As an offshoot to the News article about nursing education, an opinion was brought to the board that LPNs are not adequately prepared to care for patients, and that their education is not strenuous like an RN program is. Having been in the field for awhile, what is your opinion on the differences between LPNs and RNs, other than the legally different aspects (LPNs cannot do initial assessments or IVs in my state for instance)
I'm not looking to start trouble, but rather discuss the topic in an area other than an unrelated thread.
Differences in LPNs vs RNs (educationally, functionally, intellectually)
Best way to combat any possible negatives of the above
Advice for an LPN student (who is too far through her program to just throw it out and start over in an RN program - already applied for an LPN to RN program starting Jan 2010)
Should I really expect to run into attitudes in the workplace about my not being worthwhile as an employee and a care provider because I chose the path that I have? How do you handle it if you do?
There is a local small rural hospital that pays incredibly well for LPNs right out of school and who has been trying very hard to recruit us during clinicals... am I going to be inequipped to care for patients there because of my education? I would never want to get into a situation where patient care was compromised because my education was lacking somehow...
Specializes in Community Health, Med-Surg, Home Health.
The problem really lies in the consistancy of programs-LPNs from one program may be great, and others may turn out-self taught from books students. Some current workers may be ready to be RNs, others not.
I agree with the others that the BONs are to blame for the confusion of job roles; that hospitals prey on nurses the way they do is despicable. Asking an RN to work with an LPN with experience, or assigning an LPN that may come from a corrospondance course is asking for two very different reactions. The problem is that you know what the RN has to know, and expect a learning curve from a newbie; but the ADN has 4 semesters of clinicals. The new LPN/LVN is a complete unknown and has only a year for book and clinical time. (at least in my neck of the woods) and the experienced LVN/LPN has a limited scope of practice. A sure nightmare anywhere assessment, and narcotic pushes are the norm!
Again, I think it's hard for those of you who are fully functional as LVN/LPNs in your states to see the predicament posed by them in a state with limited practice. I also am surprised to hear some don't want the responsibility of an RN. If RN was required, all nurses would be at the same operational level, making hospitals a safer place and nursing more effective. My core group of patients should not suffer because you are limited in your scope of practice-waiting while I provide elements of care to your patients. It isn't safe, it isn't right, and hospitals get away with murder paying such low rates for your hard work!
I can't speak for every LPN, but the reason why I don't want the responsibility is because of the bull that goes along with it. I function better with more stable situations and I am not as distracted this way. This system is really abusive to everyone...patients, nursing staff of various levels, physicians, etc... And, I have seen firsthand that it does not seem to matter whether many are at the same operational level or not, it is the integrity of the person behind it that makes the difference. Believe me, I know it is hard for some to understand that RN is not attractive to everyone, but I can't help how I feel. I would be doing a disservice to myself, the patients, collagues and facility to take on something that my heart already told me I am not ready to do. It doesn't have to mean that I can't contribute positively to patient care, though. I think that what is hurtful to dedicated LPNs is that the message seems to be that if you don't even desire to become an RN, then, you are deemed lazy, worthless and not worth being shown appreciation and loyalty. I think that what made my decision easy is that I had to choose between peace of mind and money...my peace of mind won.
Granted that LVN/LPNs are not in the hospitals anymore where I live (except those grandfathered) LVNs are the main components of LTC facilitates. With the retiring baby boomers, if anything, we will need MORE LVNs, I don't think LTCs could afford to primarily hire RNs, and in this setting, LVNs are nearly equivalent to RNs as far as what is needed for patient care.
Personally, I don't think we are going to have to worry about LTC, you'll see we will be cutting non-compliant patients who get sick-OFF, limiting benefits with real age cut-offs, and to those who are very ill and have a bad prognosis. The pendulam is going to swing away from do everything, to maintenance and expiration of benefits. After working in the ER sometimes I am not too sure that would be a bad thing. I know it's cold, but we all have an expiration date.....we just keep trying to expand it! Sometimes I think to what end, there is nothing like having an elderly person whisper "no more, please" to make you realize that's not how you want to go, putting in moments while the marvel of modern medicine keeps you rebounding for more medicine, indignity, bedsores and whatever else!
