What can an RN do than an LPN can't?

nursemaa · Oct 1, 2005

I'm not sure if someone already mentioned this or not, but another thing to consider is that the RN is responsible for the LPN's and NA's who work with him/her, which I would think would justify the higher wage. Also, in my area only the RN can push IV meds, hang blood, start IV's and mess with central lines, and develop the plan of care (the LPN can contribute suggestions though). The RN has to co-sign the LPN's assessment and an RN must do an assessment every 24 hours. The LPN can collect data for the admission assessment, but the responsibility for completion lies with the RN, who analyzes the data and develops the plan of care. The RN does the initial screenings for nutrition, PT/OT/ST etc, fall risk and pressure ulcer risk assessments, and determines which referrals are needed. Only the RN can call docs to clarify orders, get orders and only the RN can take a verbal/telephone order from a physician. The RN has ultimate responsibility for the patients. So you can't really say that the LPN does the same work as the RN.

Before anyone jumps on me, let me say that I love LPN's and think they are an extremely valuable member of the healthcare team. But they aren't "almost the same as an RN". :)

txspadequeenRN, BSN, RN · Oct 1, 2005

This is not exactly true. I am in a LVN to BSN program and I have 4 semesters total ( outside the pre-classes). For me to go to a LVN to ADN program it is 3 semsters long. The First semester is for LVN's only then they join the other BSN students for the generic nursing classes.

LPNs have to start from scratch to get a BSN.

txspadequeenRN, BSN, RN · Oct 1, 2005

This senerio is not true in a LTC situation. I'm not sure if we are just talking about a certain area of nursing or just in general, I have not read every post.

I'm not sure if someone already mentioned this or not, but another thing to consider is that the RN is responsible for the LPN's and NA's who work with him/her, which I would think would justify the higher wage. Also, in my area only the RN can push IV meds, hang blood, start IV's and mess with central lines, and develop the plan of care (the LPN can contribute suggestions though). The RN has to co-sign the LPN's assessment and an RN must do an assessment every 24 hours. The LPN can collect data for the admission assessment, but the responsibility for completion lies with the RN, who analyzes the data and develops the plan of care. The RN does the initial screenings for nutrition, PT/OT/ST etc, fall risk and pressure ulcer risk assessments, and determines which referrals are needed. Only the RN can call docs to clarify orders, get orders and only the RN can take a verbal/telephone order from a physician. The RN has ultimate responsibility for the patients. So you can't really say that the LPN does the same work as the RN.
Before anyone jumps on me, let me say that I love LPN's and think they are an extremely valuable member of the healthcare team. But they aren't "almost the same as an RN". :)

icugirl33 · Oct 1, 2005

It's up to you to decide which track you would like to take. An LPN is prepared mostly for technical task, which would explain the reason an LPN might be more advance attechnical task. While an RN is also prepared for technical task, however, the focus is more on being the eye and ears of the physician and critical thinking.

It works the same way for ADN/BSN nurses. The ADN nurse most of the time is more technically prepared than the BSN nurse due to having more clinical hours in the hospital. However, being a nurse isn't just about putting in catherters, starting IV's, and giving meds. It's about being able to think outside of the box and using scientific knowledge, evidence based practice, and critical thinking skills to care for someone and reduce adverse outcomes. Those three things you can only get in the classroom with higher education.

There's a BIG difference between doing a task or actually underdanding the reason behind completing the task!!

TNRNMAN · Oct 1, 2005

It's up to you to decide which track you would like to take. An LPN is prepared mostly for technical task, which would explain the reason an LPN might be more advance attechnical task. While an RN is also prepared for technical task, however, the focus is more on being the eye and ears of the physician and critical thinking.
It works the same way for ADN/BSN nurses. The ADN nurse most of the time is more technically prepared than the BSN nurse due to having more clinical hours in the hospital. However, being a nurse isn't just about putting in catherters, starting IV's, and giving meds. It's about being able to think outside of the box and using scientific knowledge, evidence based practice, and critical thinking skills to care for someone and reduce adverse outcomes. Those three things you can only get in the classroom with higher education.
There's a BIG difference between doing a task or actually underdanding the reason behind completing the task!!

