RPNs/LPNs vs. RNs

[rant]

I know this has probably been discussed a fair amount on this forum, but as a RPN/LPN that is currently bridging to become a RN, I wanted to share my experiences, questions, and conclusions about the inherent differences between the two nursing roles.

I completed my RPN program in June 2007, and immediately enrolled into the bridging program at McMaster University in Ontario, Canada in September 2009. I have since completed my first year of university towards my BScN.

Before I begin, I would like to note that I have not yet experienced a clinical rotation in the RN role (that begins this year). So the viewpoint that I will be representing is purely from an academic perspective, and not a practical one. I realize that this may be severely impacting upon my bridging experience.

It is my belief that there should not be two types of nurses. And when I say this, I do not mean to say that one is better than the other. Upon the contrary, I believe that RPNs and RNs have a similar breadth of knowledge and that there should no longer be a segregation in pay, entitlement or recognition between them.

I acknowledge that this may sound like some sort of "RPN paranoia" against RNs, but please be assured that is the farthest thing from the truth. I am not saying RPNs are "better" than RNs, at all. But I am not, as yet, willing to concede that in their base ACADEMIC knowledge, RNs are very much more superior than RPNs.

Having gone through one year of RN training in the science-based aspects of the discipline, I can honestly and truthfully say that there wasn't much that I learned this year that went beyond the scope of the RPN. Our physical assessment course was identical to that of the one I took in my RPN program. The anatomy and physiology course was identical, as well. Pathophysiology with a pharmacologic inclusion was a new course that I had not taken, but (and perhaps it was because of the professor and her choice of course planning) I do not feel as though I walked out of the course feeling like I had a superior amount of knowledge prior to the amount that I had walked in with. The course material was very basic, and very rushed. I anticipated that I would be learning common and complex disease states for each system of the body, and how to treat them pharmacologically. However, we focused on basic/common concepts like inflammation and common CV/resp diseases. Pharmacology barely came into it, and I felt very disillusioned. I felt, truly, that I had learned much more in the first year of my RPN program than I had in my first of the RN program.

Many of the RPNs that I have worked with have clinical skills that equate that of the RNs. I have been told many times that the only true difference to be found between RNs and RPNs are leadership skills. I am starting to believe this is true. Because although many RNs have superior disease/pharmacology knowledge to RPNs, I believe this only because of exposure. RNs are granted access to more complex and unstable patients, and it is THIS that gives them the superior knowledge. It is, from what I have seen thus far, not because of an inherent difference in their education.

It seems to me that there should no longer be two types of nurses. But I don't know what to do with that feeling. Because to suggest that we should remove RPN education seems ridiculous. And doubly so to say that we should remove RN education. But I feel as though this dichotomy is causing a rift in our profession. RPNs get paid almost 40% less than RNs for the same clinical skills. RNs get replaced with RPNs who don't have as much knowledge simply because institutions can pay them less.

I don't know what to do, or how to feel. And it hurts and saddens me greatly. I would appreciate any thoughts on this matter. It is deeply appreciated.

[Fiona59]

Well, the American's around here don't know what an RPN is. To western Canadians an RPN is a registered psychiatric nurse.

[rant]

That's why I included LPN.. I hoped that might clarify. I apologise if it didn't!

[roser13, ASN, RN]

What is an RPN? I've never heard of it.

Whatever it is, this statement:

"I would like to note that I have not yet experienced a clinical rotation in the RN role (that begins this year). So the viewpoint that I will be representing is purely from an academic perspective, and not a practical one"

causes me to discount your disagreement with the current state of nursing. Once you have finished your schooling and logged some time as an RN, come back and raise the issues. Then I and other experienced nurses will place more credence in your opinions.

[aileenve, ASN, RN]

You did not mention taking RESPONSIBILITY for a ward or a group of patients! RN liability is much greater.

[LinzyRN]

causes me to discount your disagreement with the current state of nursing. Once you have finished your schooling and logged some time as an RN, come back and raise the issues. Then I and other experienced nurses will place more credence in your opinions.

I second that! Maybe the scope of practice is different in Canada for RN and LVN than in the United States but I think you should revisit this once you've had RN experience.

