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.
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.
Here are my thoughts on the role of the LPN in today's world. What I will not do is rewrite what I have already written or respond to posters who wish to cause discord instead of engage in intelligent but polite debate.
I believe that the BSN to be the best entry into nursing we have today and that all young people who wish to enter the field get the BSN for reasons that I have already written about.
What then do we with the roles of LPN, ADN, or diploma educated RN who are already in practice?
I do not advocate that they are thrown out like yesterday's garbage. Yet, in this world of corporate nursing, this is what often happens. Studies that are often poorly designed and biased are used to do this very thing. I believe that we should follow in the footsteps of another respected profession, also dominated by women, which are teachers. Years ago, teachers at the elementary level did not train at 4 year colleges or universities. Instead, they trained at something called a Normal School and were granted a certificate or diploma to teach the primary grade until grade 8 I believe. Eventually, the training shifted to colleges. What was done with the teachers who were trained in the Normal School fashion? Many times, they were given the opportunity and financial incentive to return to school to obtain their degree. They were never throw away and told "you're no good because of (insert X,Y and Z and then give some research passed off as fact). We honestly learn so much on the job that can never be learned in school, and much of what we learn in school is never used again. The old school marm who trained at the Normal School 35 years into her career wasn't forced out, and was often one of the best teachers on staff and she was that way because of her experience and informal education. When she retired, she was replaced by a BA educated teacher. Now, many teachers require a masters degree to obtain a continuing contract, and many of our school RNs have MEd or MSN degrees, and they see quite a bit more money for obtaining these degrees. It is simply the way of things to require more formal education. In reality, teachers will also tell you that they learn the most about teaching from experience vs being in school. I know, I now work with them.
I believe that is the most ethnical thing to do. Some facilities, mine included, are grandfathering these nurses in. I was grandfathered myself back in the 1990s when they stopped hiring LPNs in critical care (although they did break the rule a few times). I think its despicable when veteran nurses are forced out of jobs which they have done well for many years. However, that is the corporate world of nursing that many of you live in. I'm glad I retired before I had to deal with most of it.
I think I've said enough here and I doubt that I will post on this particular topic again. I expect posters to be willing and able to read what has already been written and above all I expect politeness, which is NOT too much to ask.
I think that words here have been extremely misunderstood and in some instances, there has been a lack of tact.
All I'd like to toss in, is that the more education you have does not instantly and automatically make you a better nurse. In all honesty, sometimes you can't fix stupid. There are A+ nurses with certifications and degrees and there are also just-barely-passed nurses...lest we forget the extremely intelligent with a severe lack of common sense (which also involves the putting the knowledge to action part of nursing).
I am and will always be proud to be (or have been) an LPN. A facility I used to work at decided that one floor in particular should have all RNs because they'd perform "better nursing." My manager (who was a BSN-RN and almost done with an MSN) fought tooth and nail against it to keep her LPNs. That tells you something. Not that all LPNs are sooooo skilled, but that she knew the quality of what she had and didn't want to give it up.
But don't get me wrong, I plan on continuing my education as far as time and money allows through the rest of my life. I am not against furthering your education. Do I believe it will make me a better bedside nurse? In some instances, sure. But in other instances, no. Nursing is without a doubt a knowledge based profession....but you also need social skills, a keen eye and ear, and the ability to troubleshoot and problem solve. Not every nurse, no matter what degree you have, has those abilities and some things just cannot be taught, you need to figure them out on your own.
I believe as humans we learn every day. As nurses, we learn all of the time. Every day that you learn something new or make a mistake that you learn from or encounter something you never have....that improves your abilities. Makes you a better nurse. Experience is a big part in a quality nurse....and a whole lot of education behind that experience surely doesn't hurt. There are some LPNs that even as I further my education, I can only hope to be as good as they are. And hazel, I feel like you might be one of those.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I don't think most physicians are wired into this debate nor do they ask you "are you an ADN or BSN? I need to know if I should view you as a professional". Honestly, why would they fuss over something like that due the reality that compared to the length of medical school/residency/fellowship the difference isn't all that significant.
Perhaps it would be more so if you speak narrowly about APRNs and certification in their specialty.
I think you make a lot of good points. With all of the elderly we will be seeing in the near future and special needs home care kids, I think that LPN's can be an asset to the team. I have worked with many LPN's in the past. They primarily worked on postpartum. I did not micromanage them or any other nurses. The LPN's I worked with were skilled and knowledgeable NURSES. We collaborated, I did what I needed to do, and trusted them to let me know when they needed me. I was rarely disappointed. I am sad to see that we do not use LPN's much anymore. Because of their scope of practice, they are not a great fit for intrapartum care BUT they are wonderful on postpartum, nursery, and as scrub nurses in C/S. It is degrading to have them as nursing assistants. They have much more knowledge than a nursing assistant. In PA, our acute care nursing assistants are not certified. The NA in some hospitals may have previously worked in a factory or at Wal-Mart. The trouble with LPN's in the hospital setting, is that many facilities tried to use them as a "cheaper" alternative to RN's and put them in in situations which were not a good fit for their scope of practice. For example, an L&D nurse needs to be able to give her own IV push meds and read her own EFM strips. Having an PRn who has her own labour patients "cover" this for an LPN is not practical. With all of the push for nurses working to the limits of their license, maybe we will see LPN's working within the full scope of their license in LTC, physician offices, and home care settings. That would be a good thing. Unfortunately with the ADN getting pushed out of many hospitals, they are now often competing with the LPN in LTC settings. That is not something I agree with, but in this area we see it more and more.
