I'm an LPN and I understand.


Not being phased out. But being forced back to our traditional role as Licensed Practical Nurse. This article addresses the LPNs role being phased out of acute care and what future LPNs should know about the practical nursing profession.

Specializes in Nursing Home. Has 9 years experience.

I'm an LPN and I understand.

I'm a new Nurse. I spend a lot of my time on a nursing home corridor behind a med cart, or more like a rolling Walgreens kiosk. I stay at work 1, 2 sometimes maybe 3 hours after shift change behind a nurses station. After 4pm , I function alone. I'm the one in charge. I'm the one who assesses residents, makes judgements, contacts physicians, contacts family members, sends residents to the hospital, it's all me. It's a big responsibility. It's a big job. I'm a NURSE. I'm the NURSE. But I am not an RN. I'm an LPN.

There's been much debate on not only this website, but around the country; about RNs and LPNs and what's the difference. It seems like around every corner you hear, don't become an LPN, or LPNs can't work in acute care. In my area LPNs can work in acute care and are growing strong in med-surg and ortho/rehab units in acute care. But that's not to be naive to the fact that in many parts of the country this is not the case. But I understand. I understand why LPNs have been phased out of ERs, OBs , ICUs, med surg in some areas, and it really does not come as a shock to me.

The current trend for LPNs is not new. LPNs came about ages ago to assist the RN by tending to stable patients with predictable outcomes. But with today's healthcare costs, and all other modern day alternatives to costly acute care like Rehab, LTAC, LTC/SNFs, Home Health, those patients with predictable outcomes just don't camp out on med surg like they used too.

Hospitals today house highly acute patients. And our skill sets as LPNs just aren't effective in this kind of environment. It does not make us any less of a Nurse, it's just not traditionally our role. Our role has moved with the times outside of hospitals. But that does not mean our role is gone. There's a Home Health Agency, Nursing Home, LTACH, Rehab Hospital hiring LPNs in bulk around every street corner.

So my question to all LPNs? Why would you work in a CNA capacity just to get hospital experience? All prospective LPN students need to understand that an LPN is not an RN. Just like a Podiatrist is not an MD. All are doctors. But different types. RNs and LPNs are both NURSES but different types. RNs are acute care nurses, and nurse managers, made for coding patients, and IV drips, and newborns in distress. As LPNs we are there for Accu Checks, PEG Tubes, Walkers, foleys. We LPNs are Nurses whose expertise is management of long term chronic illnesses. But we are Nurses.

Don't waste your time going through podiatry school if you want to be an MD. You'll be disappointed. Same thing if your dream is to be an RN on a busy NICU but you're sitting at clinicals at your local trade school in an LTC facility. We need to embrace the type of Nurse we are and our role as LPNs. Why go to school to be an LPN to work as a Tech on med surg, when you can use your Nurse smarts and leadership abilities in long term care.

I think the problem with LPN insecurities today is we LPNs try to be something we were traditionally not meant to be. It's not the magnet status talk or the BSN requirements. With shortages of Nurses in LTCs and tough budget cuts to federal programs paying a BSN RN to pass meds in a busy nursing home for $15-17$ dollars an hour is scheduled for the 31st of Never.

So let us embrace the LPN's role in nursing as the "chronic illness stable condition nurses". I'm proud to be a long term care nurse. I don't want to deal with critical drips , titrations, deteriorating newborns and such. I want to provide the best nursing care possible to people in need of long term management for chronic illnesses. If these jobs are outside the hospital, we have to follow them. We have to be proud of the Nurse we chose to be.

Again don't become a family medicine specialist if you want to be a neurosurgeon. Both are physicians both have similar knowledge. But the skills and individual knowledge they have match 2 different types of client populations. It's the same with LPNs and RNs. I know that in a perfect little world the LPN is an assistant to the RN and the RN delegates and supervises every little move and task that an LPN makes. Let's get real now. In small rural nursing homes where the DOC knows the Nurses on a first name basis, the LPN has more autonomy than MSN-RN in a large hospital.

Not knocking anybody's role. RNs have more acuity skills according to the BON, they have a better understanding of the big picture and i understand. But I have a role as a Nurse. I'm a long term care nurse. I manage chronic illnesses. It's what I signed up for. I would suggest anyone who wants to fly on helicopters, and start atropine drips in the ER, or care for an infant in the NICU, do yourself a favor and strive to be an RN. Because I do not have these hopes.

