LPN = Life's Perfect Nurses

Published

I'm sure that you all have heard the negative comments made about LPNs. Some people call us "Little Play Nurses," "Low Paid Nurses," and "Let's Pretend Nurses." A small handful of RNs have mentioned that we're incapable of thinking critically, and so forth. I think it is time for some positive feedback regarding LPNs, because we do occupy an important place in the healthcare system.

Since we frequently spend a whole lot of time with our patients and can offer them care with the personal touch, I think we should be referred to as "Life's Perfect Nurses." I believe we have enough practical knowledge to provide comforting care without becoming lost in the sea of bureaucracy. Does anyone agree, or wish to comment?

But without differentiating between the LPNs and RNs, how can you be specific about how LPNs impact nursing and patient care?

I think it would be more clear to talk about the nursing role being performed - such as LTC med nurse (where I am this role is usually filled by an LPN but an RN can hold the same position with essentially the same responsibilities) or acute care LPN with team nursing (RN and LPN share same patients) or acute care LPN with "RN coverage" (LPN essentially has primary care for his/her patients).

It's easier for me to conceptualize the unique contribution of a nursing assistant - who doesn't have any "extra" skills or responsibilities compared to the nurses - because I'm more clear on how their role differs from nurses. They assist the nurses with specific nursing tasks (baths, toileting, etc). An experienced nursing assistant may be better than any of the nurses at getting baths done efficiently or at turning and positioning patients. Still, if a nurse isn't working with assistants and has to do all this her/himself, then the nurse can be quite proficient at this as well - though she/he may never get as good at it as the assistant because the assistant is doing baths, turns, etc all day whereas the nurse generally works with fewer patients and is responsible for a wider range of tasks.

Those of you who have had both LPN and RN training - I'm very curious to hear your experiences. Still, one person's experience as a LPN (or RN) may be very different than another persons and we can't necessarily generalize that that's the situation across the board. For example, I've heard that in some places the LPN isn't responsible for contacting physicians, but in others, they are. And I've heard that in some places the only the charge nurse contacts physicians no matter if the other nurses are RNs or LPNs. It can be quite confusing!

Up Vote Up Vote ×
Specializes in Medical Telemetry, LTC,AlF, Skilled care.

I am very very fortunate my RN co-workers are very Pro-LPN and in the type of setting, facility, etc it is difficult to really distinguish me from one of my friends who just graduated with a BSN. We're both primary care nurses, we both get the same types of pts, the main difference is that he can hang blood and push a couple more cardiac drugs than I. I don't know, there's just not a competition between me being the LPN and my co-workers being the RN's which I'm very greatful for, we all have our strengths and weaknesses and we just band together and get it done.

Up Vote Up Vote ×
Specializes in Community Health, Med-Surg, Home Health.
But without differentiating between the LPNs and RNs, how can you be specific about how LPNs impact nursing and patient care?

I think it would be more clear to talk about the nursing role being performed - such as LTC med nurse (where I am this role is usually filled by an LPN but an RN can hold the same position with essentially the same responsibilities) or acute care LPN with team nursing (RN and LPN share same patients) or acute care LPN with "RN coverage" (LPN essentially has primary care for his/her patients).

It's easier for me to conceptualize the unique contribution of a nursing assistant - who doesn't have any "extra" skills or responsibilities compared to the nurses - because I'm more clear on how their role differs from nurses. They assist the nurses with specific nursing tasks (baths, toileting, etc). An experienced nursing assistant may be better than any of the nurses at getting baths done efficiently or at turning and positioning patients. Still, if a nurse isn't working with assistants and has to do all this her/himself, then the nurse can be quite proficient at this as well - though she/he may never get as good at it as the assistant because the assistant is doing baths, turns, etc all day whereas the nurse generally works with fewer patients and is responsible for a wider range of tasks.

Those of you who have had both LPN and RN training - I'm very curious to hear your experiences. Still, one person's experience as a LPN (or RN) may be very different than another persons and we can't necessarily generalize that that's the situation across the board. For example, I've heard that in some places the LPN isn't responsible for contacting physicians, but in others, they are. And I've heard that in some places the only the charge nurse contacts physicians no matter if the other nurses are RNs or LPNs. It can be quite confusing!