That was an awesome post and well said there is no arguing with this it is the bottom line and I love it and I have been an LPN and was darn good at it too but there were things that I learned in RN school that made me go WOW I should have known that earlier. WAY TO GO WELL SAID GREAT POST!!!!!!!!!!!:)

luv4nursing · Oct 1, 2005

It's up to you to decide which track you would like to take. An LPN is prepared mostly for technical task, which would explain the reason an LPN might be more advance attechnical task. While an RN is also prepared for technical task, however, the focus is more on being the eye and ears of the physician and critical thinking.
It works the same way for ADN/BSN nurses. The ADN nurse most of the time is more technically prepared than the BSN nurse due to having more clinical hours in the hospital. However, being a nurse isn't just about putting in catherters, starting IV's, and giving meds. It's about being able to think outside of the box and using scientific knowledge, evidence based practice, and critical thinking skills to care for someone and reduce adverse outcomes. Those three things you can only get in the classroom with higher education.
There's a BIG difference between doing a task or actually underdanding the reason behind completing the task!!

That is so true....you gain a little more knowledge at each level. For example, one of the reasons LPNs arent being used to their full capacity(at least here) is that CNA's/PCTs cant do almost the same things these days with special training/classes. They dont get paid as much, but they can do most of the tasks. My instructors said that the problem with that is they are doing these tasks but they dont understand the reason behind it. So I can understand what you mean. CNA's are taught basic patient care skills, LPNs get a basic knowledge of the systems and disease processes, and RNs get a more in depth understanding. Then BSNs and so on.

Im a graduate Practical Nurse waiting for boards, and I wont even argue about it bc IMO those who say get paid what you are worth are right. Just an extra year of school opens the door to many more opportunities and a lot more money! Who would have a problem with making more money for essentially the same job with a different title? That is the reason that the main question most LPNs are asked by others is "Are you going to get your RN?". Although its none of their business, they just cant understand why someone would want to do basically the same job for way less money. If an LPN can handle the responsibility of being charge nurse in a nursing home, then surely they can handle being a floor nurse in a hospital. And yes, LTC pays LPNs higher wages, but think of the workload they have. 20-30 patients to one LPN? I couldnt imagine.

I do agree that LPNs (depending on state) can do most of what RNs do, and put in more clinical hours while in school. I believe that RN is more of learning more theory than skills. LPNs are capable of doing most of the tasks that separate the two, however the law doesnt allow them to. This is the reason Im going for my RN degree thru distance learning. I can go at my own pace and hopefully in a year Ill be an RN too! The main objective is the theory in my opinion bc the handful of skills that arent allowed in the nurse practice act can be easily taught. Ive heard many LPNs who transitioned to RN were actually a little dissapointed to see that they actually didnt learn a whole lot more than before, but I guess its all about titles! We have already been taught the nursing process, careplanning, assessments, etc. Its just a matter of building on that knowledge.

I have no regrets about getting my LPN though. I would still be waiting for a spot in the ADN program, yet I can now work and gain experience in my field while I go to school for my RN. Its the same 2 years as ADN, only split up. And the pay, though considerable less than RN salary, will still be at least twice what I was making working any other job Ive ever had. I also have a sense of purpose Ive never had.

Even if it comes out wrong, most ppl mean well. Most older LPNs have told me to go back to school now while Im young bc they regret not doing it earlier and now they are too tired! :)

jsteine1 · Oct 1, 2005

There's a BIG difference between doing a task or actually underdanding the reason behind completing the task!!

Very well stated. I started as an LPN and became an RN a few years later. When I was an LPN, I couldnt see the difference either. Of course, later I did.