For those who live, they deserve everything they have worked for. If that is an RN, so be it!
I can't speak for every LPN, but the reason why I don't want the responsibility is because of the bull that goes along with it. I function better with more stable situations and I am not as distracted this way. This system is really abusive to everyone...patients, nursing staff of various levels, physicians, etc... And, I have seen firsthand that it does not seem to matter whether many are at the same operational level or not, it is the integrity of the person behind it that makes the difference. Believe me, I know it is hard for some to understand that RN is not attractive to everyone, but I can't help how I feel. I would be doing a disservice to myself, the patients, collagues and facility to take on something that my heart already told me I am not ready to do. It doesn't have to mean that I can't contribute positively to patient care, though. I think that what is hurtful to dedicated LPNs is that the message seems to be that if you don't even desire to become an RN, then, you are deemed lazy, worthless and not worth being shown appreciation and loyalty. I think that what made my decision easy is that I had to choose between peace of mind and money...my peace of mind won.
I see your 20+ years as fantastic! You can run circles around newbie anythings, why not get paid for it! The grief comes to everyone in the system, again, if we were all the same and could stop this infighting it would be a hugely postive step for the profession.
Specializes in Community Health, Med-Surg, Home Health.
I see your 20+ years as fantastic! You can run circles around newbie anythings, why not get paid for it! The grief comes to everyone in the system, again, if we were all the same and could stop this infighting it would be a hugely postive step for the profession.
I don't want to repeat school for any reason. I really didn't like it, although I enjoy what I do. I know that this will probably never end, the strife of these titles, unfortunately. But, I am not going to place energy into something I don't want to do. But, we do exist, and I want to reach out, shake hands and say "Let's work this out in peace". I can't make it happen, though. I express these things so passionately here on AN because I do want people to know that we can be a value to the service. To those that still believe we don't, I'd have to step graciously to the sidelines. I do enjoy reading your posts and interactions, MaisyRN-ER and hope that this difference of opinions does not mar the stimulating discussions between us.:heartbeat
I don't want to repeat school for any reason. I really didn't like it, although I enjoy what I do. I know that this will probably never end, the strife of these titles, unfortunately. But, I am not going to place energy into something I don't want to do. But, we do exist, and I want to reach out, shake hands and say "Let's work this out in peace". I can't make it happen, though. I express these things so passionately here on AN because I do want people to know that we can be a value to the service. To those that still believe we don't, I'd have to step graciously to the sidelines. I do enjoy reading your posts and interactions, MaisyRN-ER and hope that this difference of opinions does not mar the stimulating discussions between us.:heartbeat
Are you kidding, mutual admirations all the way! I feel the same about you, you are always on the money and truly not dismissing you in any way, I just wish there were a way to sift the chaff from the wheat no matter the level a good nurse is a good nurse, regardless of education.
That's what counts for the patient and matters to our co-workers!
i can speak for myself in saying that coming on this board and reading threads like this make me really upset. i know i shouldn't be, but it makes me feel like a burden, like less of a nurse, and like an incompetent person who is in the way of the RN.
i got more respect as a paramedic than i do as a LPN. yes, it's a choice i made, because the waiting lists here are rediculous.... it's a choice i don't regret and i am proud of my accomplishments as a LPN. i am in the process of applying to a bridging program to become a RN because that was my original goal.... but for now, i'm a LPN and i work very hard in the hopes my RN counterparts at the hospital will respect me and for the very most part--they do. they have never whined about me being in their way, because they know i will always be there to help them out no matter how busy i am and that i am not a person who passed their boards only by the eenie-meenie-mo fashion.
i'm sorry to all of you who have worked with poorly trained LPN's who do not have either book smarts, clinical skills or common sense and somehow passed their boards. i too have worked with both RN's and LPN's like this alike. sometimes it's the training, sometimes it's the person, sometimes it's both.
i find it somewhat unfair to lump all LPNs into this category and like a previous poster said it is the fault of the state BONs who do not properly regulate these programs and require accross the board standards for all practical nursing education. i've seen a few PN students from the local trade school who scared me with their lack of clinical skills. but i have also had RN students during their practicum ask me what a positive troponin and CK-MB was. so there is always room for improvement and education everywhere!
