I'm an LPN and I understand.

[downsouthlaff]

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.

[meta091]

And those upper level degree classes...they're about management, research, etc., not skill.

You are making my point clearer. Being a nurse is not about clinical skills. To be an effective Registered Nurse, one needs to have a higher degree of education (with the classes you mention) to match the growing field of healthcare.

[No Stars In My Eyes]

Old fogey here, putting in my 2 cents. This, of course, will never happen, but "in the days" of true team nursing, there was room for all, we each worked a slightly different strata according to our educations, but each person had an important place as a team member. All contributed in a joint effort at caring for the patients. Nobody was 'better' than anyone else. In addition to our primary jobs (Charge nurse, an RN; med nurse, an LPN) we all took a patient assignment. Usually we worked by twos. Sometimes I was paired with the RN, sometimes with an aide.We all did 'bedside' nursing.

I think the way of today, having an RN responsible for total care, for everything involved with a patient's care, has increased the stress level considerably. And then there's the nurse-patient ratio which is a set-up for burnout if I ever saw one.

Nursing is not a contest of who is better, more experienced, who has the most letters after their name, who is climbing the ladder to get where-ever. Seems like now everyone devalues the others for one reason or another. It didn't used to be that way, and it will probably never change back to be that way again. More's the pity for the patient. (regardless of their acuity level.)

[meta091]

To the glorious NP that thinks education is everything, experience means a great deal too.

I agree. Experience and education are vitally important. I've never stated experience is not needed. Tone down the aggressive, and insulting, tone.

I wonder how long you have total years in the field.

Doesn't matter. We can spend all day equating years of experience in different clinical settings compared to different healthcare systems. It does not matter. While I do not have RN after my name any longer - we are still in the same vein of healthcare professionals, and no one should jump to the accusatory "how long have you been a nurse" line of questioning.

You cannot teach someone how to think critically.

Yes you can. It's all anyone does in nursing school.

As for the science courses. I've completed all the ones required for a BSN- a 4.0 average.

Good for you. I mean that in a non-sarcastic way. I feel I'm being villianized here for no reason.

[gypsynurse]

Loved this...... "Old fogey here, putting in my 2 cents. This, of course, will never happen, but "in the days" of true team nursing, there was room for all, we each worked a slightly different strata according to our educations, but each person had an important place as a team member. All contributed in a joint effort at caring for the patients. Nobody was 'better' than anyone else. In addition to our primary jobs (Charge nurse, an RN; med nurse, an LPN) we all took a patient assignment. Usually we worked by twos. Sometimes I was paired with the RN, sometimes with an aide.We all did 'bedside' nursing."

Thank you "No stars in my eyes" , and yes , "mores the pity for the patient... it is not a competition, but loving to give the care we provide our pts, otherwise, don't be in nursing !

" I'm out too !" round and round and round we go !

[SWM2009]

I never had any notion that my LPN education would pave the way for me to work in acute care. None of my classmates did actually. Most of us are now in LTC, some in home health, some in MD offices or clinics. Some of us plan to further our education, some don't. All in all, I spent 18 months going part time to a LPN program and I was able to double my non-nursing salary with that 18 months of education. Could I have pursued the RN/BSN option first? Absolutely but it would have required taking on additional debt and I was not willing to do that. I graduated debt free and my LPN will finance any future educational opportunities I pursue.

In other words, LPN is still a pretty darn good career path if one is willing to consider working in areas other than acute care. If acute care/hospital job is your dream job then by all means go for that RN/BSN because that is what you will need.

My 2 cents.

[nursel56]

Seems like now everyone devalues the others for one reason or another. It didn't used to be that way, and it will probably never change back to be that way again. More's the pity for the patient. (regardless of their acuity level.)

How I miss those days. Not to say there was no disagreement, but the belittling and disparaging is like walking through a gauntlet of razor blades now.

So I don't get it. You were taking offense to the fact I said higher education enables someone to be a better nurse. Since you're going to become a NP, my question is why? Because to practice at the level of a nurse practitioner requires higher education. It is now a doctorate, and was a masters, and prior to that was a certificate.

I was not aware that a doctorate is required to practice as an NP now. Also, if you're talking about the DNP, my understanding is that it is meant as a doctorate more focused on clinical practice as opposed to a PhD being focused on research, but it is not a doctorate-level nurse practitioner, despite the initials, but a "doctorate in nursing practice". Is there a more recent document than the AACN DNP Essentials?

I'm not saying the LPN or diploma RN won't be very caring or good at some clinical skills, but that is not a "nurse." You can teach anyone to put in a cath or walk someone to the bathroom. Being a healthcare professional demands higher levels of education.

I don't understand why you would be confused about people taking offense at your attitude after saying something like the above, not the least of which is that it simply isn't true.

