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

[pdpeanut]

I started my CNA class last night, and it's being taught by a woman who's been an LPN for 40 years. When she found out that most of us in the class were going for an RN, she advised us that it was not worth it to get an RN, and that an LPN is just as good and they can do everything an RN can. She said if you want to sit at a desk all day and do paperwork, get your RN. Needless to say, I was confused because I thought there was a lot that LPN's can't do, but I'm also new to this so I'm not sure. Can anyone help? If I could cut my schooltime in half and save some money, I would get my LPN.

Thanks.

[RN34TX]

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.

I would welcome any clarification of this because it's always been a mystery to me.

As an LPN of almost 7 years in several different states, I've heard the old "The RN has the ultimate accountability/responsibility" parroted over and over to me but never really understood what this meant in terms of LPN's.

As an RN now, I understand that I have the ultimate accountability to the patient in terms of what I do or fail to do as well as nursing care delegated to CNA's but since getting my RN I've never worked in any area that utilizes LPN's so I've never experienced working alongside LPN's as an RN myself.

But as an LPN, hearing that phrase over and over didn't seem consistent with what was my reality on a given Med/Surg or even LTC unit.

In the states where LPN's weren't allowed to give IV push meds, I felt like I was constantly having to hunt an RN down to medicate my patients.

I realized at the time that they too, were overworked, but it was very frustrating to see my patients need for pain meds being put on hold until an RN was finished with all of his/her patients meds and only then addressing my patients.

I often had to wait for them to give IV Reglan or something else that I considered to be less important than pain meds to their own patients first which often made me question RN programs educating nurses on how to prioritize.

My patient's scheduled IV meds such as Lasix would often be off schedule because I was constantly having to ask someone to give these meds and often had to repeatedly ask to no avail.

Then my supervisor would ask why certain things that required an RN to complete weren't done and I would tell her that I asked and no one ever came to help.

Every sup or charge would tell me that it was my responsibility as an LPN to make sure that these tasks were completed and to keep asking if they weren't.

How many times do I need to ask and check up on whether an RN responsibility on one of my patients has been completed?

My next question then is, if I do have to keep asking and checking, then just who exactly is supervising and/or delegating to who?

Constantly having to ask someone to complete a task and then checking whether or not they did it is starting to sound like an LPN delegating and supervising an RN to me so I don't get it.

Also, whenever something didn't get done by the previous shift, med errors or omissions occurred, or an MD was angry over something getting missed or messed up, the charge or sup RN would always point the finger my way and it was me who had to fix what didn't get done and answer to the patrient, MD, or family when things didn't get done.

I don't recall one single RN ever having to answer to or be accountable for anything that went wrong with any of my patients as an LPN.

The phrase "Let me find that patient's nurse for you" was always what was said by the RN to an angry MD or family member whenever things went wrong.

The phrase about the "RN has the ultimate responsibility/accountability" was nowhere to be heard whenever things went wrong.

So what am I missing here?

As an LPN, I never sent the CNA to a room to explain to a family member why a bath wasn't given or to explain to an MD why I&O wasn't done on a patient even though those tasks were delegated to CNA's to complete.

At the same time, the RN's I worked with as an LPN seemed to have no problem with the old "I'll get your nurse" routine and put it all on me while taking credit for having the "ultimate accountability."

[Tweety, BSN, RN]

At the same time, the RN's I worked with as an LPN seemed to have no problem with the old "I'll get your nurse" routine and put it all on me while taking credit for having the "ultimate accountability."

I understand what you're saying. The old "my license is on the line" is so tired. RNs rarely get their licenses revoked for what an LPN does.

Having "ultimate accountability" does not mean you don't hold the LPN accountable for their job description.

On the flipside of what you're saying it does not mean when things go wrong the LPN can say "I'm not ultimately accountable, talk to the RN" and then run and hide when things go wrong. And yes, I've had LPNs pull that stunt on me. When an MD is upset about something pertaining to a patient under their care, with a couple of them it was always "talk to the charge nurse".