i know that my training was excellent and although i did not get along with many of my classmates for catty reasons, i would be confident in saying that they will be great, competent nurses. our program was almost 2 years and we sat with RNs and used the same books as the RNs for many courses. we were at clinicals at the best hospitals in the area including university affiliated ones and taught by nurses who were up our butts all the time in a drill sarg fashion. if you couldn't explain what you were doing and why you were doing it, you were the CNA for the day and got a fail for the clinical day.
i have spent most of my career in a hospital, apart from the years at the fire department. most nurses fresh out of school, whether RN or LPN, are green, unsure of their skills, and have not mastered the ins and outs of nursing, especially those who start in a specialty area such as tele or ER. it is unfair to say that an LPN is "unfit" to work with an RN in these settings, simply because they are an LPN, because everyone deserves an orientation and a chance to prove their skills and knowledge.
i don't know why i feel like i have to constantly prove myself to other nurses, when i am a nurse, and a darn good one at that. my circumstances are somewhat different, as i have six years as a licensed paramedic also, so for someone to say that i don't know how to critically think enough to insert an IV or know when someone is taking a run for the drain, makes me laugh.
i have worked with nurses from all ends of the spectrum, no matter what level of education you have---you can still be an idiot. you cannot lump all LPNs into the incompetant category right off the bat.
i don't understand the big deal with working with an LPN over a CNA, and i probably never will. i plan on becoming an RN within the next year or so and will never forget what it was like to be pooped on as a LPN...... just as now i have never forgotten what it was like to be a tech in the ER and be the one wiping up vomit from the floor while the nurse that found it came to get me to clean it up and then sat and read magazines at the desk.
i don't have any sour grapes towrds anyone with a higher education than myself--i have utmost respect for all health care providers, because our job is HARD! and its HARDER because of things like this where it proves to be every man for themselves instead of teamwork. i am not bashing anyone with an RN degree---i'm engaged to one and i was birthed from another.
so i ask you this RNs, when the lowly LPN says "please push this drug for me", why don't you say "ok, LPN. i'll push this for you if you go and check my blood glucose in room 3". or when the LPN says to you "can you please help me do this admit assessment?" say, "ok, LPN. let's go in the room together, i'll do the physical and you document the history and do the MAR reconciliation".
if you think we don't belong in acute care, that's fine with me. if you think that people in LTC should be taken care of by RN's too, that's also fine with me. that is your right and your opinion. just realize that we are still around, and that we do deserve a chance for earning your respect, and that we too are nurses.
Specializes in Peds, CCU, ICU, Cardiac, ER, MS, SNF's,.
Back in the Dark Ages, my first employer was at a Univerity affiliated hospital, one of the Top 10 in the USA. I worked night shifts in Peds; 2 licensed staff, no aides on a night, 16 bed unit.
When the on-call Intern for the night found out that a "New Grad" RN (ie. a nurse with less than 1 year experience) was "In Charge" of the unit for the night shift, the Doc would not even go to their sleep room; they would find an empty bed or chair to sleep in on the unit because they knew they would be awoken multitudinous times during the night from the new grad's calls; and save themselves alot of steps back to the unit to respond to the calls.
UNLESS the other staff on duty was an experience LPN; then the Doc knew that the LPN had the knowledge and insights as to when it was appropriate to call or wait to call the Doc.
From what I observed, the LPN programs provide alot more actual clinical and bedside hours in their preparation than any of the various RN degreed programs currently do. They were much more able to get organized, do the job, and prioritize than any new grad RN's. Many new grads had never even performed a full shift from start of getting report to end of giving report during their years of education.
Unfortunately, the absolute BEST RN programs, the 3 year Diploma Nurse programs were killed off by the ANA back in the 70's and 80's; now THOSE were the nurses to learn from and emulate.
I fully agree w/the writer who wishes all nurses started at LPN/LVN levels then advance to RN level. Then the best of both worlds would be achieved, in Practice/Clinical and in Theory.