I would encourage LPNs to become RNs if at all possible for this reason: Over the last 30 years, per practice acts,insurance reimbursement regs and medicare, the LPN role continues to "shrink" in so many settings, frustrating those LPNs with excellent skills and also frustrating us employers who want to avail ourselves of their talents!

jsteine1 · Oct 1, 2005

In this state, one thing an RN can do that an LPN can't, is be a CNA instructor.

I think the 40 yr LPN instructor is giving bad advice. Depending on where you live and which setting floats your boat, sadly, LPNs ,due to practice acts and regs are limited in their choices. I was an LPN myself, then became an RN. I was extremely technically proficient by the time I went to RN school and was put in advanced placement and finished in less than a year. Nursing school by day, college by night, but I had that kind of energy back then.

As I look back, I could do most anything technically or procedually as well as any RN, but the differerence is: An RN is more likely to know when NOT to do it or question an order. In my state, you have to be a BSN to teach CNAs. Years ago, I taught CNA programs for a private for profit techical school in New York and it was absolutely the most fun I ever had working!

Darlene K. · Oct 1, 2005

I'm not sure if someone already mentioned this or not, but another thing to consider is that the RN is responsible for the LPN's and NA's who work with him/her, which I would think would justify the higher wage. Also, in my area only the RN can push IV meds, hang blood, start IV's and mess with central lines, and develop the plan of care (the LPN can contribute suggestions though). The RN has to co-sign the LPN's assessment and an RN must do an assessment every 24 hours. The LPN can collect data for the admission assessment, but the responsibility for completion lies with the RN, who analyzes the data and develops the plan of care. The RN does the initial screenings for nutrition, PT/OT/ST etc, fall risk and pressure ulcer risk assessments, and determines which referrals are needed. Only the RN can call docs to clarify orders, get orders and only the RN can take a verbal/telephone order from a physician. The RN has ultimate responsibility for the patients. So you can't really say that the LPN does the same work as the RN.
Before anyone jumps on me, let me say that I love LPN's and think they are an extremely valuable member of the healthcare team. But they aren't "almost the same as an RN". :)

I work under my own license. I am responsible for what I do and for what I delegate. I am all for further education....and I am all for the higher the education - the higher the compensation.

nursemaa · Oct 2, 2005

I work under my own license. I am responsible for what I do and for what I delegate. I am all for further education....and I am all for the higher the education - the higher the compensation.

It probably depends on where you work, in my location the RN has ultimate responsibility and delegates to the LPN and the NA. That's not to say that the LPN isn't also responsible or liable for what they do. And I know that in LTC the LPN is often in charge, so again...it probably depends on your location.

icugirl33 · Oct 3, 2005

I started as a CNA, earned my LPN and have less than a year to go to get my RN.
The difference? Well there's some clear differences in both skills and responsibilities and our program drills them into us! The main differences are pretty clear cut:
LPN's are supervised by RN's. Yes, even in LTC's and rural hospitals, there has to be an RN available (often within "proximate" distance which is a legal term for being able to get to the facility when called).
LPN's can monitor IV flow rates and may, under very specific circumstances, stop an IV prior to notifying the RN and MD. LPN's can remove IV's but can't start or change them. In many states there is a special certification program for LPN's so they can give IV meds. This usually requires a length of service as an LPN and passing a special course. Even then IV management is limited to adults and these LPN's still can't start IV's and often can't give the initial dose of IV meds (only subsequent doses).
LPN's differ in the scope of their assessments. Often they must have an RN reveiw their initial (admitting) assessments and may have other limitations. RN's get additional training in assessment techniques and situations that LPN's don't get. These additional skills build on the basic LPN skills and required a greater degree of analysis than an LPN is formally trained to do.
LPN's are limited in the teaching and careplanning to 'canned' forms in many states. RN's have a body of knowledge that allows customizing teaching plans and careplanning. In many states, the LPN "contributes" to the careplanning while the RN "creates and monitors" the careplan. (A colleague, tongue in cheek, made the observation that LPN's follow the careplans written by the RN's. :) )
The list goes on... Your state's "mileage may vary".
In general LPN's are practical nurses, trained with the practical skills necessary to deliver nursing care using assessment, intervention and evaluation. LPN's contribute to analysis, and planning. RN's are trained beyond this level with skills related to assessment and planning that LPN's don't have. Along with these skills come greater responsibility for managing patient care (paperwork and communication). RN's are responsible to the whole nursing process of assessment, analysis, planning, intervention, and evaluation. As for pay, in my facility a new CNA makes about $9, a new LPN makes about $16, and a new RN makes about $24. The $$$ reflect the different levels of responsibility in each role.
There is plenty of need for both RN's and LPN's. And, outside of these differences, most of the nursing work *is* the same. We pass the same pills, do the same interventions, and have the basic responsibilities of the CNA too. That's why the program I enrolled in requires us to enter as a CNA and get our license as an LPN halfway through. They want us to understand and experience the different roles. Something that has been of incredible value to me.
The best advice is to search for your states nurse practice act and read it. You'll likely get a copy with your license anyway and you'd be responsible for knowing the differences in the scope of practice regardless of the level of licensure.