[sbic56, BSN, RN]

The old "my license is on the line" is so tired. RNs rarely get their licenses revoked for what an LPN does.

I agree totally, Tweety! I have never seen an RN go down for what an LPN may have done wrong. If it happened very often at all, we'd all know about it. I think that accountability line is nursing school propaganda that some RN's fall for even though there was little basis in fact to it. It used to burn me up when I was an LPN and those few paranoid RN's tried to lord over me. It nauseated me when I heard the rhetoric for myslf out of a few instructors in RN school. Unfortunately, encouraging that mentality only proves to be devisive.

[RN34TX]

I understand what you're saying. The old "my license is on the line" is so tired. RNs rarely get their licenses revoked for what an LPN does.

Having "ultimate accountability" does not mean you don't hold the LPN accountable for their job description.

On the flipside of what you're saying it does not mean when things go wrong the LPN can say "I'm not ultimately accountable, talk to the RN" and then run and hide when things go wrong. And yes, I've had LPNs pull that stunt on me. When an MD is upset about something pertaining to a patient under their care, with a couple of them it was always "talk to the charge nurse".

I have heard of this. Old colleagues who work Med/Surg tell me stories of that happening.

Like I stated earlier, I've never worked with LPN's as an RN so I only know it from the reverse situation.

It really bothered me to hear stories like that because most LPN's IMHO are striving toward better recognition, a widened scope of practice and better advancement in the nursing profession and it does a considerable amount of damage when LPN's attempt to seek refuge under the "I'm just an LPN and don't know what I'm doing so go ask the RN" routine when things go wrong.

It reinforces the stereotype that LPN's are merely trained to perform tasks and are clueless as to why these tasks need to be done and have no critical thinking skills. They just blindly do whatever is on the MAR or treatment plan and never question orders or be the "eyes and ears" for the MD. Way wrong.

[luv4nursing]

i have heard of this. old colleagues who work med/surg tell me stories of that happening.

like i stated earlier, i've never worked with lpn's as an rn so i only know it from the reverse situation.

it really bothered me to hear stories like that because most lpn's imho are striving toward better recognition, a widened scope of practice and better advancement in the nursing profession and it does a considerable amount of damage when lpn's attempt to seek refuge under the "i'm just an lpn and don't know what i'm doing so go ask the rn" routine when things go wrong.

it reinforces the stereotype that lpn's are merely trained to perform tasks and are clueless as to why these tasks need to be done and have no critical thinking skills. they just blindly do whatever is on the mar or treatment plan and never question orders or be the "eyes and ears" for the md. way wrong.

as a new lpn i agree with this, but anyone with a license that can be taken away a lot easier than it was earned should have the common sense to seek out the knowledge as to the why's of procedures and medications and be familiar with body systems and disease processes. i was lucky enough to have great teachers so i feel that i do have a pretty good understanding of whats going on. we were taught that the nurse (whether lpn or rn) is the last line of defense for the patient and if u dont know whats going on with your patient or the reason that a drug is being given, then u are likely to make a med error that could kill your patient. if u give a medication that shouldnt be given, even if the dr. ordered it, and something happens to your patient......bye bye license for not questioning the order! no, u cant know every drug, but at least u have a clue if u at least know its classification and how it works on the body.

one other thing id like to point out is that although rn education probably goes into slightly more detail, its the same information learned in lpn school. in lpn school we had a crash course and rn school offers more time to each system,etc. but we are given enough to have a clue as to what is going on. we arent trained to be robots completing tasks and not knowing why. i know this for a fact bc i am currently in an nclex review class that has both lpn and rn grads in it. we are going thru saunders comprehensive nclex review. they have the saunders rn book and with the exception of delegation,triage, etc. all the practice questions are the same. so obviously the education proficiency cannot be all that different if we are expected to have the same level of knowledge on the nclex.