Specializes in Community Health, Med-Surg, Home Health.
i can speak for myself in saying that coming on this board and reading threads like this make me really upset. i know i shouldn't be, but it makes me feel like a burden, like less of a nurse, and like an incompetent person who is in the way of the rn.
i'm sorry to all of you who have worked with poorly trained lpn's who do not have either book smarts, clinical skills or common sense and somehow passed their boards. i too have worked with both rn's and lpn's like this alike. sometimes it's the training, sometimes it's the person, sometimes it's both.
i find it somewhat unfair to lump all lpns into this category and like a previous poster said it is the fault of the state bons who do not properly regulate these programs and require accross the board standards for all practical nursing education. i've seen a few pn students from the local trade school who scared me with their lack of clinical skills. but i have also had rn students during their practicum ask me what a positive troponin and ck-mb was. so there is always room for improvement and education everywhere!
i have spent most of my career in a hospital, apart from the years at the fire department. most nurses fresh out of school, whether rn or lpn, are green, unsure of their skills, and have not mastered the ins and outs of nursing, especially those who start in a specialty area such as tele or er. it is unfair to say that an lpn is "unfit" to work with an rn in these settings, simply because they are an lpn, because everyone deserves an orientation and a chance to prove their skills and knowledge.
i don't know why i feel like i have to constantly prove myself to other nurses, when i am a nurse, and a darn good one at that. my circumstances are somewhat different, as i have six years as a licensed paramedic also, so for someone to say that i don't know how to critically think enough to insert an iv or know when someone is taking a run for the drain, makes me laugh.
i have worked with nurses from all ends of the spectrum, no matter what level of education you have---you can still be an idiot. you cannot lump all lpns into the incompetant category right off the bat.
i don't understand the big deal with working with an lpn over a cna, and i probably never will. i plan on becoming an rn within the next year or so and will never forget what it was like to be pooped on as a lpn...... just as now i have never forgotten what it was like to be a tech in the er and be the one wiping up vomit from the floor while the nurse that found it came to get me to clean it up and then sat and read magazines at the desk.
so i ask you this rns, when the lowly lpn says "please push this drug for me", why don't you say "ok, lpn. i'll push this for you if you go and check my blood glucose in room 3". or when the lpn says to you "can you please help me do this admit assessment?" say, "ok, lpn. let's go in the room together, i'll do the physical and you document the history and do the mar reconciliation".
if you think we don't belong in acute care, that's fine with me. if you think that people in ltc should be taken care of by rn's too, that's also fine with me. that is your right and your opinion. just realize that we are still around, and that we do deserve a chance for earning your respect, and that we too are nurses.
sorry for the rant.
i understand your frustration and certain points i bolded to comment on.
we can speculate as much as we like, but for the moment, at least, lpns do exist. some of us are limited to ltc, others are still in hospitals. but, unless the decision is to suddenly swipe the slate clean overnight, we are still people who are working rather than collecting money doing nothing. originally, i felt like a burden, or that i wasted my time. i was granted a leave with pay to obtain my lpn license, and the moment i returned back to work, the first comment was "go back to school". i was appalled! not many people told me that they were glad to have me on board, congratulations, but, go back to school. period. while our scope here in new york is wider, my facility opted to take away stupid things (an example is administering flu and pneumococcal vaccines to adults only with an rn screening-even though the doctor wrote an order-which meant it was already assessed by them) that lpns can, in fact, do...which caused strife with the rns, because this is so inconsequential that they get aggreviated when we come to them. did we make up those rules? no!!
there are, at least in my opinion, certain places within the hospital that lpns can function...maybe not icu or nicu, but there are plenty, if the administration would make the duties a bit more clear.
recently (last week, actually), it was decided that patient care associates can no longer do fingersticks because they were not reporting the readings to the nurses. now, nurses (both lpns and rns) have to run around to do fingersticks, chase the aides to sign for their specimen collections because the labs were saying that they were mislabeled and yet, the nurse is the one getting written up. but, then, they want to allow the pcas to take an ekg course to monitor in telemetry. now, what is the rationale of that? this is not saying that they are not capable, but wouldn't this do the same thing...except this time, they won't report an abnormal rhythm! the difference in my eye is that the lpn is licensed as well, and is legally accountable if she does not intervene, even if it is to tell the rn/physician...because, she does know a bit more about why this is dangerous to ignore. and, yet, some rns wish to say that we should be done away with??
i do believe that we can, until (or even if ) this problem with education is resolved to not be selfish, at least not with those that are willing to help within their legal limits. the examples you made were perfect...you do this, which you are legally responsible for, and i'll do that, which i can also do and know what to say to you that warrents further attention. our screaming about how each gets on each other's nerves will not solve, nor will wishful speculation.
