LPN vs RN - serious question about differences

[jjjoy]

I know this is a touchy subject and I don't want it to become a flame war. As someone with RN training and no LPN experience, I'm still honestly confused by these two different nurse licenses.... so here goes...

Many say "a nurse is a nurse" but that's not always the case. There is different designation and licensing for RNs and LPNs. And facilities often advertise "LPN openings" - but if a nurse is a nurse, why would they ever advertise for just LPNs? Wouldn't it just be a nursing job which either an LPN or RN could fill? And then other positions would be RN-only.

Unless an RN has been an LPN, it IS confusing to RNs what LPNs are and aren't legally qualified to do and why they aren't legally qualified to do certain things yet often function in an almost identical role RNs (eg only can't do initial assessments and hang blood in acute care). We all know that many LPNs have great assessment skills and technical skills and critical thinking skills. A patient wouldn't recognize any difference between a good LPN and a good RN. In that case, "a nurse is a nurse."

But then what more exactly did the RN learn in their program to allow them to qualify for significantly more pay than LPNs in most facilities? Why ISN'T an LPN allowed to do an initial assessment or hang blood? It wouldn't take that much extra formal training to bring them formally up to speed on these tasks and include that in their scope of practice. So what more does the RN education have to offer in regard to actually practicing nursing in most settings?

[jenni777]

As a nursing student preparing to graduate, I, too, wonder about the RN/LPN differences. As one other poster replied, often the LPNs that I will be working with have years of experience over and above me - but, as I have learned, there are actually many differences in the two roles. As it has been summed up, the RN (or MD, or chiropractor, etc.) is ultimately responsible for the actions taken under his/her direction. In my school, RN & LPN students are together for the 1st year, and it is the second year, that is mostly made up of complex med surg and complex family medicine, that the RN is differentiated from the LPN. If I base it on just what I have learned this second year alone, I feel like my scope of abilities is much, much broader than it was at the end of the first year. It has really been a "putting it all together" year for me. Many of the LPN's I went to school with are transitioning to the RN program, it may have been that an A- in a prerequisite or one point less on the TEAS test that kept them from the RN program in the first place. I've heard that finding jobs as an LPN is getting more difficult, and the increase in pay from LPN to RN is also a motivator. LPN's are a vital part of the nursing team, and I really hate to hear that there are not as many around in the hospital setting.

I have found that reading my state's scope of practice really helps me differentiate what the difference between RN and LPN scope of practice is. Also, the previous post linking users to the federal government's descriptions of RN or LPN was also very helpful

[kjlpn]

I was referred to this site by a friend that also didn't know the difference between an LPN and RN. Many of the responses that I read were accurate from a legal point of view. A LPN must work under the direct supervision of a physician or RN. They must abide by the laws of their state in regards to passing of medications, hanging IVs, starting IVs, hanging blood, the types of medication that they can pass, and even the type of work that they can do.

I do wish to challenge those that question and/or state that there are critical differences in the way they are taught and work, ie the critical thinking vs task oriented. I have been an LPN for 38 years and in that time I have seen a myriad of different approaches to nursing and how to improve what nursing provides. I have seen good RN's and I have seen bad RN's, but in practise, I have never seen the need to become an RN other than for the pay.

LPN's are more than capable of seeing the picture. They are as good as an RN in assessing and establising care plans, because there was a time that LPN's did do those things. If they aren't getting that education now, shame on the schools that are teaching. I am appalled and was when the idea was first broached over 20 years ago, that only RN's with their BSN's are capable of being good nurses. Of course, this was promoted by acadamia, not by the facilities that need the staff or by the people working with nurses of all titles.

What I learned, and learned the hard way, is that there are two kind of employers in this world. Those that acknowledge your abilities, and those that acknowledge the initials behind your name. Consequently, I have lost respect for the field of nursing. Nurses don't do hands on care; they are no longer intellectually challenged by what they see and do; they no longer partner with a team. Nursing care is no longer about observation, evaluation, and action, but about numbers, EMR's, and providing as much care as possible in the least amount time. Patients enter hospitals sicker than ever before, and leave less sick, not well.