This is why I was saying that one of the reasons why an LPN may be frustrated is because there are different scopes of practice between the states as well as the facilities. And what an LPN sees most likely is that she is DOING a great deal of the SAME skills depending on the circumstances. The bottom line is that many (including myself) view this as if a person can perform a skill SAFELY, then, who cares about all of the theory?? Especially if it results in a positive outcome? And, if that role is not clear or differentiated, then, how can one really tell if the pay and recognition is really justified?? Personally, I am all for being different from RNs. I would like to wear a different uniform than they, and clear cut scopes of skills that I can or cannot do. If an LPN is dealing with pic lines, IV push, and a host of other things, it is basically saying that it does not take all of the theory of a rocket scientist to perform these skills. Therefore, if you are asking an LPN to perform these skills without the theory of the RN, then, she should be compensated monetarily and given the similar recognition or respect. This is not taking away the role of the RN, but to acknowledge that the LPN is a nurse in her own right.

I have had some friends that went into RN programs and have stated that they have not really learned much different than in the LPN programs and then there are others that state differently. Each person walks in with their own perspective.

What keeps me from being an RN is the politics and the higher expectations that I don't plan to keep up with. I have seen messy nurses from both ends of the spectrum; LPNs and RNs. I just want to do my job, be primarily responsibile for myself only and go home. With all of the paperwork that is forced upon them, it takes more time away from really assessing and paying attention to the patient. I don't see me being effective in that position because I would be too irritable and rebellious to the powers that be...so, I am fine where I am.

Up Vote Up Vote ×
Specializes in Community Health, Med-Surg, Home Health.
I am very very fortunate my RN co-workers are very Pro-LPN and in the type of setting, facility, etc it is difficult to really distinguish me from one of my friends who just graduated with a BSN. We're both primary care nurses, we both get the same types of pts, the main difference is that he can hang blood and push a couple more cardiac drugs than I. I don't know, there's just not a competition between me being the LPN and my co-workers being the RN's which I'm very greatful for, we all have our strengths and weaknesses and we just band together and get it done.

That is so cool. I have that issue in my clinic as well. The RNs do not see us as being less than nurses; they collarborate with us and treat us well. I am about to do per diem on med-surg shortly. There, I understand, is a different ball game...

Up Vote Up Vote ×
Specializes in Occ health, Med/surg, ER.
But without differentiating between the LPNs and RNs, how can you be specific about how LPNs impact nursing and patient care?

That is a good question... Well, take the RN/LVN debate out of the equation. Differeniating the two doesnt mean valuing one more than the other. LVNs do in fact hold a license and are responsible of their own practice. So, what is the impact of that practice on the nursing?

Up Vote Up Vote ×
Specializes in Occ health, Med/surg, ER.
The bottom line is that many (including myself) view this as if a person can perform a skill SAFELY, then, who cares about all of the theory?? If an LPN is dealing with pic lines, IV push, and a host of other things, it is basically saying that it does not take all of the theory of a rocket scientist to perform these skills.

Wow. Why care about all the theory behind a skill?? I think that is a careless statement. Sometimes, various procedures/medications are ordered by the doctor and, as the MOST IMPORTANT PATIENT ADVOCATE, nurses MUST UNDERSTAND the theory behind why medications/procedures are ordered for a pt! If they are not safe, it doesnt matter if you can perform a skill with your eyes closed, it could potentially harm the patient!!!!! Sure, anyone can learn how to perform skills perfectly (sp?), but without explaining why the patient needs the procedure/medication, its really unsafe.

Up Vote Up Vote ×
Specializes in Med-Surg.
Wow. Why care about all the theory behind a skill?? I think that is a careless statement. Sometimes, various procedures/medications are ordered by the doctor and, as the MOST IMPORTANT PATIENT ADVOCATE, nurses MUST UNDERSTAND the theory behind why medications/procedures are ordered for a pt! If they are not safe, it doesnt matter if you can perform a skill with your eyes closed, it could potentially harm the patient!!!!! Sure, anyone can learn how to perform skills perfectly (sp?), but without explaining why the patient needs the procedure/medication, its really unsafe.

I agree. I cringe when a patient asks a nurse the reasoning behind a med, test or procedure and the nurse "I don't know, the doctor ordered it, ask your doctor".

Up Vote Up Vote ×

I wish my director would feel the same. I'm an LPN with a hospital based home services/hospice. My director a BSN and 10 cent millionaire, refers to the RN's as "NURSES" and then there are the LPNs. In a recent memo from her it was addressed "Nurses and LPNs" I kid you not! After 18 years of being an LPN, providing RN care, I decided to go back to school and get my ASN. I've worked for this woman for 5 years and this year, for the first time, she sent me a birthday card. I was SHOCKED!!! In addition to that, I'm usually assigned to visit 6-8 patients a day where the some of the RN's whine if they have more than 4. To quote my director "It's cheaper to send an LPN than an RN to a medicare visit" Yep, charge them the same price, pay the employee less. I love my job, hate the politics.