[newtress, LPN]

Well, I was watching some nurses being interviewed on TV in Minnesota and they were titled as RPN identified as Registered Practical Nurse if this helps. I am an LPN and thought, wow how close to RN can you get, it might as well be. This rediculous separation by the term practical or vocational has gotten kind of rediculous. As LPN's we are being given more and more administrative tasks on top of everything else. We certainly aren't glorified CNA's but as Rant posted are on the much lower pay spectrum. I agree 100% with the OP. You did an excellent job presenting the academic knowledges and exactly why the RN having the exposure to more complex and unstable patients, and that gives them the superior knowledge. I have worked with quite a few RN's who have told me that they didn't have much exposure or experience with such things as Foley catheters or starting IV's when they started nursing, and stayed away from it because it was all done by the LPN. I worked my a$$ off on a med surg floor at a hospital, and thought I was just as worthy of an RN's salary. I wish the two would just merge and be done with it and all be "registered." Licensed, Registered.. geez we all sit for an NCLEX state board. I personally know LPN's who are assistant DON's, MDS coordinators, wound care/ostomy treatment LPN's and utilization review LPN's in my hometown. Reminds me of the time back in history of "Separate but not equal" doesn't it?

[loriangel14, RN]

You did not mention taking RESPONSIBILITY for a ward or a group of patients! RN liability is much greater.

I am an RPN and I am responsible for my patients, not the RN on the floor. I work under my license, not hers.

[ruralgirl08]

I hear what you are saying. When I took my 4 yr BSN degree, we had a couple RPNs in our class (before the bridging programs), they found the first 2yrs of our program repetitive to RPN, but said the last 2 yrs did build on to their knowledge base, such as: more in depth Pathophysiology, Microbiology/Immunology, Stats/Research, more in depth Community, more nursing theory, Leadership, ect. (The new RPN program (I have heard) is very similar to the old RN diploma program, more practical/hands on.) But to be honest, the most learning I have found, happens on the job. You receive more specialized training in which ever area you work. You will likely also need to get advanced certifications, ect. As an RN you do have access to more critical patients, which does require more responsibility/knowledge for treating and educating both patients and anxious families. I have worked with many brilliant RNs and RPNs.

But, I do agree. I would prefer to have one kind of nurse. I think "tiering" nursing and creating similar scopes of practice has not benefited nurses. It was done to save a buck. I have yet to see it create good team cohesion and satisfaction, no matter how great the people you work with are.

[Fiona59]

I am an RPN and I am responsible for my patients, not the RN on the floor. I work under my license, not hers.

Lori, I think that's why this topic was moved to the Cdn. forum where it belongs. Americans have no idea of how we are utilized and usually get it wrong.

The argument makes me think that the 2020 project proposed by CNA is happening whether we know it, want it, or are aware of it. I think AB and Ont are being used as the trial run for it. We've both seen the PN education programme basically become the old diploma course without grads getting the pay or recognition that the existing diploma RNs have.

Further education is a great thing but to say that PNs are not up to it is insulting. We have a lot of material crammed into two years so that we can hit the floor and work. Once we find our area, we upgrade on our own time and dime, usually by attending the same workshops and seminars as our RN counterparts.

[linzz]

I'd say it is just wrong to say that RPN's aren't capable of further education. I already have one degree, in which I wrote many essays, did research and passed statistics courses the first time. I took the RPN program because I have a family and could not afford to spend four years in school. There are no accelerated programs anywhere near me.

I doubt we will ever see the day of one level of nurse because the provincial government of Ontario is running a large deficit and cost cutting will be the order of the day for some time yet. Our premier has said many times that health care costs are rising at an alarming rate and he intends to rein them in regardless of the outcome. Yuck.

[Smith.C74]

From what I've seen, there are some areas of work that seem to be restricted to RNs. I don't doubt the fact that RPNs are being used more as a cost cutting measure (2 RNs @ $30/hr = 3 RPNs @ $20/hr - more people to spread the work around to). In some settings, RNs seem to hae more of an administrative roll.

I don't agree with the segregation of the different levels of nursing. They have to be able to work together and the segregation doesn't help when there seeems to be so much bitterness betwee the 2 groups.