Who's to blame? Maybe acadamia, physicians, hospitals, and insurance companies. Probably all of them. But one thing about nursing hasn't changed. All nurses are worked like dogs, put their health on the line, and are rarely appreciated for everything they do.

Thank you for letting me voice my opinions.

[Cuddleswithpuddles]

LPN's are more than capable of seeing the picture. They are as good as an RN in assessing and establising care plans, because there was a time that LPN's did do those things. If they aren't getting that education now, shame on the schools that are teaching. I am appalled and was when the idea was first broached over 20 years ago, that only RN's with their BSN's are capable of being good nurses. Of course, this was promoted by acadamia, not by the facilities that need the staff or by the people working with nurses of all titles.

The following is merely my personal experience.

When I went through a LVN program in 2005, we were not required to do care plans. Many LVNs I know were not required to do one on a regular basis. One professor went against the grain and required my clinical group to do one on each patient we had. We moaned and groaned but it was a fantastic exercise. I saw the big picture much easily and was able to verbalize my plan of attack at the beginning of the shift.

As a RN with 5 years of work experience, I see the reasons why my professor did this. Say what you want about how useless care plans are in the real world and how the profession has placed way too much emphasis on them, they are a wonderful way to teach the nursing process to students.

I feel that my LVN program filled us with facts and skills but did not emphasize integrating them together, prioritizing and anticipating what's next. Although you could say that about ANY nursing program, I did notice that my RN program emphasized the whole picture more than my LVN program did.

But, ultimately, I think it takes real life experience and determination to become a skilled professional. Neither are the sole domains of either LVN or RN.

[AngelicDarkness]

Its a tough question because it honestly depends on your employer. Not all employers use RPN/LPNs to their full scope of practice, but the main difference I was taught is that RNs have more theory to look after unstable clients. RPNs look after stable clients.

However I'm more confused since LTC facilities will only hire RN DOCs but retirement homes hire RPN/RN DOCs...............I currently work in a retirement home and some of our clients are unstable. Just like some of the ones in LTC are very stable, just more care demands.

Either way, I'm happily an RPN who would love to do RN in the future but I'm in no rush to get there lol.

[AngelicDarkness]

Most typical LPN programs are between 9-12 months; the ones that are 24 months (at least on my side of the world) are part time ones, but the hours amount to the same. Yes, we make less money, and we have to be suprevised by an RN. However the facilities may be different; maybe the RN may be available by telephone, for example. I have worked alone on a home care case, but I was to call the agency RN if there was any difficulty (never experienced it, so, I had no reason to contact her). Some require that at least one RN is on the grounds as a supervisor, making it very possible for the LPN to be the only nurse on the floor.

Maybe it is different in Canada in terms of education, but I haven't seen an RPN/LPN program in 12 months. My program was 2.5 years long. I make less money than an RN, but I don't need to be supervised by an RN, unless it is something I haven't been trained before, or it is out of my scope of practice.

The downside is for RPNs to take the RN program in Canada, there is no fast track upgrade. 3 years is a long time to put in when I've put in 2.5 years. I would be happy putting in 2 more years, but I'm not putting in 3 years when the program is 4 years for no previous health education.

[kiminga]

The PN school I attended we started IV's , inserted NG tubes, hung IV bags and piggybacks, passed meds, and did care plans for ea pt we had. As an LPN in GA the only things I can not do is spike a bag of blood, I can monitor it , DC it and flush afterwards, I can not push cardiac drugs or insulin, other wise if it needs to be hung I can hang it. I can draw labs from central lines and flush them, I can access PICC lines , set up a PCA pump, I can take off orders , call the MD ,I don't do admissions, but there are more things I can do as an LPN then I can't do. I love being a nurse . I guess it all depends on the state you are working in.

