Does the existence of LPN's make being a RN more impressive?
This question has nothing to do with the competence of individual RNs or LPNs. I do not intend to offend LPNs by posing this question (isn't that what everyone says?). For what it's worth, I am a RN who used to be a LPN and I have a high regard for anyone who is good at his or her job. I realize a title has no bearing on competence.
I'm struggling to find the words to communicate my thoughts, so I apologize in advance if this doesn't make sense. What I am attempting to ask is something along the lines of: If all nurses were RN's, and the LPN role was completely eliminated, would that eventually lead to less prestige for the "RN"(prestige probably isn't the right word). I will use SNFs as an example to help clarify my question. In some skilled nursing facilities, most of the floor nurses are LPNs (I realize this is changing in some areas). When a RN works in LPN-dominated facilities as a floor nurse, they are sometimes admired (secretly or overtly) by other staff members who strive to become a LPN/RN or who have placed the title of RN on a pedestal (sorry that sentence sounds so pretentious). I have observed that RNs (the title, not the individual) seem to be more prized outside of hospital settings where LPNs are more prevalent.
An "all RN world" would likely result in the expansion of the pseudo-LPN/non-licensed roles (which is already happening to some degree). Would this be beneficial, neutral, or detrimental to the standing of RNs?
We all know that there is a push by professional nursing organizations to eliminate LPNs/ADNs in an effort to improve the professional image of nursing and redefine what it means to be a nurse. We are also all aware of the obstacles that make this option impractical in certain areas.
What do you think of this compromise?:
1. Entry-level RN: BSN+ only
2. Merge the existing ADN/Diploma and LPN programs to an 18 month "Practical Nursing Program"(a few PN programs are currently 18-24 months) . This option would preserve the LPN role while simultaneously combining and eliminating entry-level ADN programs. In other words, just combine LPN and ADN programs. Add or subtract six months to the existing LPN and ADN programs to transition to the new 18 month PN programs (similar to the Canadian model). Hospitals could continue to use LPNs with extended training to prevent nursing shortages in rural/underserved areas.
I regret that this option implies registered nursing collectively has low self-esteem and needs another nursing role beneath it to elevate (or preserve?) its professional standing. That being said, if there were no other nursing roles below RNs, would RNs end up at the bottom of the licensed totem pole? Or would non-licensed support staff seep into new segments of healthcare and become the new de-facto LPNs, making this a moot point?
In essence, if we are all beautiful, is anyone actually beautiful, or does the word lose its meaning? I'm sure nothing posted above is an original idea and it has probably been beat to death already. I just want to see fresh perspectives of what nurses think of this concept. I doubt any significant changes will take place in my life time, so this is more of a theoretical inquiry. I apologize if my post comes across as pretentious. Please be nice.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I think that anytime you gett a group of people together they will begin to establish a pecking order, no matter what "class" or background they come from and that if prestige is as big a deal as it seems to be for some people here, they will probably find themselves disappointed in direct relation to the amount of effort they put into arranging their circumstances with that goal in mind.
I really don't see the logic of folding ADNs into the LPN status other than as an attempt to rarify the bachelor's degree, since they take the same licensing exam.
Yes the RN has a bigger scope of practice, but the LPN studies just as hard in their schooling and are also well versed in their role.
THIS.
I think GrnTea hits the nail on the head: Grandfathering in terms of the RN entry; otherwise the title "nurse" is respected, whether an RN (diploma, ADN, BSN)
or a LPN.
Since I have been both, I found that I respected for my practice rather than my title; I've help construct educational programs and policies as a LPN; the only issue was in terms of although I was a proficient LPN (7 years of practice) I couldn't get certified as an "expert" in the areas I worked; , the upgrade to expand my scope and become an expert in my practice is important to me; a better nurse makes a better patient population, at least to me.
I still believe there is a place for RNs and LPNs; there is no possible way to eliminate millions of competent nurses it would CRIPPLE the healthcare system.
Most laypeople are ignorant in my experience. They only know "nurse," not Diploma/ADN/BSN or LPN. So I don't think having a "lower class" of nurse elevates the RN title in any way.
I also think that until nurses stop belittling themselves by dividing and classifying, we will never get the respect we deserve as a profession.
When docs think of themselves, they don't immediately think "cardio-thoracic surgeons go to school longer than hospitalists, but intensivists are the best." (Yes, that statement is purposefully ridiculous.) All docs think they are awesome. Therefore they get the respect that they expect.
Nursing as a whole should have the same mindset. We are all equally awesome, we just practice differently and fill different needs.
Well, maybe you're OK with being "demoted", but I'm not. I'm a diploma RN who passed the same NCLEX as the ADNs and BSNs. While you may be OK with it, there's is no way I would accept a lower scope of practice.
Plus, let me ask you this: what about other degrees? Is a BSN the only degree that infers education? I have a bachelors in another field as well as non-nursing post grad work. Are you saying that doesn't count as education?
And how would you manage these demotions? Simply remove the non-BSN staff and replace with new grads? Brilliant.
And if ancillary staff has an issue with your perceived lack of education, that's not because you're a ADN, that's because of how you present yourself.
