RPNs/LPNs vs. RNs

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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.

Specializes in NICU, PICU, PCVICU and peds oncology.

Here's a bucket of cold water. I'm closing the thread for a cooling-off period.

Specializes in NICU, PICU, PCVICU and peds oncology.

Let's see if we can keep this dabate friendly and on topic, shall we?

kb14:

You need to do some research on the history of nursing in Canada. Practical nurses (only Ontario uses the designation RPN) have been around for over 60 years. We were introduced to assist in the nursing shortage brought about by WWII.

PN skills, scope, and education have continued to expand over the decades just as the RNs has.

The BScN education started to gain more acceptance in Canada in the mid-1970s. I remember UBC started theirs around 1977 or 78. I believe the U of A has one of the oldest programmes in Canada (for some reason 1923 sticks in my mind). Many hospital trained nurses feel the degree has developed the wrong way. One year of the education is in Arts (English, Soc, Psych all worthwhile courses in their own right but nurses should come prepared to write a simple short essay).

I've had several friends do the degree after their PN here in Alberta and all have agreed that far too much time was spent writing essays. I even remember tutoring a couple of them on their first year English essays and electives.

The term RPN is fairly new. They used to be called RNA's before. Registered Nursing Assistants. The change happened in 1995 I believe.

Actually there are three types of nursing professionals in Canada (the practical nurse, psychiatric nurse and registered nurse).

Very little (if any) consultation has been with actual working nurses on how their eduation should change. The Registered Psychiatric Nurses (RPN) are being told their education has to become a degree programme to fall in line with the RN education. This has led to a scramble to get into the Psychiatric Nursing field because not all students can afford four years at University. There are some fantastic RPNs working the surgical and medical units in my hospital (their education allows for experiences in all areas of care but their primary focus is on Mental Health).

Nobody consulted the working RPNs to see if they felt their patients would be better served by a degree based nurse.

The provincial colleges very rarely consult their membership on how we feel that our next generation should be educated. I remember when the Practical Nursing programme was changed to include all the first year university Arts courses. Nobody consulted with the working nurses. The strange thing was that many working LPNs already had these courses under their belt prior to taking their nursing education. The new grads are no different from the "old" grads, they just have a bigger student loan.

For the BScN grads, what we constantly see in the workplace is new grads that are very unsure of themselves and their skills. They don't spend enough time on the units learning their craft/trade. When we precept the university students, we have to virtually drag them into rooms for the hands on stuff (yes, I know you've already done a this procedure once and had it checked off BUT the more often you do it, the easier it becomes). They have no experience of working shifts because most clinicals are over by 22hr. So finding that first job and facing reality becomes a major slap in the face.

Profiles of kb14 and a couple of the other posters don't give us much info on where they are in their nursing career. But once they've walked a few hundred shifts in our white shoes, maybe they will understand where the "older generation" of nurses are coming from.

The average nurse will never go into management or do research. Those spots are few and far between. Instead they will hospital nurse until burnout, retirement or a better non-nursing opportunity hits them in the face.

why would you expect them to consult with RPN's who are done school? Why on Earth?

WOW, your last paragraph is crazy.

I have my BScN and yes I did OR nursing for years. Now, I have a very cushy job doing case management. There are tons of nursing jobs that are not hands on. Many many RN's do them.

This is why I got my degree. It will be YOU, the hands on nurse who burns out. Not the one with the BSCN.

So what I'm reading is that my three years of college to get my RN isn't worth any more than the RNA (registered nursing assistant here in Quebec) who went to a two-year technical program. Then why on earth would anyone bother to go for the longer program if they can get the same place with the shorter one? Seriously.

When I began nursing, when the dinosaurs roamed but after hospital schools, there was a clear distinction between RNAs and RNs. The RNAs were truly assistants. They could do many things, like take vital signs, care for patients who weren't acutely ill, and so on. They could not give medications, couldn't assess, couldn't start IVs, etc. Now, they can do all that (except assess) so now how should I feel? If you can do everything I can do, why bother hiring me? That's what is going too happen.

Facilities will know they can hire X number of LPNs, RNAs, or whatever the term is in the province and pay them less than they would pay the RNs. You haven't gotten any further ahead. in fact, you're saving them a ton of money.

Vancouver Vocational Institute has been training PNs since 1948 and inthe 1970s that is the name they were known by: Practical Nurses.

In Western Canada RPN is the term for a Registered Psychiatric Nurse.

http://www.rpnc.ca/pages/about.php

Traditionally they have been educated to the diploma level. In the last couple of years there has been comments in the media about making it a degree. That is why I say than none of the working RPNs have been consulted in the change in their education.

People need to cease thinking that nursing in Canada revolves around Ontario and its terminology.