[kiminga]

LPN vs RN

[T-Bird78]

I know LPNs don't make jack compared to RNs. I graduated with a handful of girls who got accepted into the BSN program at a local, major university offering the program, but it was a two-year wait to start. They graduated and got licensed as a LPN then bridged over to get their ASN before they would have even started the BSN program. One has already gone on to get her BSN but has been working all this time instead of just waiting or being a fresh graduate.

One thing that bugs me is people calling RNs "Real Nurses" and hearing "oh, you're JUST a LPN." We are Licensed Practical Nurses, and while we can't do everything the RNs can do, we still had nursing school, graduation, state boards, and are licensed by the state. We are strong and valuable and darn good at what we do. I've thought about bridging over to get my RN but I want to work in a doctor's office until my kids are grown, then I'd have more flexibility to work in hospitals.

[Mdavi]

Most typical LPN programs are between 9-12 months; the ones that are 24 months (at least on my side of the world) are part time ones, but the hours amount to the same. Yes, we make less money, and we have to be suprevised by an RN. However the facilities may be different; maybe the RN may be available by telephone, for example. I have worked alone on a home care case, but I was to call the agency RN if there was any difficulty (never experienced it, so, I had no reason to contact her). Some require that at least one RN is on the grounds as a supervisor, making it very possible for the LPN to be the only nurse on the floor.

There are many reasons why a person may choose an LPN program over an RN; the main one being what you mentioned, the competitiveness to get in. Other reasons are that people wish to see if they can handle nursing at all, graduating quicker, not being able to pass the college level pre-requisites for the RN programs, wishing to work faster, or like me, who does not desire to become an RN. Also, some states allow an RN student to sit for the LPN exam at some point during their program, so that they can work as nurses while continuing their RN degree.

In most cases, vocational schools train LPNs in the necessary skills to function in their title, but there are more bridge programs that are allowing people to continue with their education to become RNs.

While it is true that we work under the auspice of an RN, we are also under the auspice of a physician, dentist, physician assistant or nurse practitioner, but we are not autonomous, so to speak.

An RN would definitely get paid more because of her advanced education, unless she holds both, her LPN and RN license, which I know plenty of people that do this. But the disadvantage of this is that you are held to the responsibility and accountability of the HIGHER license if something goes down, because you are supposed to KNOW.

In my hospital clinic, for example, I usually work the late clinic, but I can't do it alone...I must have an RN present with me in case there are any problems.

My LPN program was 20 full time months plus a year of science and math.

[RNsRWe, ASN, RN]

My LPN program was 20 full time months plus a year of science and math.

I wonder what your program covers that others clearly don't.....must be quite a lot, since it's twice as long! In my area, LPN programs are 10 months' duration, no pre-requs, no college courses. And they are eligible to take the NCLEX-PN once completed.

Seems like there must be either deficiencies in one type of programming....or excessiveness in another?

[Mdavi]

I have no idea as I haven't been through other programs but we were required to have all the same pre-req's as the RN's plus go through our program then if we chose we could go on and get our RN. I do know that there are lot's of different kinds of LPN programs offered. A friend of mine got her LPN at a technical school and she only had two pre-req's and it was 13 months long. I personally had never heard of a 9-10 month long LPN program.

You are right though there does seem to be a lot of disparities and I personally do not like it. I wish that they would just make nursing school uniform across the board.

[RNsRWe, ASN, RN]

I have no idea as I haven't been through other programs but we were required to have all the same pre-req's as the RN's plus go through our program then if we chose we could go on and get our RN. I do know that there are lot's of different kinds of LPN programs offered. A friend of mine got her LPN at a technical school and she only had two pre-req's and it was 13 months long. I personally had never heard of a 9-10 month long LPN program.

You are right though there does seem to be a lot of disparities and I personally do not like it. I wish that they would just make nursing school uniform across the board.

Kinda makes you wonder if Nursing would be so high up on the "Most Trusted Professions" lists if the general public knew there was SUCH a disparity between programs: their requirements, their expectations, etc.