The elderly are a blessing and I'm doing what I love. I'm a NURSE. A long term care LPN and proud of it. It's what I do. You stick an ER RN in my job and it probably won't go well. You stick me in the ER, I know it wont go well! So please prospective LPNs. Consider our tradition. Accept it, or strive for your RN, beause we're not the same. And as an LPN I understand.

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157 Comment(s)


Specializes in critical care, LTC. Has 20+ years experience.

I started my career 30+ years ago as an LPN on a med/surg unit in a hospital. I pretty much did the same thing as the RN's with the exception of starting IV's and a few other technical things. I even mixed IV solutions (back in the day when MEDS such as potassium had to be manually mixed into a bag of fluids) after the RN checked the dose. 4 1/2 years in, they decided we weren't good enough and laid off all the LPN's. I went back to school and got my ASN. I worked critical care for 22 years. Now the hospitals (around here) don't think 2 year degrees are good enough. I worked LTC for several years. I personally don't like spending hours passing meds. I am now back in a hospital in an inpatient hospice unit. I do miss critical care but like what I do. Not sure when the powers will stop wanting more alphabet soup on s name tag until they realize those with all the initials don't want to work direct patient care.


Has 41 years experience.

Very well and eloquently said. I was an LPN, RN, BSN, and now an NP. We all have our niche!


Specializes in Geriatrics, LTC.

The current trend for LPNs may not be new in your area, but it most definitely is in mine.

In the past 5 years I've gone from being the only one in the facility (or only LPNs) after 4 pm and handling all that encompasses. Now fast forward to today and even our NPs want to speak with an RN more often than not.

I routinely have to make chart checks while on the med cart to prevent dangerous drug combos. The RN and NP are not always skilled at looking at the big picture when making meds changes. It seems the RN is run ragged trying to meet demands and the NP is making sure no one is doing anything that would prevent them from being able to charge for a visit. Meanwhile (insert resident name) is at risk because the nurse who is assessing and medicating the resident on a daily basis is being suppressed in function.

Yes. This IS new and it is frustrating at best.

downsouthlaff, LPN

Specializes in Nursing Home. Has 9 years experience.

Actually in my area , LPNs still work in the vast majority of acute care hospitals. And they do function as Nurses who take on an appropriate patient load. And the RN Unit Charge Nurse functions as the LPN Resource. But it seems that the trend around the country is LPNs are not working on med surg anymore and this is because with all the LTACHs and Free Standing Rehab Hospitals LPNs are no longer needed in true high acuity care. But we are very needed in long term care. I think its rediculous that the ANA continuea to advocate to get rid of Nurses. Theres clinically no difference between a BSN and ADN. And the role of the LPN is very needed as well. Again do you honestly think that BSN Nurses will work on a nursing home floor for 15$ an hour ? Nah. Its funny how things are so contradictive. You have the ANA pulling mortality rate studies pleading that all BSN Nurses would be a perfect world , but in corner b you got medications aides in some states who arent even licensed passing meds. What does the world want ????


Specializes in Geriatrics, LTC.

I know.... It's senseless...I gotta take my pay and forget about it. My idealism is gonna do me in ...aaaggghh.

downsouthlaff, LPN

Specializes in Nursing Home. Has 9 years experience.

The nursing home where i work employs 3 RNs. 1. The DON. 2. Weekend 1 8 hour Supervisor. 3 Weekend 2 8 hour supervisor. Thats it. The ADON is an LPN, The MDS Coordinator is an LPN, the QA Nurse is an LPN. The Wound Care Nurses are LPNs. LPNs continue to rock in Long Term Care, utilize there scope to the full extent, and put money back in the owners pocket all at the same time. We also have had a defiecency free survey two years in a row. Could BSN Nurses do any better in these roles?


Specializes in Cardiac (adult), CC, Peds, MH/Substance. Has 8 years experience.

As an LPN, I worked in critical care, PACU, ER, inpatient pediatrics, med-surg, mental health, a jail (the stories I could tell!), NICU, maternal-child, L&D, and a lot of other places. My responsibilities in most cases were the exact same as every RN other than the charge nurse. I read journals on my off time, because I enjoyed it, and most of the RNs asked me how to do things properly. Increasing a license level has no effect on my abilities. It just creates a pay raise. There's nothing wrong with being a really competent LPN/LVN, but seriously - in your off time work towards getting a license change so you can get paid for being more competent than the people around you who are currently making more than you :)

On the ANA study: BSNs versus others. Give them a call and discuss acuity and nursing staff ratios versus mortality, regardless of license/degree. They'll clam up, because they won't want to tell you that it's better to have an ADN and an LPN at the same price as one BSN than the BSN, or that two CNAs and an LPN at the same price are better than one BSN. Because that wouldn't feed their ego :)

downsouthlaff, LPN

Specializes in Nursing Home. Has 9 years experience.

