Are LPNs the Answer to the RN Shortage in Some Locations?
Allnurses staffers recently attended the 2017 Emergency Nursing Conference in St Louis. We had some interesting conversations...
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Allnurses had the opportunity to talk with multiple healthcare systems throughout the US at a national conference. Many had the same issue: not enough RNs. Some had sign on bonuses - up to $10,000 for experienced critical care nurses, while others offered tuition reimbursement, high PTO accrual rate, guaranteed days off, self-scheduling, and free meals. Many nurses at the conference were reporting mandated overtime, on-call time - again that was mandated and staffing shortfalls. Several of the nurses were overheard discussing the sheer exhaustion they were experiencing as a result of "always working short." It is a phenomenon that allnurses hears and reports all the time. So...what's the solution? Decrease the acuity? Doubt that will happen anytime soon - our patients are sicker than ever. Increase the staff? As the hospital recruiters told us, the sign on bonuses are not always the answer.
However, one healthcare system, Erlanger Health Systems in Chattanooga, TN, spoke to us about how they are meeting the demand for RNs.... by hiring LPNs. Here are some of the guidelines:
Obtain a certification to give IV meds within 7 months of hire date
Become an RN within 3 years of hire date
The LPN to RN transition program is about one year in length and they partner with a community college to facilitate clinicals.
As we all know, healthcare needs ebb and flow. In 2011, Media Health Leaders brought us this news; speaking about primary nursing models, "and in this model, we're going to replace LPNs with more RNs and also more nurse aides. It's a model which, essentially, does not use LPNs."
From 2007, HC Pro reports; "Kaiser Permanente hospitals in Sacramento and Roseville, CA, are to replace their licensed vocational nurses (LVNs) with registered nurses (RNs) as part of efforts to provide a higher-level of care to patients. A total of 280 Kaiser LVNs will be affected by this change, which was made following negotiation between the health maintenance organization and United Healthcare Workers West, the labor union representing the LVNs."
And these are just two examples of how over the past few years, LPNs have been moved out of the acute care environment.
Now, Erlanger Health System in Chattanooga, TN is bringing LPNs back to the hospital. From their website, they have multiple LPN positions available that are inpatient-based.
When we discussed this trend with the staff from Erlanger at the conference, they welcome LPNs in the hospital and encourage them to continue their education and in fact offer an LPN to RN bridge program. They couple an LPN with an RN and are using a team nursing approach for the ever-increasing acuity of hospitalized patients. This has resulted in higher satisfaction for the RN, LPN and has improved the patient experience as well. LPNs are able to provide nursing care within their scope of practice which far exceeds what an unlicensed person can provide. As licensed staff, they are held to a higher standard but they also have more knowledge and more ability to affect patient outcomes.
The Institute for Health Improvement recommends a team-based care approach across all domains of care including acute care. They cite the "definition of "team-based care" for all care settings that is most widely accepted and consistent with the World Health Organization."
ANA published a white paper in 2015 about staffing strategies for nurses and stated; "Over the years a number of nurse staffing strategies and models have been tested and utilized across and within healthcare organizations. Inherent weaknesses in some models present opportunities for improvement that benefit patients, nurses, and healthcare organizations. The underlying discussion essentially involves the contrast between fixed or rigid models and those which include components that allow for the greatest degree of flexibility to ensure staffing needs are met in real time."
There are many different outlooks on team nursing, primary care nursing or some hybrid type of nursing care. While none of them are perfect, we as nurses need to speak up, voice our opinions and continue to encourage innovative strategies such as the ones at Erlanger Healthcare.