[missnurse01, MSN, RN]

In the states where LPN's weren't allowed to give IV push meds, I felt like I was constantly having to hunt an RN down to medicate my patients.

I realized at the time that they too, were overworked, but it was very frustrating to see my patients need for pain meds being put on hold until an RN was finished with all of his/her patients meds and only then addressing my patients.

I often had to wait for them to give IV Reglan or something else...

oh i hated this when i was an Lvn in california. i figured that the law for only rn's giving iv meds was b/c the med was more potent, more potential prob associated with giving it. But what diff does it make if the rn runs in the room, gives it to the pt, and never sees them again? what was the difference of an lvn giving it? i still had to know and monitor for adverse affects...so glad i don't work there any longer! without a dedicated charge nurse, there was never enough time for anyone to do everything...i agree, it was very difficult.

[Indy, LPN, LVN]

oh i hated this when i was an Lvn in california. i figured that the law for only rn's giving iv meds was b/c the med was more potent, more potential prob associated with giving it. But what diff does it make if the rn runs in the room, gives it to the pt, and never sees them again? what was the difference of an lvn giving it? i still had to know and monitor for adverse affects...so glad i don't work there any longer! without a dedicated charge nurse, there was never enough time for anyone to do everything...i agree, it was very difficult.

I agree with you. I would feel uncomfortable doing IV push meds on anyone else's patients, and I work with a very smart LPN on occasion. And although I've not thought of it in that light, I would also agree that to keep asking an RN to give IV push meds to your patient implies a degree of supervision and/or delegation.

I didn't like the last quarter class we had that seemed to have our teachers harping on RN vs. LPN scope of practice. (can't tell you my nickname for that class, would violate TOS) In the real world, I see people doing one of two things: either working their bootie off, or not. The dividing line between those two types of people is not one of degrees (lpn-rn/adn-bsn, etc) but one of personality. I respect those who work for a living.

[Marie_LPN, RN, LPN, RN]

Originally Posted by bluesky

LPNs have to start from scratch to get a BSN.

Mmmmm, no they don't.

[Darlene K.]

I would welcome any clarification of this because it's always been a mystery to me.

As an LPN of almost 7 years in several different states, I've heard the old "The RN has the ultimate accountability/responsibility" parroted over and over to me but never really understood what this meant in terms of LPN's.

As an RN now, I understand that I have the ultimate accountability to the patient in terms of what I do or fail to do as well as nursing care delegated to CNA's but since getting my RN I've never worked in any area that utilizes LPN's so I've never experienced working alongside LPN's as an RN myself.

But as an LPN, hearing that phrase over and over didn't seem consistent with what was my reality on a given Med/Surg or even LTC unit.

In the states where LPN's weren't allowed to give IV push meds, I felt like I was constantly having to hunt an RN down to medicate my patients.

I realized at the time that they too, were overworked, but it was very frustrating to see my patients need for pain meds being put on hold until an RN was finished with all of his/her patients meds and only then addressing my patients.

I often had to wait for them to give IV Reglan or something else that I considered to be less important than pain meds to their own patients first which often made me question RN programs educating nurses on how to prioritize.

My patient's scheduled IV meds such as Lasix would often be off schedule because I was constantly having to ask someone to give these meds and often had to repeatedly ask to no avail.

Then my supervisor would ask why certain things that required an RN to complete weren't done and I would tell her that I asked and no one ever came to help.

Every sup or charge would tell me that it was my responsibility as an LPN to make sure that these tasks were completed and to keep asking if they weren't.

How many times do I need to ask and check up on whether an RN responsibility on one of my patients has been completed?

My next question then is, if I do have to keep asking and checking, then just who exactly is supervising and/or delegating to who?

Constantly having to ask someone to complete a task and then checking whether or not they did it is starting to sound like an LPN delegating and supervising an RN to me so I don't get it.

Also, whenever something didn't get done by the previous shift, med errors or omissions occurred, or an MD was angry over something getting missed or messed up, the charge or sup RN would always point the finger my way and it was me who had to fix what didn't get done and answer to the patrient, MD, or family when things didn't get done.