Bless y'all!

Up Vote Up Vote ×
Specializes in Community Health, Med-Surg, Home Health.
Wow. Why care about all the theory behind a skill?? I think that is a careless statement. Sometimes, various procedures/medications are ordered by the doctor and, as the MOST IMPORTANT PATIENT ADVOCATE, nurses MUST UNDERSTAND the theory behind why medications/procedures are ordered for a pt! If they are not safe, it doesnt matter if you can perform a skill with your eyes closed, it could potentially harm the patient!!!!! Sure, anyone can learn how to perform skills perfectly (sp?), but without explaining why the patient needs the procedure/medication, its really unsafe.

I don't think that it takes LOADS of theory to explain how to do certain skills. For me, a basic explanation and reasoning is enough for me to ensure that things are done safely. And, obviously, because different states have different scopes of practice, it seems to be that the governing bodies feel it does not matter when push comes to shove. What I think LPNs are angry about is that a great deal of them are performing MANY of the SAME skills that RNs are DOING without the recognition, respect or monetary compensation for doing so. They, too, may be questioning WHY am I doing this skill if was not considered to be qualified to perform it?? Most learn these skills on the job with not much rationale or reason...they just say 'do it'. How would one NOT be confused, then? What will be the hallmark between the LPN and RN if they are continuing to add other skills to a lower licensed person (while some states are saying that they shouldn't or can't because they don't have the education behind it)? I do understand what I do before I do it, or I will refuse to do the skill ordered.

While I understand why you made this statement, I think you misread what I was thinking or trying to express. Basically, I am saying that there should be a difference in the scope of practice at all times between the two types of nurses; it should be illustrated accurately rather than vaguely and not when it is convienent. If the LPN is going to be expected to perform advanced skills, then, she should be compensated for it somehow, or there will always be bitterness and misunderstanding. In many cases, LPNs are not considered for the same benefits such as educational leave, most nursing organizations are pro-RN and we are not considered in many cases to be included in the same batch, but, depending on where they live or pratice, are performing many of the same procedures. From what I see, most LPNs are bitter because we perceive ourselves to be DOING many of the same things. Maybe we have less theory behind what we are doing, however the performance and positive outcome is still required.

Up Vote Up Vote ×
Specializes in Community Health, Med-Surg, Home Health.
I wish my director would feel the same. I'm an LPN with a hospital based home services/hospice. My director a BSN and 10 cent millionaire, refers to the RN's as "NURSES" and then there are the LPNs. In a recent memo from her it was addressed "Nurses and LPNs" I kid you not! After 18 years of being an LPN, providing RN care, I decided to go back to school and get my ASN. I've worked for this woman for 5 years and this year, for the first time, she sent me a birthday card. I was SHOCKED!!! In addition to that, I'm usually assigned to visit 6-8 patients a day where the some of the RN's whine if they have more than 4. To quote my director "It's cheaper to send an LPN than an RN to a medicare visit" Yep, charge them the same price, pay the employee less. I love my job, hate the politics.

Bless y'all!

Again, another reason for some LPNs to be angry. It seemed that it took you to become or aspire to become an ASN to be worthy of a birthday card. How sad! Actually, I don't take it too personal by what they think, I am more concerned by what people seem to be comfortable in saying when unasked. We have had announcements printed like this often; "the NURSES and lpns" (I stated LPNs in small letters to demonstrate that we seem to be an afterthought...like...'oh, and them, too'). It can be offensive to the sensitive person, and it also diminishes the efforts that the LPN made in order to make it through nursing school as well. I do congratulate you for furthering your career in any sense. I am proud of everyone who faces school another time!

Up Vote Up Vote ×
Specializes in Community Health, Med-Surg, Home Health.
I agree. I cringe when a patient asks a nurse the reasoning behind a med, test or procedure and the nurse "I don't know, the doctor ordered it, ask your doctor".

Again, I believe that what I stated was seriously miscommunicated. This is actually hurtful to me because that was not what I intended to give out and most importantly, this is NOT HOW I PRACTICE. I say this because I am constantly reading material and taking notes to review things further at home in order to illustrate to a patient what is happening in a way that they comprehend (not that everyone here can see what I do or how...). We have computers at work where I will look up information I am unsure of in order to offer information needed for the client as well as for myself. What I am saying is that as long as the scope of practice for LPNs is varied according to the states and facilities in terms of what skills we are supposed to perform, there will be a thinner hallmark of veil of the differences between the two types of nurses. For myself, I don't function very well with deep rooted theory and reading to understand the point of why something needs to be done, how, or the risk involved. It confuses me more for some reason. But, when I speak to most LPNs the cry is "I do most of the same things they are doing". And, many times, this is covered up or allowed until something happens. Then, it becomes "why was this allowed"?