And that last comment was by no means a personal sabatoge of RNs or BSN prepared Nurses. They work hard for there 4 year degrees, and a very well educated professional nurses. The above comment was just to prove my point, that just because we are not working in busy trauma centers, or on burn units, or on OB/GYN units "the dream jobs" doesnt mean that our role and scope are fading out like some young upcoming student nurses believe. And its evidenced by successful LTC Facilities with LPN Nurse Leaders. Thats the only point i was trying to make.


Specializes in Long term care; med-surg; critical care. Has 9 years experience.

When I was in clinicals there was an LPN on the acute care floor where I was a student and it was like hitting the jackpot to be assigned to her for the night. She was fantastic. We were so disappointed to hear that not long after our rotation the hospital phased out all LPNs from the facility. She considered going back to school for her RN, but after 20 years really didn't want to go back to the academic environment. She also had some serious reservations about how well she would succeed in, and could she even get in? So unfortunate that the practical aspect of her nursing expertise, along with many others, was completely overshadowed by the lack of the "proper" title. LPN, ADN, diploma, so many very valuable resources being portrayed as inferior to the almighty BSN, while for many it is just because they took the most practical route into a field in which they are very competent. I am an RN in long-term care with many excellent LPNs as colleagues and it's unfortunate that they're sometimes made to feel like lesser nurses, especially when it comes from other nurses, everyone should be acknowledged for providing quality care to those that need it, in whatever setting they are.


Has 6 years experience.

This is an interesting subject matter, one that comes up often in the medical field today. We have a very distinct hierarchy of skills, degrees and pay grades in the medical field. This hierarchy strokes some peoples ego's and diminishes the feelings of self worth in others. It really is a shame that the medical culture feels the need to rank the "importance" or relevance of a person based on where they fall on the spectrum of education or skill. I do believe that LPN's working in home health, long term care facilities, physicians offices, etc is a cost saving measure and a needed one. If LPN's were phased out and ADN's were all forced to go back to school for their BSN's then the pay demanded by all RN's to staff these LTC facilities would break the medical field bank, so to speak. The expenses would be astronomical.

You'll see this push for all RN's to be BSN's, no LPN's in the hospital setting, nursing assistants being forced to get their CNA license, BSN's going back for their NP's and CRNA, current CRNA's and NP's being encouraged to get their doctorate. The nursing profession is attempting to gain more relevance, autonomy, political power, respect and impact on the overall picture of healthcare. From the beginning of healthcare it has always been 100% MD ran with nurses being background handmaidens with very little academic education and mostly "on the job" clinical training. The medical field is changing and with it will change the amount of education required to practice in it. I could take a high school student and have them insert an IV or Foley 100 times in clinical practice over time and I'm betting they would get pretty good at it. In order to gain autonomy and political power for change in the healthcare industry we can not be seen as a very minimally educated person who has learned a basic skill very well. The measuring stick that we are inevitably being held up against are MD's and D.O.'s with 8 years of didactic education and many years of residency following. In order to be a viable member of the discussion it's fair to request we at least show the dedication, ambition, intelligence and commitment to obtain our BSN's.

I enjoy this article because it does highlight that LPN's have a very specific and valid role. They are needed and appreciated for their hard work in Long Term Care facilities and for taking care of our Grandparents and disabled. I believe where the conflict comes from that this author discusses is when a student goes to LPN school in order to obtain an RN-BSN position and pay grade but without having to commit to the time, money and work to obtain the BSN degree. That would be like me getting my BSN and going to work in the CV-ICU and getting mad that I don't get the same pay and position as the CV Surgeon. There are no quickie degrees and easy paths in the medical field. You will have to work for everything you obtain. That's free advice.

I recently obtained a RN degree after 10 years as an LPN. While I was getting that degree I was "stuck" in LTC, but what I realized while working in the nursing home is that I really enjoy working with this population. I will not continue pushing the cart, but I want to continue to provide care to this under appreciated group.