LPN vs RN? Not as clinical as society thinks?

[downsouthlaff]

Well I've been doing alot of research on this. And it appears that the real difference between RNs and LPN/LVNs is not so much in the clinical scope of practice as people think the difference is in the style of education. RNs are educated through the university route.They take college level language classes and English classes and biology and economics and are educated at a very professional level before nursing school. Where as LPNs are evaluated for basic competency in these areas (high school level). RNs are the college educated professionals with a college degree. LPNs are they everyday, more down to earth and more middle class, Nurses, who are highly knowledgeable

And skilled in there trade, who isn't going to know college level sentence structures, or the whole periodic table, but are very competent and highly knowledgable about real world everyday frontline nursing, with a vo tech diploma. I think RNs are paid more not because they are better Nurses, but because of there more professional non nursing educational background. From my experience as a CNA dealing with both LPNs and RNs, RNs tend to know alot about healthcare facility policy and procedure and are better at than LPN floor nurses do. But like I said when it comes to to Practice and skills, minimal differences.'

[Pangea Reunited, ASN, RN]

It's best if people check their state's scope of practice for the most accurate information on the differences. In California, LVNs can become IV-certified and administer medications other than IVP, including hanging blood products. They do, in practice do assessments independently, in environments like home health and LTC.

Facility policies may further restrict what LVNs are allowed to do, but there is a difference between that and scope of practice.

AndyBRN, thanks for explaining the details about nursing education in Canada! I knew there were differences, but not the details.

OK, now I'm confused. The IV certified LVNs I work with in CA aren't able to hang antibiotics or push any IV meds at all. They are allowed to hang blood, from what I understand, but my hospital does not allow it. The nurses in CA look shocked when I tell them that the LVNs I'm used to working with give their own IV meds. I know they (LVNs) can hang some fluids as well as monitor and flush lines, I just haven't heard of them administering anything else.

I think it's bizarre that LVNs can hang blood, but not administer zosyn, BTW.

[Pangea Reunited, ASN, RN]

At Pangea reunited- or anyone for that matter;

What differentiates assessment and data collection. If my understanding is correct, an assessment involves the possibility of an intervention- what kind of intervention is that?

When a pt requests pain medication due to pain & then the LPN/LVN administers the pain medication (via the route allowed by scope of practice and provider's order) is that an assessment? Or is that data collection? If it were an RN, is that an assessment or data collection?

When I took my NCLEX-PN, I was asked to identify multiple breath sounds. I "data collect" the pt has rhonchi, rales, wheezes, etc and report to the provider for further orders... Is that an assessment or data collection?

If a nurse (RN/LPN) cannot administer meds under our own license then the word assessment is pointless with regards to pharmacological intervention.

What about interventions regarding repositioning. Does the LPN have to report to the MD to obtain orders to reposition a pt to prevent skin breakdown? Of course not. So what, I repeat, is considered to be the difference between an assessment and data collection?

A pt has a potassium of 6.3. The nurse will of course immediately notify the doctor and implement appropriate protocols, but what will be the difference? The LPN and RN will both check for CP, heart rate, auscultation, mentation, etc. Is it assessment or data collection?

It seems to me a nurse's hands are always bound by the physician. They say an RN is independent while an LPN is dependent. If both are under the supervision of the physician then what is the real difference?

I agree that it's tricky. The difference, as I understand it, is that an RN (in California) cannot legally delegate assessment to an LVN. I'm not saying that LVNs are incapable of assessment, but when the regulatory "people" come around (I'm not sure who they are, honestly), they are to be told that our LVNs are "collecting data" to report to a supervising RN. We are not to tell them that LVNs are assessing and managing their own patients.

[nursel56]

OK, now I'm confused. The IV certified LVNs I work with in CA aren't able to hang antibiotics or push any IV meds at all. They are allowed to hang blood, from what I understand, but my hospital does not allow it. The nurses in CA look shocked when I tell them that the LVNs I'm used to working with give their own IV meds. I know they (LVNs) can hang some fluids as well as monitor and flush lines, I just haven't heard of them administering anything else.

Well I just returned from a research jaunt and I think you are right about the antibiotics as of at least 2004. It's not easy to pin down specifics as the LVN Nurse Practice Act doesn't delve into details but leaves regulation to the BVNPT. I did find this document that clarifies some of the specifics related to assessment as well. An LVN . . .

1. can administer electrolytes, nutrients, and vitamins via primary

or secondary peripheral venous infusion lines.

2. can administer blood and blood products, including immune

globulin.

3. can flush peripheral locks with dilute heparin or normal saline

to maintain the patency of the lock.

4. cannot administer intravenous medications via primary or

secondary lines.

5. cannot access central lines (including peripherally inserted

central catheters or midline catheters), but can change central

line dressings

I agree that the rationale as well as separating the components of assessment into data-collection and not is ill-defined and frequently doesn't make much sense, as in the case of breath sounds libran mentioned.