Specializes in Community Health, Med-Surg, Home Health.
ImAgypsy made some great points. I was just talking to my best friend, who is an RN, and I said to her that if an RN had mastered more of the bedside skills by the time she graduated from her program, it would have been easier to get the documentation portion together. I am not sure, but it may be too stressful to try and balance out the observational and bedside skills, which can potentially kill someone while dealing with the demands of voluminous documentation that only says that you did things that you may not have actually done. She only had one day of clinical a week-for 5 hours at that. Told me that she didn't remember what she did last week because she was creating beautiful care plans and learning the theory.
I was in a new program where clinical instructors were grabbed at the last minute. Most of them had second jobs, so, they used to cut our clinical hours short, and even canceled a great deal of them, forging that we were there when we were not. It gave me time to graduate top of the class, but, what did that mean? Then, I returned back to my job where the orientation for new grads was nothing short of horrible. We were dumped into places where the "Dark Age" nurses had better training and they thought that we were ready to rumble...HA! What a surprize that we knew nothing, were scared to death and did not recognize most of what we saw!! Oh, and don't forget the bullying! I was just fortunate that I went to a floor where my best friend was and she sort of put the word out that I was cool, so, they didn't really bother me the same way that others were.
So, we fight, we try to prove ourselves, we hide, we suffer...ALL of us. Now, with this economy as it stands, now, do you really wish to add more viable people on the food lines because of this war between the nurses? If this nurse, may it be LPN or RN were worth her salt, I want to see her working beside me, so that we can support and mentor each other. Otherwise, this same hungry person who, once had a job that can feed her family is now about to hit me upside my head because she can no longer work with any dignity. That should not happen either, based on the mistakes that happened years ago when people did not have the forsight to see where this would lead the LPNs and RNs of today.
Specializes in Peds, CCU, ICU, Cardiac, ER, MS, SNF's,.
re: Your Nursing Student friend: "...Told me that she didn't remember what she did last week because she was creating beautiful care plans and learning the theory..."
Oh LORD IN HEAVEN; is this STILL the way/focus of RN programs? :crying2:
(I've been out of the hospitals for the past 8 years so haven't had much interaction w/any student nurses or new grads; I had been hoping that RN programs were providing more bedside and less "make it all look good on paper in theory" in their training.)
Will the ANA NEVER Get their Priorities Right? They are the ones that push/lobby for what is important in nursing programs; and as far as I'm concerned, have done little to address the realities of how we nurses can PROVIDE the CARE the patient needs without being stressed for time to document, document, document.
The last few years I worked in acute hospitals, I remember joking when stressed and trying to catch up on documenting when call bell rang during the night;
"Don't those darn Patients know they are interferring with my paperwork/documentation? :angryfire How can I ever get it done if they NEED something else????"
Thankfully are nursing programs are not created equal. I had two full days of clinical each week and during my last semester we had "reals" which was having at least 2 patients but more often 3-4.
I feel sorry for students that don't get enough time on the floors.
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:crying2:
pagandeva2000, LPN
7,984 Posts
I can't speak for every LPN, but the reason why I don't want the responsibility is because of the bull that goes along with it. I function better with more stable situations and I am not as distracted this way. This system is really abusive to everyone...patients, nursing staff of various levels, physicians, etc... And, I have seen firsthand that it does not seem to matter whether many are at the same operational level or not, it is the integrity of the person behind it that makes the difference. Believe me, I know it is hard for some to understand that RN is not attractive to everyone, but I can't help how I feel. I would be doing a disservice to myself, the patients, collagues and facility to take on something that my heart already told me I am not ready to do. It doesn't have to mean that I can't contribute positively to patient care, though. I think that what is hurtful to dedicated LPNs is that the message seems to be that if you don't even desire to become an RN, then, you are deemed lazy, worthless and not worth being shown appreciation and loyalty. I think that what made my decision easy is that I had to choose between peace of mind and money...my peace of mind won.