It had nothing to do with how you present yourself.
Some Medical Assistance presnt themselves as nurses,does that make it right?
For what its worth,I also work with lots of Filipino nurses,all of whom have Bsn degrees.
You ever wondered why employers would rather hire them than Usa nurses with Adn degrees?
There is a big reason,and it has nothing to do with salaries. Its because they are more educated(Bsn degrees).
We as American trained nurses could scream to the moon,it won't change the fact that we need to raise our education standards.
When docs think of themselves, they don't immediately think "cardio-thoracic surgeons go to school longer than hospitalists, but intensivists are the best." (Yes, that statement is purposefully ridiculous.) All docs think they are awesome. Therefore they get the respect that they expect.
Have you ever looked at the student doctor forums? I think docs do (at least many of them) believe in this hierarchy.
As nursel56 said above, pecking orders tend to get established. Sometimes it's just "who's been here the longest," sometimes it's RN vs. LPN, sometimes it's RN and MA, sometimes it's who's the loudest or whose chronic condition is considered the most crippling...I've experienced all of these. It can get pretty toxic.
OP, I think I get what you were trying to say here, and I dont know if my thoughts on it will be wildly unpopular or not, but here they are:
First, let me be transparent and say that I am a BSN RN and have never been anything else. If anybody wanted me to help decide how to "change the system", I might suggest this - LPN exam and RN exam are two separate career paths, not hierarchical but complimentary. And their unique roles should be fleshed out more (and standardized). As an analogy - Advanced practice nurse roles are ARNP, CNS, , or CRNA. All advanced practice, separate but equal paths. RN and LPN are the level below that, separate but equal paths and the one you choose is a career move. Just as with doctors, they are all doctors but they choose different specialties. LPN and RN are different specialties.
I think this would give BOTH titles the respect that they deserve, as well as portray nurses as a respectable profession. I dont think having multiple levels below RN is the answer to that though. I don't think "nurse" should even be considered an "entry-level" job - we work too hard for that! And being a career bedside nurse would then imply that you stayed entry level your entire life, even though you have a vast wealth of knowledge. Now, to further your career, there are a myriad of certifications available to get, but RN or LPN alone is something to be proud of.
So in my head there is a lovely tree/pyramid now:
ARNP CNM CNS CRNA
RN LPN
CNA MA
Yes....the more I think about this the more I like it.....
Oh, and as far as the degree question - I don't really care what degree you have, I care what NCLEX you sit for. JMO.
OP, I think I get what you were trying to say here, and I dont know if my thoughts on it will be wildly unpopular or not, but here they are: First, let me be transparent and say that I am a BSN RN and have never been anything else. If anybody wanted me to help decide how to "change the system", I might suggest this - LPN exam and RN exam are two separate career paths, not hierarchical but complimentary. And their unique roles should be fleshed out more (and standardized).
As an analogy - Advanced practice nurse roles are ARNP, CNS, , or CRNA. All advanced practice, separate but equal paths. RN and LPN are the level below that, separate but equal paths and the one you choose is a career move. Just as with doctors, they are all doctors but they choose different specialties.
LPN and RN are different specialties.
I think this would give BOTH titles the respect that they deserve, as well as portray nurses as a respectable profession. I dont think having multiple levels below RN is the answer to that though. I don't think "nurse" should even be considered an "entry-level" job - we work too hard for that! And being a career bedside nurse would then imply that you stayed entry level your entire life, even though you have a vast wealth of knowledge. Now, to further your career, there are a myriad of certifications available to get, but RN or LPN alone is something to be proud of.
So in my head there is a lovely tree/pyramid now: ARNP CNM CNS CRNA
RN LPN
CNA MA
Yes....the more I think about this the more I like it..... Oh, and as far as the degree question - I don't really care what degree you have, I care what NCLEX you sit for. JMO.
What you are describing IS what nursing hierarchy has already established; again, LPN and RN are two different scopes.
The issue that makes it hairy is the discussion about the RN having one entry into practice, along with internal factors that a percentage of our colleagues have with LPN vs RN.
I think that anytime you gett a group of people together they will begin to establish a pecking order, no matter what "class" or background they come from and that if prestige is as big a deal as it seems to be for some people here, they will probably find themselves disappointed in direct relation to the amount of effort they put into arranging their circumstances with that goal in mind.
I really don't see the logic of folding ADNs into the LPN status other than as an attempt to rarify the bachelor's degree, since they take the same licensing exam.
I'll concede this is basically about a pecking order. Although pecking order has such a negative connotation. In many professional environments, some degree of professional stratification is necessary for an orderly workplace. You have to know who to go to for different problems, what you can generally expect from a certain group of professionals/technicians, etc. This is more about the general professional image of nursing (going forward). Although I highly value education, I cannot comfortably say that BSN prepared nurses generally provide better care. That's why I will re-emphasize that this has nothing to do with patient care. Patient care is what matters most; I am writing this post with the long-term professional standing of nursing in mind.