I agree with you 100%. Your view on the matter is realistic and to the point without hurting any feelings.

missnurse01, MSN, RN · Oct 3, 2005

ugh, don't want to really get embroiled in the whole dirty mess but i do have somethings i want to say! i haven't spoken much of this to anyone over the last 8 years but u all are my colleagues so here we go. when i graduated lvn school i was so totally floored that we went thru all that torture, learned all that stuff, for the hosp to not let us do any of it. i couldn't understand why they would have their program set up like that and then not allow us to do it. even when we were in clinicals, they would only allow us to write our narrative assessments out of an extra page in the chart, not where it is normally done. the instructors also thought it was bunk, but had to conform to hosp policy. I think this is where true division comes in-in either an lpn or rn program. it all depends on what is taught (sp?) and how much each individual student puts into the class. i have met many lvns/lpns in the 3 states i have been in that did not have the type of in depth classes that i had. i think it all needs to be more standardized anyway, but if we are going to phase out the lpns to offices and make them more technicians, then why go through all this major schooling? (i agree that ltc is different, but also agree that if u want that respon esp being the one license there at night then might as well get paid as an rn. seems to come down to money a lot!) u guys are the first lpn to rns that i have heard say they learned a lot in rn school-everyone else i have spoken with over the years has said that there wasn't much difference. for me, rn school was a review of everything that we went over in lpn school-except for some minor technical skills. i would not have been so upset in my years as an lpn if i had been allowed to do what i was trained to do-and if my training had been more of a technical nature and that was how i expected to function after i graduated, then that would have been ok too. for me it was a let down to learn so much, then be told that the hosp would not let us do it. even things that nurse practice acts said that we could. so, where am i going? i don't know, but i wanted to vent all this that i have kept inside for so long! so thanks everyone! i do not know where the future of the vn/pn is going to end up, but it seems with the way that 'managed care' is going these days, we all need extra education just to help our pts. so to the op, u really need to read your nurse practice acts, interview some practicing rns and lpns near where u live, and maybe even hosp nurse recruiters. other than that, u also need to look at where u want to go in life-it seems that acute care is becoming less of a reality to most lpns nowadays. good luck with your schooling and your decisions. as for me, getting my rn was mostly a money issue. here where i work in ga in the ER, the only thing that i get to be trained in during my rn orientation is triage. for us in this hosp, they allow lpn's to go to the fullest extent of the law. so for the past 3 years the only diff for me was money and triage. at least now i get to be the senior person with the same title as most of the other nurses RN, it was weird being the one with the most experience as an lpn. the other nurses didn't know what it think about it, but in our small hosp it has been difficult getting experienced rn's here. actually, of all the hires over the past 3 years i think that only one of them had any critical care exp, and that was icu not er...anyway, i'm rambling again. thanks for letting me vent guys!