This actually offends me greatly! Bearing in mind I live in a different country and I am not being phased out of acute care. I do work in acute care in a rural hospital and do many different highly skilled jobs in my day. ( I can read efm strips and ECG strips, I can manage a critically ill newborn, I give all my own meds in all their various routes including IVP and through a CVAD as well as peripheral IV, manage and initiate IV lines, care for post op patients, work in the ER, be part of a code team, I can lead community education classes, I can work to my full scope on a cardiac or stroke unit, I can work full scope on a L&D unit or a post partum unit, I can assess patients and understand when someone stable becomes unstable and communicate that to the appropriate person. I work as part of a team, a multidisciplinary team.) I do not want to be a long term care nurse (although for others it is where they shine) or an RN, I don't want to be the RT or physiotherapist. I want to be what I am, a highly skilled, well trained LPN who knows my job, my role and my abilities. I take offence at others thinking my skill set and abilities means I'm only good enough to work with the stable patient. I'm not skilled enough to manage very unstable patients requiring a very high skill set nor am I skilled enough to do chemo meds etc., but neither are a lot of new RN's. My college outlines my competancies, (which demand a high level of knowledge, skills and flexability as well a critical thinking skills) my province employs thousands of LPN's in high acuity departments, rural centers, city hospitals, Doctors clinics, long term cares and home cares. I'm very grateful I don't practice in the states and have to tolerate this narrow minded antiquated thinking.
I agree with this in many ways, its definitely refreshing seeing someone happy to be where they are! I know where i'm from there is still a large stigma attached to LTC and homecare nursing, even my own family members have made comments that i'm JUST a LTC and homecare nurse. The thing that irks me the most is when i get the "You're JUST an LPN...". Yes, that may be true but while i care for those that have chronic illnesses, that frees up time for RN's to care for those who need more immediate attention. I do have less knowledge than someone with a BSN but i have the proper knowledge for the tasks i'm designated to do.
The only thing that i don't necessarily agree with is your depiction of what LPNs should be doing, that may only be because with my training, i am able to do a lot more than i get credit for. Here in Alberta, LPNs have one of the widest scopes in Canada and i'm grateful for that. I enjoy my job, i LOVE working with the elderly and with the trend of today's healthcare system, more and more of these sub-acute clients will be heading into nursing homes or even going back to their own homes. I'm thankful that i'm well equipped with the knowledge and (some) experience to care for them effectively.
Specializes in Hospital, Foot Nurse, NRSNG Educator.
My GOODNESS....... ! I ONLY POPPED BACK IN HER TO SEE, I had a message that there were "Likes on my posts" never payed much attention previously. Wish I had not this time either.... yes..... I am ashamed at times to be part of this family of Nurses.... and YES !!!!! "Nurses eat their young" and here is proof !!!
BUT ....
IS THIS NOT MOOT, ARE the discussions back and forth in this thread, doing exactly what we are taught NOT TO DO !!!???, the very blood of our career, our beings.... ?!?!?!? we are HEALTH CARE PROVIDERS, ??? ...... we are doing to each other what we promise have an oath, not to do to our patients !!!
NOT TO JUDGE, NO PREJUDICE , DISCRIMINATE, BE UNJUST, BIGOTED, HAVE A PRECONCEIVED IMAGE OF SOMEONE ELSE'S LIFE ?
LEAST OF ALL ASSUME, OR BE RUDE , INSULT, how dare we perceive to know someone else's abilities based on their path, it is made up of so much more than books and bedside.
in reading back .... I am saddened by it all, in this day and age, and in this world.... as it is... (and as crazy as it is, like to know that any one of us would do our all for the other in an emergency) call me naive....
"we are far more alike than we are different," and .... "LIKE" it or not, I feel we need to embrace that, not pull it apart , no matter what or how many letters after our name we are hiding behind..... !!!
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.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Once again, I respect how people want to define the role of an LPN for themselves, but it has to be factually accurate. There is no actual separation between the two that intends to have LPNs in longterm care and RNs in acute care.
The way it would work would be that within the staffing construct of a unit as far as acuity patients would be assigned. There are a lot of variables in that. One of those is that RNs and LPNs work together in an acute care setting. I've noticed over the years a definite (and I feel very unfortunate) trend to build walls between CNAs and nurses, LPNs and RNs, and now ADN and BSN. The actual differences are defined by each state's scope of practice. That's not what I'm talking about. It would be ridiculous to say there are no differences. Education matters.
The trend is to create perceptual walls beyond that. I remember being very surprised when I returned to nursing after being out for a while that a CNA was not allowed to know the patient's diagnosis in some facilities and people behaving in a turf-guarding manner over that which seemed so unnecessary to me.
Then I hear it said that only certain types of nurses know how to "critically think". So you're telling people that if an LPN looks at her patient and he seems to be turning blue they must "collect the data" and report to an RN? That's just silly and counterproductive.
I view this with a different twist and it involves time and money. For me - LPN program is 10 months. After ten months, I have the opportunity to work as a licensed practical nurse, and then while making good money and gaining experience, I can do a transition program of approximately 1 year to do the RN. So 10 months + 1 year = RN all while having the opportunity to work at LPN level pay for the latter. 2 year RN programs are highly competitive where I live and can often take years on a waiting list. My time is money.
Sure now a days LPN's are presumed in the LTC corner but it shouldn't stop someone who wants to ultimately be an RN or BSN or NP from pursuing it. I view it as building blocks.
Michele9261
2 Posts
Does school trump years experience? I guess it depends on what kind of facility the 50 years experience was at.