Is magnet status hospitals shutting out all LVNs

ladymaam · Jul 3, 2012

you make a very compelling argument. I would love to add a grand line like that to my responsibilities as an LVN. I don't want to take a position that I don't relate to, and get bored or feel like "it's not a good fit". At this time, I haven't turned down any job offer, I'm waiting for a final response. I just didn't close the deal. I just ended it. I was too stuck on the position I wanted rather than what the position could offer me.

ladymaam · Jul 3, 2012

Trust me, I know what I'm up against. I don't throw away opportunities. The way the position was being explained, sounded like I would be in a position to be hated by the RNs and if they didn't learn to trust me, or refused accept the changes of LVNs being added, where would that leave me. I've been in positions that companies made up because they were looking at the bottom line, and I was first to go because it didn't work out.

I hate job hopping, for whatever reason, and if my intuition says that I need to look closely at what is being offered, then that's the decision I'm going with.

I know what's best for me, and sometimes landing a job is the easy part, finding a good place to get planted so you can grow is a little more difficult.

ladymaam · Jul 3, 2012

I kinda resent your cheeky remarks. I know my worth.

this is in response to response #20.

kcmylorn · Jul 3, 2012

If you were referring to my post as being cheeky - I can assure you it wasn't meant to be "cheeky" in the least- my post is based on 32 yrs of observation, listening to the concerns of managment, listening to the general nursing workforce on hospital units and some LTC facilities and watching the shifts in personel and licensure levels over the years. Cheeky is not what I was going for.

I have seen hospital units go from equal numbers of LPN's and RN's to all RN's and no LPN's. It began way back in the late 1980's when all the LPN's were transferred out of the ICU/CCU's to the general med/surg floors and eventually out of the hospital altogether. The LPN's went to the LTC facilities at that point. Now this trend is moving toward LTC and the reasons I heard I actually overheard. I overhead this disertation in a restaurant- the corporate group had NO idea I was a nurse as I was not in uniform.

My supposition on the clinic is based on my observation of the patients that are walking in and out of the clinic day in and day out. These patient's are sick and complicated. No longer are patient's admitted to the hospital for a GI work up for a week. If patients are admitted to hospitals today- they are really sick most are on deaths door. Some of thoise are medical nightmares on paper(the labs). So where do those who are"not that bad" end up when years ago they would be admitted to the med/surg units- the PCP office. Everything today is left up to the PCP. They don't understand why they are taking the meds they are, they have language difficulties,educational difficulties, their money is tight, their food is cheap and of no nutritional value and healthcare is not a priority. Surviving their dangerous neighborhooods is the priority. Most are employed but the employers offer no medical benefits, they have transportation problems so getting a kid to a cardiologist in a city 30 miles away is a challenge- the kid ends up with no cardiologist and the beta blocker being given once a week when the kid starts palpatations. Not to mention the crack and narcotic addicted babies and mom is out of control and inappropriate in the exam room when she decides to bring the kids in for care.

allnurses Guide · Jul 3, 2012

Hope Commuter won't mind my linking her articles again. Some people in this thread might find them helpful - as well as knowing the difference between assignment and delegation.

LPNs: Myths and Misconceptions (Part I)

https://allnurses.com/lpn-lvn-corner/lpns-myths-misconceptions-746909.html

LPNs: Myths and Misconceptions (Part II)

https://allnurses.com/lpn-lvn-corner/lpns-myths-misconceptions-750179.html

BrandonLPN, LPN · Jul 3, 2012

I posted this in the LTC boards, but I thought it worth bringing up here, too.

There is definitely a slow but sure trend of more LTC facilities hiring more and more RNs in floor positions in place of the LPN. This has little to do with any increase i

n acuity. Yes, LTC pts are sicker, but still well within the LPN scope of practice. If someone is sick enough to need meds by IV push or blood transfusions, they should be in the hospital. The reason more RNs are working the floor in LTC is entirely

due to the economy. Many new grad RNs are desperate. They can't get into the hospital, so they turn to LTC. And most don't make but a few dollars more than new LPNs in the same position. Of course a facility will hire a RN over a LPN if

there is minimal price difference.

These LTC administrators are exploiting the glut of new RNs. If they really "needed" RNs for their higher education, they would pay them accordingly. They pay them LPN level wages because they are doing LPN level jobs. There are many wonderful RNs working in LTC, and I'm sure they are learning a lot and using skills. But if they were doing work that "only" a RN could do, then they would be making RN level pay. That's the "magic" of capitalism. Employers are only too eager to take advantage of the tough job market. There's no excuse for a BSN RN who spent FOUR YEARS in school to make 21.00 an hour when they graduate. Yet that's about the going rate where I live for a new RN in LTC. THIS is why I will never work for a facility that dosent have a union.

kcmylorn · Jul 4, 2012

I made the same amount of pay in as an RN new to LTC doing bedside as I made as an experienced hospital RN doing bedside. Hospitals in my area do not pay RN's for their BSN's; they pay by experience level and speciality certification. Patients are often dischaged from the hospital to LTC who should never have been and wouldn't have been dischaged 10 -15 yrs ago. That was the advent of the sub acute units in long term care. Insurance companies will only pay for a certain number of day in the hospital for certain diagnosis. After that they kick the patient out- hence the controversy over hospital readmission rates. If the hospital nursing case manger says - the insurance compay will not approve any more bed days, that patient is set for hospital discharge and I do believe, IV push meds are not a criteria to keep a patient in the hospital anymore unless the med requires cardiac monitoring- IV push dilaudid, IV push Morphine, IV push lasix- all these meds can be given by hospice nurses in the home setting, neither is IV ABTX via a PICC line or a TLC but they are RN only administration. TPN , IVIG and blood transfusions are also given in the home settings by infusion nurses which are RN's and that RN sits with that patient for the entire length of the infusions. Some of these infusions are also given in the home settings to pediatric patients. These infusions can be given in LTC as long as there is an RN in the facility- I was that RN. I had also given all these infusions in the hospital setting. This is off topic

