Is magnet status hospitals shutting out all LVNs

Peterjoy93 · Jun 27, 2012

I work in an acute care hospital in Tampa florida and they are not hiring any more LPN's. I would have jumped on the position if I were you. My hospital offers tuition reimbursement and will work around your school schedule. I will be done with my ADN this fall. The hardest part for a new nurse is to get hired and you turned it down? Also many hospitals like to promote from within. Hopefully it is not too late to rethink your decision.

manager123 · Jun 27, 2012

Ladymaam, by identifying the state as California, you have cleared up much of the mystery. With our staffing ratios, many hospitals initially hired a large number of LVNs because the ratio laws speak only to LICENSED staff. It does not specify RN staff. The hospitals that hired LVNs to meet the licensed ratios have been under attack from the RNs who instead of meeting ratios for just their patients are now responsible for the LVN patients as well due to scope and standards. On a med-surg unit, the RN essentially cares for 10 patients instead of the 5 indicated in the ratio laws. Totally legal and within the scope.

However, hospitals are highly keyed into nurse satisfaction. I am certain this is NOT a nurse satisfier for RNs in this state. New RNs are also looking for jobs in droves and many RNs are unable to find that first nursing job. The job market currently is allowing employers to pick and choose who they want to hire. 2nd strike against you in todays market.

There are only 26 Magnet Hospitals in California. The Magnet "journey" takes multiple years as there are many requirements that muse be met before even applying. Hospitals are hiring BSN RNs preferentially to meet higher education requirements and doing everything they can to increase patient and staff satisfaction scores if they are on the journey.

The break nurse is not a glorified CNA job. It also gets your foot in the door for future opportunities. If you turned it down, it was a classic mistake of thinking you can find "better". As an LVN, you are HIGHLY limited in acute care hospitals, especially any that might be on the Magnet journey.

CherylRNBSN · Jun 27, 2012

Don't be discouraged. Times are just changing, and we all have to change with them.

I was an LVN (Tx). I was hired at a hospital in Houston over 20 yrs ago, and even then, at that , I was relegated to work as a nurses' aide, i.e., taking VS, ambulating pts., no meds or IV's. So this process began a long time ago.

I resigned that job, b/c I did not want to lose my skills. I was able to find a position in med-surg at another hospital where I was able to fully practice in scope.

Now, all these yrs. later, I am a BSN, but have been away from the bedside for over 10 yrs. I am having a difficult time getting hired. Hospitals can just afford to be picky.

I realize I will NOT likely be hired back into critical care (though I have 6 yrs. experience in Texas Med Center, high acuity ICU, and another 6 yrs. experience med-surg). So I am prepared to take a step back and put my time in on the floor, then tx back into critical care.

It's expensive to hire and precept new employees, and the hospital is not willing to take a chance on a nurse away from bedside for so long. While I KNOW I can do the work, why would they hire and train me over someone w more recent experience?

I agree w OP; you cannot take it personally. It's a business, and the business is changing. Just educate yourself about the changes, and make a new game plan.

That's why I said "Don't get discouraged". You have a path, and a plan. You WILL get there, it just may not be the more direct route you envisioned.

ANY patient care experience is helpful. TRY TRY TRY for ANYTHING in acute care, but if that fails, don't be disappointed or discouraged if you can get a position in a hospice, or a rehab, long term care, etc. I may have to do the same thing. If I do, so be it.

While this will not make you or anyone else searching for a job feel better, I remember in the 90's walking into a hospital and leaving with a JOB 30 minutes later! It was just soooo much easier. I was shocked at how much the environment has changed when I began job search for acute care position.

I am now in month three of job search in acute care at one particular institution. I've had two interviews. At interview on Monday,Nurse Manager was very frank and helpful. We discussed hiring environment, etc., and I sought her best advice for my particular situation. I was very open and not at all defensive, and she basically told me I should aim for floor, then tx back into critical care, as they are filling positions internally, and with new grad BSN residencies. Now, if I'd had current experience, I'm sure I would have been a candidate.

So I just readjusted my expectations, and THANKED her. I would encourage you to do the same. Ask questions when you are interviewed! Seek advice from those doing the interviewing and hiring about where the see nursing and healthcare headed, ask about their institution and what they are looking for, and what they would do if they were in your position.