I don't recall one single RN ever having to answer to or be accountable for anything that went wrong with any of my patients as an LPN.

The phrase "Let me find that patient's nurse for you" was always what was said by the RN to an angry MD or family member whenever things went wrong.

The phrase about the "RN has the ultimate responsibility/accountability" was nowhere to be heard whenever things went wrong.

So what am I missing here?

As an LPN, I never sent the CNA to a room to explain to a family member why a bath wasn't given or to explain to an MD why I&O wasn't done on a patient even though those tasks were delegated to CNA's to complete.

At the same time, the RN's I worked with as an LPN seemed to have no problem with the old "I'll get your nurse" routine and put it all on me while taking credit for having the "ultimate accountability."

That's exactly what I was trying to say. Everyday when I go to work, I am assigned 4 beds, I get whatever patients happen to come in and get into those beds. I am responsible for their total care. If they vomit, I call the doctor - get a verbal order - get the medicine from the pixis - go give the medication - continue to monitor my patient. From start to finish, I am responsible for the task. If I ask the PCT to do an accu check for me, I am responsible that the task is completed, the results are within range and if not, I am responsible for calling the physician and following thru with his instructions. It is also my responsibility to know when to ask for help or report changes in patient status to my charge nurse.

Again, the RN certainly deserves a higher wage than the LPN, without a doubt. They have earned it. They have a higher education level and they do have more responsibilities in most areas of the hospital. In my hospital I don't hang blood, do the initial assessment or IV push narcotics. If my patient needs morphine, I put it in a 50 ml bag of NS and hang it. I wouldn't dream of adding more burden onto the RN to come and "push" something that I can hang faster than I can go and find someone.

[yellowjacket91]

I work as an lpn in a hospital setting and have also had problems getting rn's to give iv push meds for me. After being told several times that my pt's would have to wait to get their meds, I started asking if there was something I could do for the rn to give her a few free minutes to push my drugs. I have done accuchecks, hung new bags of fluid, helped pt's get to bathroom, and many other things to help my rn's out which in turn gives them time to do iv stuff for me. They are often very appreciative in return. I am also currently in an rn program. I hope when am able to work as an rn that the lpn's working with me will be as helpful to me as I try to be to my charge nurses. That is called teamwork and it works well when everyone pulls together whether you are an rn, lpn, cna, or secretary.

[neygray]

I think your instructor was way out of line giving out such "advice". She is only fueling the RN vs. LPN flame. In some settings, the LPN and RN do basically the same thing IF the RN is doing bedside care and the LPN is paid less than the RN they are working alongside, however, it can't be overlooked that the RN DOES have more education than the LPN. They have taken many more hours theory than we have. I think that as far as clinical experience goes in school, the LPN does have more clinical time and we are more "floor ready" upon graduation than most RN graduates. We are being basically trained on the job for the job that we will be doing, which is bedside nursing.

To answer your question: in GA, the LPN can't spike blood products for transfusion, however, we can and do monitor the infusion. We cannot draw blood from, push drugs through, or maintain a central line, we do not do the initial assessments (unless you are working LTC and a resident comes on a shift when no RN is on duty, which is rare, then you do it and an RN comes behind you to sign off on it), we do not initiate the care plan, however, we most certainly participate in the process. Also, LPN's must work under the supervision of a MD or RN. Now, in a lot of LTC facilities, the RN's work days, so the evening and night shift LPN's are not under the direct supervision of the RN, BUT there is an on-call RN at all times and yes, I have had to call my RN in the middle of the night to come out to the facility to give some IV push morphine when we were pushing through a central line. If I had wanted to get all huffy about it and whine that it was ridiculous, I could have, but I simply looked upon it as one of those things that their degree affords them that my diploma doesn't afford me.

