What Happened to LPNs/LVNs in Hospitals?

[Nurse Beth, MSN]

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Dear Nurse Beth,

I've had trouble finding the answers to the subject of LPN's being eliminated from working post partum. When did that change, and what was the criteria? I've worked ob/post partum for 22 years in the same facility in different capacities, the last ten and a half years as a LPN. Nobody can give me an answer. [/TD]

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Dear Where are the LPNs?,

In the early 2000s, LVNs/LPNs were utilized in hospitals under different delivery of care models, such as team nursing. Many of us who were LVNs/LPNs or worked under team nursing thought it worked well.

I can speak to my experience in CA. One reason for eliminating LVNs/LPNs is that the CA BRN (BON) and CA state law says that patients in acute care must be assessed by an RN. CA nurse-patient ratios are specifically based on the number of RNs to patient, and not the number of LVNs. Read Mandated Nurse-Patient Ratios.

There are also limits to scope of practice. LVNs in CA can administer blood, but not IV antibiotics.

So the problem is in having RNs cover these aspects of care while having their own patient load and still remain within ratios. Just what I've seen. As a result, LVNS/LPNs are employed in sub-acute areas where nurse-patient ratios are not in effect.

Very recently I've seen some hospitals bring LVNs/LPNs back into the ED but I'm not sure how that's working yet.

Projected changes in supply and demand for LPNs between 2012 and 2025 vary substantially by state. I hope others from different states will share their experience on LVNs/LPNs in acute care.

Best wishes,

Nurse Beth

Author, "Your Last Nursing Class: How to Land Your First Nursing Job"...and your next!

[bugya90, ASN, BSN, LVN, RN]

All of my local hospitals phased LVNs out over the past 5 years. I worked in a clinic as a LVN. I finished my RN and am working acute care now and our floor director is hoping to bring back a few LVNs and use a team nursing approach because we can't ever keep full staffed with just RNs. It would mean a higher patient load for each RN (all patients would still have to be assigned to a RN due to state regulations) but the LVN would share part of that nursing care.

[AuntieEmNurse]

If it means that I still have to be ultimately responsible for all of those patients, I'd rather just have more RN's. LVN's/LPN's are a very crucial asset to healthcare. I am knot knocking them one bit. But what I've found is, at the end of the day, I actually had more to worry about because I was responsible for not only my work, but the work of the LPN. I'd rather just have more RN's so that we can have better staffing ratios.

[Nurse-please, BSN]

The hospital I worked at last year, on the PP unit, actually brought the LPNs back when they had been phased out of the entire hospital years prior. We functioned under the team model. Although there was a lot of backlash from staff, and even more so from other floors, it seemed to work out okay. Our floor was so critically short that we had to do something because we just didn't have enough RNs applying. According to management, there was no choice.