Is magnet status shutting out LPN's- No. The hospital administrations are.

okscrapper · Jul 4, 2012

As I said before, I am a 2 year LPN. I am studying thru Excelsor the LPN/RN bridge. Still in my LTC I do IVPG, infusions, monitor blood . I have talked an RN thru changing a PICC line drsg because Ira not in my SOP to chg it, even tho she wanted me to. I know my SOP by my Standards if Practice Act and follow it for my protection. I do resent that my skills have no value to hospital administrators. I have no problem being an LPN but I do want more options. I do love nursing,

kcmylorn · Jul 4, 2012

I do believe hospital admnistrations have looked at the limits of licensure levels and the scope of practice of the 2 different licenses( RN and LPN), I would also like to think that hospital administrations have looked at the educational preperation backrounds of both the RN license and the LPN license and came to their decisions based on all those reasons. While an LPN may know the mechanics of and RN only proceedure, there is far more to it than only knowing how to perorm the mechanics of that task. Any one can be taught to change caps( we teach family members to do this depending on the infusion company's policy) and flush a PICC line but there is far more to it than the physical act of replacing and old cap with a new cap.

LPN's 'monitor' blood transfusions- they do not 'initiate' them. A blood transfusion is started by the RN who stays with the patient for the first 15 min of that infusion because that is when there is the most likelyhood of a reaction to occur- There are 5 differnet types of transfusions reactions- the most sever happens in the first 15 min that is why it is intiated and monitored the first 15 min by the RN.

If an LPN is assigned with a patient with an IVIG infusion they are 'monitoring" the infusion once the infusion is up to it's ordered rate of about 100cc/hr. They are not 'initiating" it.( grabbing the bottle, spiking it, hanging it and setting a rate. They may be asked to get Vital signs prior to or the RN may get her/his own VS) IVIG has to be stated at a rate of 25 cc/hr for at least the first 15 min and the pt has to be monitored by the RN. If there is no reaction; anaphlyactic or cardiovascular, the the infusion is again increased to 50cc/h( this is called titration- this is not an LPN scope of practice) and so on 'by the RN' until that infusion rate is up to 100cc/hr. Titration of any infusion is soley based on clinical judgement. Advanced clinical decision making skills.

This is one very small part of what hospital administrators looked at in making the decision to phase out LPN's from acute care.

let me add- I am no fan of hospital administrations! They also looked at the priority setting for the LPN based on their program of study vs those of the RN and the RN program of study in relation to a full patient load and all that could go wrong in any one of thoses rooms- all the what' if's'. The priority setting of the RN is very different then that the priority setting of the LPN and it is based on that program of study and hence clinical judgment. You may well be "talking" an new RN through the mechanical task/steps of changing a PICC dressing but you are not talking that new RN through any part of their clinical decision making process. Please bear in mind this very fact( that the RN may not know the steps to changing the drsg but does know the clinical judgement) the next time one goes to their co workers behind the RN's back and labeling that RN as "stupid" this is staff splitting and that is something else the hospital administration is well aware of. Those steps can be taught to that RN by anyone but the clinical decision making was taught in the RN program- and far too many times in the far past, this has come up to nursing adminstration along with the bullying and bashing that went along with it which factored into them coming to the decision to eliminate the LPN license from the acute care setting. The teaching of mechanical steps now involves RN's teaching RN's- the same playing field.

allnurses Guide · Jul 4, 2012

If the thought process and depth of study were as described above, LPN/LVN school would be about 8 weeks long. On the other hand, when people say that BSNs courses are filled with subjects like nursing research, community health, healthcare policy, statistics and systems - resulting in an inept nurse who the LPN "can run circles around" -- well that is just as much of an offensive generalization. The hospital may have decided that an LPN lacks the smarts to deal with a reaction to blood products, yet many work in environments where a potential life-threatening event may occurr with no support team to call, like allergy immunotherapy and in-home with unstable vent/trach patients.

The best approach is to arm yourself with the laws in your state, and treat anecdotal accounts of the supposed characteristics of any individual nurse as the subjective analysis it is. Believe me, I and most of my nursing colleagues of whatever educational background have plenty of anecdotal stories to counter any such blanket statements. I'll pass on that for now, even though some are hair-raising and will have you on the edge of your seat.

DeniseLPN754 · Jul 5, 2012

Re: ADN's & LPN's not able to find work.

i just completed a C.E.U. on Nurse.com. It was about entry-level to practice nursing. the push i believe has been going on to hire only BSN RN'S even tho this hasnt been adopted officially yet. Any ADN RN will have to get the BSN to be able to work. The article said at this point they dont know what will be the fate of LPN's. I think we are already seeing the evidence of that. I believe LPN's will be told to get their BSN RN or get trained in some other area of the health field. I believe LPN cirriuculum will eventually be eliminated. so anyone who is now an LPN, go get your BSN or start training for another healthcare career. don't wait till the axe falls.

minnymi · Jul 6, 2012

there used to be LPNs in the hospital where i work, but not anymore. they stopped hiring them and the ones who worked at the bedside either left, went back to school, or took other positions in the hospital.

some of them are discharge planners/case managers.

there are a couple who work basically as EKG techs. i don't know their real job description. i just know anytime someone needs an EKG an LPN shows up to do it.

so, there are still some LPNs in the hospital, but they aren't at the bedside. i guess they offered other jobs as options other than going back to school, but they are definitely not hiring.

oh...this hospital is magnet.