A small example of this is in my clinic, we have diabetic case managers who are supposed to teach newly diagnosed diabetics, especially those whose A1c is higher than 9%. Even our seasoned RNs are not supposed to teach the newly diagnosed at first. These women get paid a pretty penny for their positions, but are never available to the patient or always claim to be busy. Either way, we have the patient sitting before us and someone has to give them an explanation of care. Once I saw that this was not going to change, I read deeper into diabetes, and obtained simpler material for our population to understand. All of us, the LPNs and RNs have walked the patient through the exact same training that these case managers are hired to do. We spoke to dietiticans to ensure that we're teaching them the right thing, and reviewed all of the glucometers in order to teach them safely as well as obtained the information in different languages. Basically, the LPNs involved with this did the same thing that the case managers were supposed to do. I pondered within myself and wondered if I am shortchanging the patient, because maybe the case manager had more to share with them than I did with the lesser license and training. I wanted someone to describe to me what was different between what I am trying to do versus what they are supposed to do. I guess I am taking this personal because I am not a careless practitioner. It is just that it does get harder and harder to determine when something really becomes out of my hands as a practical nurse, because it was not illustrated to me, yet, however, I am just as responsible as anyone else to send the patient home with no training at all. This is a small example of how deep this can become if there is no line drawn.

Up Vote Up Vote ×
Specializes in Occ health, Med/surg, ER.
Again, I believe that what I stated was seriously miscommunicated. This is actually hurtful to me because that was not what I intended to give out and most importantly, this is NOT HOW I PRACTICE. I say this because I am constantly reading material and taking notes to review things further at home in order to illustrate to a patient what is happening in a way that they comprehend (not that everyone here can see what I do or how...). We have computers at work where I will look up information I am unsure of in order to offer information needed for the client as well as for myself. What I am saying is that as long as the scope of practice for LPNs is varied according to the states and facilities in terms of what skills we are supposed to perform, there will be a thinner hallmark of veil of the differences between the two types of nurses. For myself, I don't function very well with deep rooted theory and reading to understand the point of why something needs to be done, how, or the risk involved. It confuses me more for some reason. But, when I speak to most LPNs the cry is "I do most of the same things they are doing". And, many times, this is covered up or allowed until something happens. Then, it becomes "why was this allowed"?

A small example of this is in my clinic, we have diabetic case managers who are supposed to teach newly diagnosed diabetics, especially those whose A1c is higher than 9%. Even our seasoned RNs are not supposed to teach the newly diagnosed at first. These women get paid a pretty penny for their positions, but are never available to the patient or always claim to be busy. Either way, we have the patient sitting before us and someone has to give them an explanation of care. Once I saw that this was not going to change, I read deeper into diabetes, and obtained simpler material for our population to understand. All of us, the LPNs and RNs have walked the patient through the exact same training that these case managers are hired to do. We spoke to dietiticans to ensure that we're teaching them the right thing, and reviewed all of the glucometers in order to teach them safely as well as obtained the information in different languages. Basically, the LPNs involved with this did the same thing that the case managers were supposed to do. I pondered within myself and wondered if I am shortchanging the patient, because maybe the case manager had more to share with them than I did with the lesser license and training. I wanted someone to describe to me what was different between what I am trying to do versus what they are supposed to do. I guess I am taking this personal because I am not a careless practitioner. It is just that it does get harder and harder to determine when something really becomes out of my hands as a practical nurse, because it was not illustrated to me, yet, however, I am just as responsible as anyone else to send the patient home with no training at all. This is a small example of how deep this can become if there is no line drawn.

If you havent discussed the issue of RN/LVN roles with your nurse manager, I would suggest you do. Maybe that can be a start to more clearly define the role of both RN/LVN in your facility. You mentioned that the laws/scope of practice are vaque and unclear. Re examine the Nurse Practice Act in your state and make sure you are not practicing out of your scope. If this does not resolve the issue, maybe you should consider looking for another job were you feel the roles are more clearly defined.

I in no way intended to offend anyone by my responses in this thread. I was just stating my opinion. NO hard feelings.

Up Vote Up Vote ×
+ Join the Discussion