[Fiona59]

In my province, it is rapidly changing. Central lines will be an LPN duty by the end of the year. The only IV meds I can't give are chemo drugs and they are rarely given on my service. The patient usually travels to the Cancer Institute for those treatments (and there are LPNs working there) Travisol will be ours to administer by year end. Dialysis LPNs are certified to work with CVCs, HomeCare LPNs do PICCS on their rounds.

IV push meds only became an RN responsiblity on the general floors in the last 18 months. Prior to that only RNs in ICU and the ER had the skill. If a push was required on the floor, the resident performed it or the patient was deemed to "sick" for the floor and went to ICU.

Blood is a joke, really. Before the bag can be pierced, two nurses must check and double sign. The bag is pierced. The bag is walked by both nurses to the bedside. Verification is then performed against the actual patient. The bag is hung, the RN starts the drip. We walk away. The patient remains mine for monitoring, assessing and if necessary discontinuing the blood. Two nurses. Not two RNs, two nurses.

[HeatherMax]

Sounds like Canada makes much more sense when it comes to LPN's.

[RN/MSN1984]

Nope.

First, there are many RNs without a college degree. I obtained my RN through a diploma program. I did go back for my BSN.

Second, it is my understanding that an LPN cannot assess like an RN. In my facility, the RN is the only one who can do a true assessment.

In many states LPNs cannot pass meds that RNs can.

If the difference was minimal the LPNs wouldn't have been in the majority if my RN program. They only got out of 1 nursing class. Many had to take some basic prerequisite classes as well...again I was not in a college based RN program.

There are more differences than what I listed.

There is a huge difference between LPN and RN and you clearly do not understand that.

Actually you are wrong the LPNS at my hospital can assess and they can assess just asa good as an RN. An RN is not the only one who can do a true assessment. You are clearly mistaken.

[Esme12, ASN, BSN, RN]

Actually you are wrong the LPNS at my hospital can assess and they can assess just asa good as an RN. An RN is not the only one who can do a true assessment. You are clearly mistaken.

While LPN's can in your state...this is NOT true in every state. There are states with nurse practice acts that prohibit LPN's from performing "assessment" and their practice is restricted.

[IrishIzCPNP, MSN, RN, APRN, NP]

Actually you are wrong the LPNS at my hospital can assess and they can assess just asa good as an RN. An RN is not the only one who can do a true assessment. You are clearly mistaken.

I am not mistaken when saying there are times they can't assess. I never said they can't 100% of the time. There are states where only an RN can assess. The LPN can do an unofficial assessment but the RN is the only one who can document an assessment....which means the RN also has to do it.

Look at the nurse practice act for your state. The LPN may not be allowed to assess.

[IrishIzCPNP, MSN, RN, APRN, NP]

Actually you are wrong the LPNS at my hospital can assess and they can assess just asa good as an RN. An RN is not the only one who can do a true assessment. You are clearly mistaken.

I see you are from New York so I looked it up for you. I'm actually concerned that you didn't know this given your position educating others.

http://www.op.nysed.gov/prof/nurse/nurse-scope-lpn-rn.htm

Section 6902, cited above, does not include nursing diagnosis within the scope of practice of Licensed Practical Nurses. Thus, Licensed Practical Nurses in New York State do not have assessment privileges; they may not interpret patient clinical data or act independently on such data; they may not triage; they may not create, initiate, or alter nursing care goals or establish nursing care plans. Licensed Practical Nurses function by law in a dependent role at the direction of the RN or other select authorized health care providers. Under such direction, Licensed Practical Nurses may administer medications, provide nursing treatments, and gather patient measurements, signs, and symptoms that can be used by the RN in making decisions about the nursing care of specific patients. However, they may not function independent of direction.

[RN/MSN1984]

Actually the LPN can do an assessment and can document it as well. The nurse practice act differs yes state to state. But LPNS are able to do a full assessment and document i know this for a fact in wisconsin because my younger sister is an LPN.

[IrishIzCPNP, MSN, RN, APRN, NP]

Actually the LPN can do an assessment and can document it as well. The nurse practice act differs yes state to state. But LPNS are able to do a full assessment and document i know this for a fact in wisconsin because my younger sister is an LPN.

Like I said....it may vary from state to state. There are many states LPNs cannot assess. New York is one state...where you state you are from and where you are educating. You should know this.

[IrishIzCPNP, MSN, RN, APRN, NP]

Actually the LPN can do an assessment and can document it as well. The nurse practice act differs yes state to state. But LPNS are able to do a full assessment and document i know this for a fact in wisconsin because my younger sister is an LPN.

You know it for a fact because your sister does it? She may want to go do some research. What I'm finding is that in WI LPNs cannot legally assess.

You are an educator? Really? I'm really wondering if your profile is real.