rationale behind the nursing actions, and that we, as RNs, would be expected to to know the rationale behind the nursing actions. The implication, of course, being that non-RNs (such as LPNs) wouldn't have had the same kind of training.

I do think some instructors flat out said those dreaded words.... that LPNs are only "taught the how and not the why" in response to the questions such as "what do LPNs learn in school?" "how are LPNs different from RNs." A simple, pat answer that seems to be perpetuated to RN students over the years. I think some LPN instructors may do a similar disservice to the relations between RNs and LPNs by actively encouraging students to discount the additional education of RNs and resent the differences in scope of practice.

At my school, the role of LPNs was almost completely unaddressed. It only came in questions about what tasks could and couldn't be delegated... and assessment wasn't one of them.

So you can see why some RNs without much experience with or exposure to LPNs in certain roles are shocked at the degree of responsibility that LPNs have in some settings, where they may functionally do assessments (even if supposedly 'validated' by an RN), may have their own patient load, or aren't working with any RNs at all. It's not that such RNs are all snobby; they are just honestly ignorant 1) of the actual training LPNs have and 2) of the actual scope of practice of LPNs.

[nerdtonurse?, BSN, RN]

And it goes the other way, too...in LPN school, the unwritten theme was that we were the "real" nurses, and the RNs were just the paperwork jockeys. RN school doesn't address us at all (so far).

Once again, like I've said before, nursing school turning out a "finished" nurse is something that they tell you in class -- but it's more like going on the parachute ride at Six Flags and then thinking you are ready to skydive.....

[mama_d, BSN, RN]

When I worked gero-psych, there was no other choice. We had a LPN on days, me on evenings/nights, and any RN new hires got taught the ropes by us. When you have a floor staffed by two nurses only, not even any ancillary staff, there was no way around it.

I wish that I could precept RNs on our floor now sometimes (then, other times, when we get a real dingbat, I'm glad I can't). So, instead, I get the RNs who are precepting coming to me sometimes to ask me for advice/teaching to their orientees. I don't mind, I've been a nurse for longer than some of them have been out of high school, it makes sense to come to the more experienced nurses for stuff sometimes. Plus it tends to make the newbies trust my lowly LPN opinions...and I can guarantee you that I do indeed know the whys and wherefores, sometimes better than the RNs do, for our floor at least.

[pagandeva2000, LPN]

My nursing school instructors harped again and again that we, as RN students, were being taught the rationale behind the nursing actions, and that we, as RNs, would be expected to to know the rationale behind the nursing actions. The implication, of course, being that non-RNs (such as LPNs) wouldn't have had the same kind of training.

I do think some instructors flat out said those dreaded words.... that LPNs are only "taught the how and not the why" in response to the questions such as "what do LPNs learn in school?" "how are LPNs different from RNs." A simple, pat answer that seems to be perpetuated to RN students over the years. I think some LPN instructors may do a similar disservice to the relations between RNs and LPNs by actively encouraging students to discount the additional education of RNs and resent the differences in scope of practice.

At my school, the role of LPNs was almost completely unaddressed. It only came in questions about what tasks could and couldn't be delegated... and assessment wasn't one of them.

So you can see why some RNs without much experience with or exposure to LPNs in certain roles are shocked at the degree of responsibility that LPNs have in some settings, where they may functionally do assessments (even if supposedly 'validated' by an RN), may have their own patient load, or aren't working with any RNs at all. It's not that such RNs are all snobby; they are just honestly ignorant 1) of the actual training LPNs have and 2) of the actual scope of practice of LPNs.

I have an RN mentor that told me before I started nursing school that the CNAs are taught to do, the LPN does more with a little bit of why and the RN is supposed to know 'the science behind the why'. In real life, however, she stated that these days, with nursing education being what is currently is, no one really knows much better than the other until they are thrown in the water.

I feel that what has happened in my case is that I came in an era in my hospital where a great deal of the critical thinking was taken away from LPNs, so, we are more task oriented and didn't have a chance to enhance our knowledge unless you take a great deal of initiative and are a self-motivated individual. I have to do a great deal of teaching in the clinic, so, I had to be up on my game. When I work per diem on the floors, I am a pill pusher, so, I don't have to be a first responder to emergencies, do any 'assessments (can I say that word legally...?)' or such. This sort of limited me at times, but it takes away alot of headaches as well.

We had some BSN students the other day in OB/GYN and when a nurse asked them what to expect from a first trimester pregnant woman, she stated she did not know. It was shocking, yes; but, I didn't take it as "all RNs should know" and catagorize them. This showed me how this individual is as a student...not too involved or interested.