Best of luck to you!

rnpatrick · Jun 27, 2012

The current situation is another one of those short sighted brownie point periods. What I call the "wizard of oz behind the curtain" that decides what nursing should do(the same brain trust that caused the nursing shortage by shutting down diploma programs) has decided that hospitals need to reach 80 percent BSN.This has been going on for 35 years and resulted in only 38 percent annual BSN grads. The lobbyists for the for-profit nursing schools have bought influence with professional organizations and legislators to force nurses to go back to school. Again, the human factor was not considered so it will fall flat. Until they are forced to admit this you have to ride it out. Offices and clinics are your best bet.

BrandonLPN, LPN · Jun 27, 2012

Actually, the best bet for LPNs isn't Drs office or clinics, it's LTC. We make MUCH more in nursing homes. I started out at 20.00 an hr where I work, out of school. Of course, if you are willing to only make 13 or 14 dollars per hour, it might be worth it.

As for the whole LPNs in hospitals topic, I'm gonna go out on a limb and say I DON'T think LPNs should carry their own assignments in the hospital. Too many restrictions, at least where I live.

However I DO think we should return to team nursing. Something like one RN and two LPNs for every 10 pts on a med/surg floor is doable. And more efficient and cost effective.

If the RN role wants to be viewed as a truly " professional" role, then that means becoming more of a supervisory position.

And taking responsibility for the people under you in your team is part of being a professional. Doctors do it with mid-levels. Physical Therapists do it with PT aides. Pharmasicts do it with pharm techs. Why should a professional RN be any different?

redhead_NURSE98!, ADN, BSN · Jun 28, 2012

Our hospital is requiring all of our LPN's to be working towards their RN by the end of next year. The word on the street is because "they can charge more if the hospital is all RN." I'm not sure where that comes from, but that's what I heard.

james_lankford · Jun 28, 2012

The reason I am so bent out of shape is that one employer asked if I would be interested in a new position, where an LVN would cover breaks for the RNs. My initial thought is that this is a "glorified CNA" position. No way! I need more. I am ready to take on more responsibility, not go backwards. If it's CNAs they want, California should reconsider the scope of practice for their CNAs. Lots of hospitals in other states, allow their CNAs to do their Accuchecks. And the worst of it, if I cover breaks, I will have been responsible for approx. 30 patients in one work day. Would an RN do that...bet my last dollar, absolutely not.

it was really dumb for you not to have taken that job

you would have made contacts, you would have gained references, you would have a new line to put under experience on your resume

for all you know, one of the nurses may have quit or retired in month and then you may have been promoted or at least given more responsibiltiy, the hospital may have even been willing to pay for part of your training

if you're unemployed and have no prospects you ALWAYS take the job

compare this line on your resume

responsible for approximately 30 patients

to this line

BrandonLPN, LPN · Jun 28, 2012

^I agree. IMO, you should have jumped on this job. People who want everything usually end up with nothing.

CherylRNBSN · Jun 28, 2012

^I agree. IMO, you should have jumped on this job. People who want everything usually end up with nothing.

As my divorce attorney said "Pigs get fat. Hogs get slaughtered."

okscrapper · Jun 29, 2012

I am a 2 year LPN in Ok. I networked during my clinicals, leadership, and preceptorship. I was hired at an LTC and have been there full-time and PRN. In between I tested home health, gaining experience and skills. I took phlebotomy course for the lab and IV skills. It has pd off allowing me to care for higher acuity pts.

Now I work agency and work skilled, LTC, assisted living, and a few hospital jobs. I work full time and love the variety. I treat each assignment as a job interview and the result is repeat assignments and valuable references. LTC is hard, but the experience is invaluable.

LTC definitely pays better than clinics, and the experience I have gained let's me work in lot of different areas. My advice is go to a skilled LTC and learn everything you can. Then you will start having choices.

SinikRN101 · Jun 30, 2012

I would have taken that job because at least it is acute care that you can put on your resume. My first job as an LVN was in long term care. (Noc shift of course) Most nights I had 50+ patients with 3 CNA's. One RN and LVN team was on the other side of the building, not much help for me. My "orientation" consisted of working 3 shifts with another LVN who was afraid I would take over her job and any questions I asked were replied with "oh don't worry about that, we don't do that on the night shift." Man was I ever lost when I had to work a double. :eek:

kcmylorn · Jun 30, 2012

For my 32 yrs years of hospital based RN experience and hearing the variety of reasons for this on the job from other RN's and managment and being there, I personally feel LPN's have been phased out of acute care largely because of the 'infighting' that takes place between the RN and the LPN with the patients' acutity level on the rise.