I am not by any means trying to degrade the LPN as a lesser nurse, because I don't feel that way. I just think that we have to acknowledge that their is an educational difference that affords the RN more opportunities and more pay. Does it mean they should receive more respect? Certainly not, but I think the whole health care team deserves the same respect because each has their own job to do. Do I think there are RN's with attitudes out there that try to make us feel like we are worthless? yes I do, however, I have also seen some LPN's who get an attitude every time someone reminds them that a particular task isn't within their scope of practice, or they find out that the RN working along side them is making several dollars an hour more than they are. IMO, this is all just absurd.

I guess my point to this too long post is that we must seriously consider how we feel about our credentials as LPN's. If we feel like lesser nurses, then we will allow ourselves to be put down, and it will show in our performance and attitude at work. If, on the other hand, we feel good about what we do, and we are satisfied, then that will show through as well. I work in LTC where LPN's abound.....we ARE the nurses. I feel good about my job. I'm satisfied with my pay, and I don't aspire to work in any other specialty area, so, therefore, I doubt I'll continue my education for my degree. However, there are a couple nurses that work with me, who want to be in the ER or L&D and constantly complain about their lack of opportunities as LPN's. One is in the bridge program doing something about her situation, the other is just whining. They are not satisfied, and thus, they should continue on their educations until they are at a level that THEY RESPECT. Because, honestly, I think if you respect yourself and the job you do, you can't let someone else bring you down.

I'm a new nurse, and I can't tell you already the number of times I've had well meaning people ask me if I'm going to get my RN. My response is always the same....."I am satisfied right now, in LTC doing bedside care, if that changes, I'll consider it". Most of the time, their response is "that's great". My own personal physician asked me that question, and when I gave that response he said "I hope you are working at the the nursing home where I am the medical director", when I said I was, he said "I'm impressed" with a huge smile. A few days later, my DON told me he inquired about me on his next rounds. So, listen to me, you can get the respect you want and deserve as an LPN, you've just first got to have it for yourself.

I too worked in the state of GA and just left that job 2 months ago due to moving out of state. But, it has a lot more to do with the facility, and not just the State, as far as what you can and cannot do. I worked on the Oncology/MedSurg floor of a teaching hospital for 3 years. I did admission assessments, drew blood from central lines, assisted docs with 'in room' procedures, hung blood, wrote verbal and phone orders, pushed any and all IV meds, except for cardiac and BP. And, the only reason I couldn't push those is because we were a remote telemetry floor and no one on our floor could push them except for the MD. The only thing I was not allowed to do on that floor was change out fentanyl PCEA's. The RN's on my floor were the best. There was no RN/LPN bashing. We all worked as a team. And that is what we became nurses for...to take care of the pt's. Not to argue over what the job title was. I do believe that RN's deserve more pay. They went to school longer, they should make more. Yes, it is discouraging at times to know that you do the same work for less pay. However, most go into the profession knowing that and many will go on and continue their education for that very reason. I know I am. I want to be compensated for the actual work that I do, not for the title I hold.

[shadow2]

depending on the state you are living in or working in, many places you do the same things as the RN. Alot of places say that you can not do certain jobs but when push comes to shove and with the shortages occur, you do the jobs. also some places will hire a LPN instead of an RN. Didn't you know what LPN stands for Low payed Nurse. LPN are cheaper then RN and alot of places will hire you for that reason. Your teacher will tell you that as you begin your job, you will find out that the LPN are more knowledgeable about alot more then new grad RN's or even some older ones. Just my opinion though. Go for the LPN, first, if you do not like the job after you start, then you have not wasted so much time and money in school. You can always go on for the

RN as a progression student. Good luck in whatever you choose.

advised us that it was not worth it to get an RN, and that an LPN is just as good and they can do everything an RN can. She said if you want to sit at a desk all day and do paperwork, get your RN. Needless to say, I was confused because I thought there was a lot that LPN's can't do, but I'm also new to this so I'm not sure. Can anyone help? If I could cut my schooltime in half and save some money, I would get my LPN.

Thanks.