To address your last sentence:
Logic: It may be beneficial to have a professional/bachelor's degree as the entry-level RN degree in the future. The obstacles to doing away with everything but a RN-BSN have been thoroughly discussed through out this forum. To off-set some of these challenges (theoretically), I raised the question of expanding LPN education (basically marrying LPN/ADN) to fill the void left by phasing out ADN/Diploma RNs. This seems logical because the infrastructure is already in place for this type of transition. This seems more efficient than having MAs, CNAs on steroids, or some other yet to be created role take the place of ADN/Diploma RNs. I can understand how this seems like an insult to present-day non-BSN nurses. I suppose the most efficient route (in my life-time) would be the status quo (multiple entry for same NCLEX).
I wish there was a way to discuss the general professional image of nursing and "keeping up with the kardashians" without coming across as a pompous person focused on all the wrong things...because that's how I feel right about now.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I'll concede this is basically about a pecking order. Although pecking order has such a negative connotation. In many professional environments, some degree of professional stratification is necessary for an orderly workplace. You have to know who to go to for different problems, what you can generally expect from a certain group of professionals/technicians, etc.
Very true, but the premise of your thread raised the issue of whether or not it is necessary to have the lower strata there to make the higher one more "impressive" to other people and not integral to the points you raised or required for purposes of division of labor, delegation, or identification of resource people.
Including such a value in those things would probably be counterproductive, although in a global sense our perception of anything is defined by the presence of something to compare it to.
This is more about the general professional image of nursing (going forward). Although I highly value education, I cannot comfortably say that BSN prepared nurses generally provide better care. That's why I will re-emphasize that this has nothing to do with patient care. Patient care is what matters most; I am writing this post with the long-term professional standing of nursing in mind.
This is one of the core beliefs underpinning the 1965 ANA Position Paper on requiring a BSN for entry to practice. I've yet to see so much as a survey, let alone a comprehensive study stating anything more than a nebulous opinion that BSN ETP would achieve that goal.
I'm glad you decided not to add the patient outcomes factor. That came about fairly recently and has done nothing but create animosity within a profession that has plenty of outside stressors to contend with already.
To address your suggestion about expanding the current LPN role (which is closer to the Canadian system, which could be a great model going forward) it's going to face an uphill fight in the political arena. The powerful RN lobby would likely go ballistic over anything containing the words "expand LPN role". My reference to logic meant that since ADN programs have far more common ground with BSN programs than LPN programs and considered equivalent in terms of protecting the public from harm by every legislative body in the US via the common test.
I honestly think the marketplace will end this conlict de facto itself as a consequence of supply and demand, so I don't see any problem with what to do with current ADN/Diploma nurses who will dwindle through attrition. I guess what will happen is a vastly fewer number of mostly BSN nurses will supervise a larger number of specialized techs.
.....and you are not pompous. Not even a little bit.
Most laypeople are ignorant in my experience. They only know "nurse," not Diploma/ADN/BSN or LPN. So I don't think having a "lower class" of nurse elevates the RN title in any way.
I also think that until nurses stop belittling themselves by dividing and classifying, we will never get the respect we deserve as a profession.
When docs think of themselves, they don't immediately think "cardio-thoracic surgeons go to school longer than hospitalists, but intensivists are the best." (Yes, that statement is purposefully ridiculous.) All docs think they are awesome. Therefore they get the respect that they expect.
Nursing as a whole should have the same mindset. We are all equally awesome, we just practice differently and fill different needs.
I know I'm going off topic by responding to this, but I will anyway. I disagree that physicians don't differentiate themselves. I've seen them do it first hand. Titles and different areas of medicine are both coveted and looked down upon. Example: I've seen a sub specialty both looked down upon and admired. Pediatric pulmonology - A pediatrician may either covet the sub specialty, or look down upon the pediatric pulmonologist because they are so specialized they forget anything not having to do with pulmonology.
I know I'm going off topic by responding to this, but I will anyway. I disagree that physicians don't differentiate themselves. I've seen them do it first hand. Titles and different areas of medicine are both coveted and looked down upon. Example: I've seen a sub specialty both looked down upon and admired. Pediatric pulmonology - A pediatrician may either covet the sub specialty, or look down upon the pediatric pulmonologist because they are so specialized they forget anything not having to do with pulmonology.
I see your point. I am around mostly surgeons and intensivists. The ones I am familiar with are mostly prima donnas, so they all think they are hot stuff. I guess I overlooked the part where they believe the other services aren't quite up to their level.
However, my point was more that all docs believe that the profession itself is deserving of the utmost respect from laypeople. Nurses, in my experience, often belittle themselves by saying dumb things like "I'm just the nurse," implying that the nurse title is nothing special. I hate that.
, the upgrade to expand my scope and become an expert in my practice is important to me; a better nurse makes a better patient population, at least to me.
nursel56
7,122 Posts
I think that anytime you gett a group of people together they will begin to establish a pecking order, no matter what "class" or background they come from and that if prestige is as big a deal as it seems to be for some people here, they will probably find themselves disappointed in direct relation to the amount of effort they put into arranging their circumstances with that goal in mind.
I really don't see the logic of folding ADNs into the LPN status other than as an attempt to rarify the bachelor's degree, since they take the same licensing exam.