I have to say- the resistance to RN direction and delegation= the infighting, is probably the single most reason hospitals decided to phase out LPN's. From what I have experienced, myself and too many of my RN collegues would delegate to an LPN working UNDER us( 'under' because that is what the Nursing Practice Act states- LPN's are not independent practioners- "LPN's work under the direction of the RN') and were met with insubordination, refusals, running to the supervisor for back up on how "unfair" we were( but said to the supervisor- "She disrespected me" or 'It's not what she said but how she said it" to give creedance to the" I'm not doing it, I'm just as much a nurse as she is" argument) aka "staff splitting" and undermning the RN authority and therefore, delays in care of the patients and general discord and mayheim on the unit. The nursing managment and the PTB( hospital associations) took all these insidents into consideration and came to the decision- Eliminate the problems: phase out the LPN level positions, replace where posible with RN's- the patients are becoming sicker anyway and the RN license is more versatile- is the independent practioner( according to the Nursing Practice Acts- functions under the direction of the physician), legally responsible and able to do more complex monitoring, can give all the IV meds needed, direct the care of patients, problem solve and make decisions on a higher level etc. I think the Magnet designation criteria just followed suit- I am not a fan of Magnet designation( too expensive/another waste of healthcare money and at the end of the day- makes no difference for the nurse or the patient , only unless bragging rights to a stupid healthcare system) This kind of discord can not be going on when patients are coming into hospital settings more complex and acutely ill then they had in the past- greater number of co-morbities that demand more critical interventions even at the med/surg level. The med/surg patients of today would have been on a stepdown or ICU level of care- 10-15yrs ago. These are not stable patients. For LPN's and CNA's for that matter( they do it also and it may bite them in the end too) to be creating a power stuggle, jeapordizes the safety/life of very sick patients.

This is becoming a shift also in the licensure level in the LTC facilities. many of these LTC facilites are hiring more RN for bedside care. The day of the "nursing home" being the domain of the LPN's and all RN's can stay away is slowing being phased out also. Why: with one major LTC corporation, the reason I have heard are( ease dropping in a corporate dinner meeting): "biting the bullet and hire only RN's because of the number of falls, med errors, lawsuits and family complaints" Not my words.) That statement recognizes the fact that it is more expensive to hire all RN's but the loss of revenue down the road may be cheaper in the long run.

I am currently in primary care/ clinic aka Community Health/Public Health- I can foresee the same thing happening. 45 million people without health insurance( both with jobs and without jobs), illnesses being left go in lieu of more pressing priorities- food and shelter, when sx's become so bad it's off to the ED for care. The move in this country( Dept of Human Services and the Obamacare ACA) is to get these patients into the community health centers and out of the ED. The stop clogging up expensive ED resourses. What that does to the acuity level of the patient population, they come in with a more progressed stage of an illness- example: Hypertension. These community centers have been staffed in the past with LPN's and MA's. The pace used to be less stressed, patients less acute, essentially well walkie talkies. Now: These patients are requiring mega rounds of patient teaching( low literacy levels, over stressed families and care givers, cultural/ language barriers), case managment( increase in child abuse and neglect, doesn't understand the navigation through the healthcare system or lack the fincancial resources to get them there), disease managment( lack of disease process and medication action understanding, failure to see the relevence, lack of priority on dz control/noncompliance and again , lack of funds) and triage- these are RN responsibilities. Regulations are in place that stipulate this- especially the triage( the sorting out of patients according to sx's and resourses needed for care. assigning a numbered level of acuity based on severity of illness---RN only) because of the liability and the depth of decision making required ( the extensive educational backround in pathophysiology, pharmacology) that goes along with the triage. and for it to be done in a managed care environment. The role and performance of these roles are very complex and multifacited- this is not in the MA or LPN domain. and requires a heftey/extensive educational backround. I have had LPN's and receptionists get into battles with me over this- they have been doing the triage in the past- Well- life has changed. In view of the now regulations, management has said: Stop doing it. Not your job description according to the law". I can see if this becomes too much of a battle between RN and LPN- LPN's will be phased out of the clinic setting also.