And yes, I've met more than a few BScNs over the year who burnt out and left the profession. Jobs and their availability vary from province to province. The "cushy" jobs in Alberta go by seniority and the average BScN just doesn't have enough seniority to land one.

I like how I’m becoming the antagonist in this forum just because I disagree with most of the participants lol. Anyway, I just want to ask a question—if the moderator wants to turn this into a separate thread, then do so—but what is so threatening about new RNs (BScN graduates)? Now before you argue that you do not feel threaten I would like to point out that if you did not feel this is case then the anxiety, and interpersonal conflict between new RNs and other nurses would not exist. The reason why individuals go on the defense (in any type of conflict) is because they feel that the opposing side is threatening their self-worth. Not once did I ever claimed that new RNs are better than other nurses, in fact I asked for other nurses to be supportive rather than be scornful. New RNs should not be the scapegoats just because the deciding body (i.e., nursing colleges) made the “unfavourable” (to some) rules.

"People need to cease thinking that nursing in Canada revolves around Ontario and its terminology." I only speak for what I know of my province, I'm sorry if that bothers you. I will endeavor to learn more about the different terminologies in hopes that I become more inclusive.

"And yes, I've met more than a few BScNs over the year who burnt out and left the profession." And I'm sure there are equal amounts of BScN graduates that stayed in the profession as well. BScN grads are not an homogenous group. We all have different ways to cope with stress.

"So what I'm reading is that my three years of college to get my RN isn't worth any more than the RNA (registered nursing assistant here in Quebec) who went to a two-year technical program." As I've stressed numerous times in my posts, all I contend is that there is a DIFFERENCE... I'm not questioning your worth or competence. In fact, I praise you for your experience, thank you for paving the way for future generations. I like how people nitpick certain part of my posts without really understanding the whole picture.

Specializes in NICU, PICU, PCVICU and peds oncology.
I like how I'm becoming the antagonist in this forum just because I disagree with most of the participants lol. Anyway, I just want to ask a question--if the moderator wants to turn this into a separate thread, then do so

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Specializes in Acute respiratory, med/surg, geriatrics.
Got to love students. They are so idealistic.

I feel a little saddened by this post.

Fiona, I can -- within an intellectual realm only -- understand your frustration with the students/new graduates that you work with. I can imagine their newness, percieved unprepardness, and insecurity must become very old and tiring, fast. It is only through the goodness of the older, more experienced nurses that we can get through an hour, let alone a shift. I owe my (very small) success to nurses like these. Without them, I would be dead in the water, long ago.

I can conceptualize that the unexperienced nurses are frustrating to deal with. However, we are truly doing the best we can with what we have. We don't have the years of experience behind us that you do. Often, we don't have the wisdom of thought to think ourselves through tough situations. We need to rely on you to make it work. So when you call us idealistic, you are very right. Because all we have, in the beginning, are our ideas.

Specializes in Geriatrics, Med-Surg..

I think with new grads, the frustration in not with lack of knowledge, but just that a very few(not all) students are making it difficult for those students who really want to learn and fit in with the unit.

The other issue is understaffing which happens often and it leaves nurses just plain tired and frustrated with everything.

To end on a positive note, there are many nurses that love to teach and take the time to do it. Many of these types of nurses are on this board which makes it a valuable resource for students and experienced nurses alike.

Specializes in Med/Surg, LTC/Geriatric.

I don't understand what is being argued about here...

New grad BScNs are not as good as experienced LPNs? Nope, I disagree

Experienced LPNs are better than new grad BScNs? Nope, I disagree as well

How about each classification and experience level brings it's own pros and cons to the floor. Nurses need to work together both for policies and for the betterment of patients. Arguing about who is better is so counterproductive.

Rant: I'm replying here because I'm not sure if you can access PM yet.

What I meant is students who are still in their classrooms are so idealistic. I was even one once. They tend to believe what their instructors tell them. They often (unless they have worked as an NA before or during nursing school) have no basis for reality. They come onto units vowing to never take shortcuts, never have an off day, etc. Many believe that they will have the pick of the job market. There is very little educational time spent to the realities of the union system and seniority and how it affects what job will be open to them.

Most of us have had the "perfect nurse" arrive as a student in a group only to observe them flounder, refuse to accept assistance when offered and then crash and burn. I had a "born" nurse in my intake. She crashed and burned on her med/surg rotation and walked away from nursing school.

Experience shapes us. When you complete your education you will have a better idea of what Linzz, Lori, and myself are trying to open your eyes to. After you have experienced the futility of dealing with your registration body and union then you will understand our attitude of fatalism. The ivory towers of academia and regulatory bodies takes away individual power.

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