I was recently made into a team leader in a corridor, where I am making daily as well as monthly schedules for physicians while assigned to our clinic as well as CNAs and even agency RNs. I am not responsible for what the RN assigned to my corridor clinically, but I do assign her a room, the lunch schedule and guide her to the resources throughout the shift. I don't think they assigned me this responsibility because I am an idiot.

[Lacie, BSN, RN]

No, unless you are precepting them to do nursing duties, that normally a doctor does not do. Otherwise we are short handing the peson being precepted. Like I said, I belive LPN are good and they have a wealth a knowledge but there is an educational gap, mostly rationale wise, otherwise they will have the RN behind their name and not an LPN, is as well as AS and BSN. I graduated from an ASN program, but when I pursue my BSN, there were a lot of information and knowledge that was never gven during ASN program. My concern with LPN trainign an RN either new or experience, that is moving into a new area, is how do the LPN would be able to teach something to the RN if by their scope of practice they are not allow to do it and most likely do not know how to do it. I believe greatly in educationa nd I believe preceptorship is as important as education is. The better the foundation the better outcome for the nurses. I never seem this practice done elsewhere, but I am afraid is happenning more than I thought. Thanks all for your answers and input.

Bingo!! You hit the nail on the head with this explanation and I couldnt agree more. I didnt take all those extra pathophysiology, chemistry and all the other extra required to get that BSN for nothing. And believe me I am far from a "paper pusher" lol. I'm a DON and RN's are precepted by RN's only in my unit. (By the way I also work on the floor same as my staff nurses 4 out of 6 days) I have had some great LPN's but as you said when it comes down to that additional knowledge base it has to be there when needed. I dont practice nursing on a conveyor belt mentality based on just doing the deed. My nurses need to know why they are doing things and the rationale to back it. Not just giving an anti-hypertensive because they have high blood pressure - what is the physiological action of that med to expect a reduction in b/p and how as a very simple example. I always wanted to know why and how not just doing.

[flightnurse2b, LPN]

Bingo!! You hit the nail on the head with this explanation and I couldnt agree more. I didnt take all those extra pathophysiology, chemistry and all the other extra required to get that BSN for nothing. And believe me I am far from a "paper pusher" lol. I'm a DON and RN's are precepted by RN's only in my unit. (By the way I also work on the floor same as my staff nurses 4 out of 6 days) I have had some great LPN's but as you said when it comes down to that additional knowledge base it has to be there when needed. I dont practice nursing on a conveyor belt mentality based on just doing the deed. My nurses need to know why they are doing things and the rationale to back it. Not just giving an anti-hypertensive because they have high blood pressure - what is the physiological action of that med to expect a reduction in b/p and how as a very simple example. I always wanted to know why and how not just doing.

:angryfire:angryfire:angryfire:angryfire not nice.

i can answer this question and i always know why. if i don't know why, i look it up. i am not a trained chimp that gives pills for a banana. i don't think i would want to work for you if you turn your nose up at LPN's like the vibe you give off in this post.

taking a chemistry and statistics class doesn't make you a better nurse.

and btw, i took chem 1, chem 2, and organic chem 1, a&p1 and a&p2, physical and forensic anthropology (our final exam was actually being able to put back the peices of a human skeleton together and estimate the age, sex and race of the person), calculus 1, 2, 3, and 4 and statistics, trig, microbiology, medical ethics, diet therapy, etc, etc, etc..... i was going for pre-med before i went for my paramedic, and got a degree in EMS before the LPN. you don't have any idea of what the lowly LPN has in her/his educational background. my best friend in LPN school had a bachelors in chemistry AND biology. another girl in my class had a master's degree in engineering. but i suppose once we took the NCLEX-PN that bought us down to the level of uneducated workers who do what we're told.

assuming just makes an.. well, you know.

[jjjoy, LPN]

The differences between LPN and RN are not related to whether or not any one individual LPN might know as much as if not more than any one individual RN.

And I agree that it's counterproductive to imply that categorically LPNs practice nursing with a "conveyer belt" mentality. I'm sure we've all met RNs who don't practice nursing the way we hope they were trained. So seeing an LPN practice poorly doesn't mean that's how they were trained.

Clearly there ARE differences between the FORMAL training and education of LPNs and RNs. How do those differences influence the scope of practice and presumed knowledge/skill base that we grant to the different levels of training? There are always individual exceptions but what can we expect the *average* LPN or RN from the *average* LPN or RN program to have a firm foundation in? That is, what does having passed the training MEAN in regard to *minimum* expectations of those who have passed that training? If someone entered the program with minimum qualifications and ONLY learned through what was provided in the program, what would the differences be between what they gained IN THE PROGRAM.