[meta091]

I was not aware that a doctorate is required to practice as an NP now.

It's in the same vein as BSN vs ADN RN's. Yes they take the same test and are licensed the same, but more and more are ADN's being required to pursue higher levels of education for that profession. The same is true with NP's. A DNP is quickly being mandated for any NP as well as more specific licensing (Family Practice NP's are being asked to receive acute care specification).

Also, if you're talking about the DNP, my understanding is that it is meant as a doctorate more focused on clinical practice as opposed to a PhD being focused on research, but it is not a doctorate-level nurse practitioner

You are correct. A Doctorate of Nursing Practice (DNP) is becoming, quickly, the standard level of education for a Nurse Practitioner. Same thing with BSN and RN's. Everything seems to be moving up a notch.

And my earlier post was taken wrong. I merely meant to say being compassionate or having good clinical skills does not solely make someone a good nurse. And I stand by my stance that higher levels of education are required for nurses.

[NurseSpeedy, ADN, LPN, RN]

No. The post I was replying to asserted that extra school was pointless because it did not pertain to clinical skills.

I never said that extra school was pointless. What I said was that it wouldn't make a difference when it comes to bedside nursing. In order to be a good nurse, one has to be able to critically think. I don't believe that having a higher degree means that one can do this better than another. As the RN program that I have been going through has stated, "you cannot teach someone good critical thinking and clinical judgement. This will have to be learned through experience. You will not find it in the textbook".

Also, remember that the way your post read was that anyone can walk a patient to the bathroom or insert a catheter...this is true. This is why PCTs are allowed to do them. I was simply stating that as LPN or diploma RNs we are much more skilled than that, and it includes clinical judgement calls. It was you that stated that we are not "nurses" and that is the main reason I replied to your post.

[Bluebolt]

It seems that quite a few of these posts are splitting hairs over exactly which is more important, education or experience. Both are very important and both will be required to continue successfully in the healthcare field. Lets stop the argument over whether 51% experience and 49% education is a better ratio than 51% education and 49% experience.

I'm afraid some ego's are seeping into the posts too much and others fragile ego's are showing too easily. Lets keep this a professional and constructive topic about what the original poster suggested. Should LPN's be kept only to Long Term Care? Are the programs being completely honest and upfront with new students about where their career is headed? ADN's will be forced to be BSN's very soon, that is happening already and shouldn't even be a topic here. Education only can enrich a person and we should agree on that and drop that portion of the "better than" topic.

[NurseSpeedy, ADN, LPN, RN]

I agree. Experience and education are vitally important. I've never stated experience is not needed. Tone down the aggressive, and insulting, tone.

Doesn't matter. We can spend all day equating years of experience in different clinical settings compared to different healthcare systems. It does not matter. While I do not have RN after my name any longer - we are still in the same vein of healthcare professionals, and no one should jump to the accusatory "how long have you been a nurse" line of questioning.

Yes you can. It's all anyone does in nursing school.

Good for you. I mean that in a non-sarcastic way. I feel I'm being villianized here for no reason.

If you remember your earlier post, the one I originally replied to, you stated that LPNs and diploma RNs are "not NURSES"....the board of nursing believes different. So, if you don't want an insulting tone, don't insult other nurses. Implying that all an they can do is walk a patient to the bathroom or insert a catheter is insulting because we do much more. The reason I questioned how long you have been in the profession is because of the great emphasis that your earlier post put on education, basically as if you thought that nurses with less than a bachelors degree didn't learn anything besides a skill set, and the one that you used was a skill set that my state allows PCTs to do. Since you have skirted around the question as to how long you have worked in the field it sounds like you went straight from high school to Graduate degree and didn't stop anywhere along the way to work in the trenches with the nurses that you think are so undereducated and unqualified to to the job that many states still allow them to do in a hospital setting. Yes, the trend is BSN, and it will likely end up being what is required in the hospitals universally in time, but that does not mean that people with a lower level of education cannot do their jobs. If you had spent time working your way up, I would expect to see a larger amount of insight and respect to what each level of nursing is educated on an how being less than a BSN does not make them incompetent for bedside nursing. This is what I have seen with other nurses who have worked their way up-more respect and understanding of what each level is qualified to do. Nursing school teaches someone how to apply their critical thinking skills to the role of a nurse. We did this at an practical nursing level. Having a bachelor's will give me more management skills. It will not make a difference in my ability to think and act as a nurse, otherwise I would not have been permitted to work in ICU, where I had to think critically. Being a new grad, however, held the hospital that I worked for from placing a BSN in critical care until they had six months on the floor to prove that their clinical judgment was sound enough to work with unstable patients. I only brought up my science courses because you seem focused on a higher level of science being the need for a bachelors when both an associates and a bachelors require the same amount of science education (at least all the programs I looked at an there were many before I made a final decision). The BSN courses were geared towards management and research where yes, if a nurse want to function as a manager or work in research I agree they are needed for that area but not for bedside nursing. When you talked about the walking a patient to the bathroom I assumed you were referring to bedside nursing. As for feeling like you are being villianized...it all goes back to telling anyone who was an LPN or a diploma RN that they are not really a "NURSE" and that we may "insert a catheter or walk a patient to the bathroom"...this is downright insulting and you came off with a "better than thou" attitude. So you don't think that anyone with less than a BSN should be doing anything besides simple skills and working underneath someone with a four year degree. That's great. So tell me this, why would a hospital be willing to hire a new RN with an ADN with prior LPN experience (yes, some may ask that the nurse agree to complete their BSN within a couple of years but they will also provide tuition reimbursement, and then some are still happy with two years or diploma) but not hire the new BSN who has never worked in the field prior to obtaining their degree and therefore has no clinical background besides school? This is a common scenario in my state. Hopefully this tit for tat is over and I won't see anymore updates coming through my email that I feel compelled to defend myself because I am really over this thread.

[NurseSpeedy, ADN, LPN, RN]

I never had any notion that my LPN education would pave the way for me to work in acute care. None of my classmates did actually. Most of us are now in LTC, some in home health, some in MD offices or clinics. Some of us plan to further our education, some don't. All in all, I spent 18 months going part time to a LPN program and I was able to double my non-nursing salary with that 18 months of education. Could I have pursued the RN/BSN option first? Absolutely but it would have required taking on additional debt and I was not willing to do that. I graduated debt free and my LPN will finance any future educational opportunities I pursue.

In other words, LPN is still a pretty darn good career path if one is willing to consider working in areas other than acute care. If acute care/hospital job is your dream job then by all means go for that RN/BSN because that is what you will need.

My 2 cents.

Some of us have never had LTC experience and all of our clinical rotations were in the hospital setting. This is where LPNs started when I went to school. Trying to transition to LTC after many years of acute, usually unstable patients was a culture shock. This is why I'm taking on the debt to finish my degree that I started years ago. I'm just not cut out for LTC and the horror stories that I personally saw on a daily basis for the year that I gave it a try. Acute care was stressful but at least it seemed organized and professional. LTC from what I could see was a lawsuit waiting to happen. I worked for the largest senior living facility in the country. I had 110 residents that I was responsible for with care staff that would not show up and a blank report sheet from the days prior. Management didn't care and wasn't going to make the environment safe so I'm back to school after all these years. I just wish it would have happened sooner because going back to school for a BSN at my age is no picnic and learning was a lot easier in my 20's.

[meta091]

If you remember your earlier post, the one I originally replied to, you stated that LPNs and diploma RNs are "not NURSES"

I've already stated this comment of mine was taken incorrectly. I meant compassion and clinical skills does not make one a "nurse." I did not intend to insult other nurses.

Since you have skirted around the question as to how long you have worked in the field it sounds like you went straight from high school to Graduate degree and didn't stop anywhere along the way to work in the trenches with the nurses that you think are so undereducated and unqualified to to the job that many states still allow them to do in a hospital setting.

This is just desperation. My point was: we can argue about years of experience all you want. Where have you worked? What shift? What hospital? How long? What patients?

It's pointless. I've worked "in the trenches" as you say, but I don't wear it as a badge of honor as you do. We are professionals here and should act as such. Stop with your trivial attempts at holding something over another with years of experience. I've never said someone without high levels of education are sub-par nurses. I'm merely saying higher degrees allow for better professionals.

how being less than a BSN does not make them incompetent for bedside nursing.

I've never said that. I merely said they are being phased out because of the increasing need for higher degrees of education. This is why diploma nurses are phased out. The trend will continue.

it all goes back to telling anyone who was an LPN or a diploma RN that they are not really a "NURSE" and that we may "insert a catheter or walk a patient to the bathroom"...this is downright insulting and you came off with a "better than thou" attitude.

I've clarified this: saying that my point was clinical skills are not what makes someone a nurse. I never intended to say a LPN or ADN RN is anything less than a nurse.

So tell me this, why would a hospital be willing to hire a new RN with an ADN with prior LPN experience (yes, some may ask that the nurse agree to complete their BSN within a couple of years but they will also provide tuition reimbursement, and then some are still happy with two years or diploma) but not hire the new BSN who has never worked in the field prior to obtaining their degree and therefore has no clinical background besides school?

I've never said experience is worthless or not needed. I've again and again only said that higher degrees of education prepare the nurse to perform at the level required of being a healthcare professional. Physical Therapists are being required to get doctorates, Nurse Practitioners are required to have doctorates, RN's are required to have bachelor's. It's just the way things are moving.

I don't know why you are so mad.