What *really* separates a LPN from a RN?


as a new graduate nurse entering the world of nursing, i was wondering... what is the real difference between a lpn and a rn? is it just the tiny technicalities? is there really that much of an educational gap? is it just the pay? i can't come to a conclusion and would love to know. :redpinkhe


leigh alivia, lpn

pagandeva2000, LPN

7,984 Posts

Specializes in Community Health, Med-Surg, Home Health.

The scope of practice between LPNs and RNs differ, and I am sure (or at least hope) that they have learned more details regarding the disease process and interventions. The RN can care for acutely ill patients with unpredictable outcomes and can make initial assessments, while (at least in the states I am aware of), an LPN's initial care plans and assessments must be countersigned by an RN. Each state has their own scope of practice; some for LPNs are broader than others, while some may be more limited. In terms of pay, the same thing. I have read on these forums that some salaries between LPNs and RNs only differ by about $5 per hour...that would make me insane to have all of that additional headaches for such a small upgrade in pay but that is just me.

Bottom line is that the scope of practice, the responsibility and accountability is greater for the RN which = more pay. And, they have a broader scope of opportunities in the job market.

TheCommuter, BSN, RN

226 Articles; 27,608 Posts

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 17 years experience.

In all honesty, this question would be best answered by an RN who started his/her nursing career as an LPN. I feel that only a person who has worked in both capacities could fully encapsulate the differences between the two designations.

Where are you, Jules? Since you're an RN who started as an LPN, I hope you can come along and shed some light for those who wish to receive it.

In NYS it's assessment, care planning, hanging blood, IV push. In reality, it depends a lot on the facility.

Jules A, MSN

8,863 Posts

Specializes in Family Nurse Practitioner.

Here I be. Pagandeva2000 hit the mark although my pay raise was $15 an hour. :D

I'm in Pediatric Psych so my experience might be a bit different but there are very few things skill wise other than intake and seclusion orders that I am doing now that I didn't do as a LPN on my unit. I have absolutely no desire to do anything more than the bare minimum management wise. My responsibilities are very similar because as a LPN I had to deal with the Techs anyway and all the LPNs I work with right now have more experience than I do. Unlike a busy med-surge floor we only have 1 nurse per unit so we operate pretty independently.

My feelings regarding joining the second year of the RN program are that it was very beneficial because the lectures were far more detailed with more of an emphasis on assessments and autonomy. As many bridge students have stated the clinical portion of my RN program was a bit boring because as students we really weren't allowed to do any more skill-wise than I had been doing as a LPN.

I do think it was worth it and if nothing else 'putting in the time' is just part of the game that is academia to add the alphabet soup to the back of your name. Its not a perfect system but it is what it is. I would urge anyone thinking of doing the bridge program to find the quickest and cheapest one around and go for it. If not be proud to be a LPN!

pagandeva2000, LPN

7,984 Posts

Specializes in Community Health, Med-Surg, Home Health.

I suspected that the lectures would or should be more detailed. In terms of the autonomy, can you give an example of what you mean (I'm talking about how autonomy is taught to you)?

I have a friend who completed the bridge program from my school, and she told me that she didn't feel that she learned too many different things, except for chemotherapy treatment and such. The only reason why I believe it (somewhat) in her case is because she was in the first bridge class, and they used the same professor that used to teach the LPN program, so, what I suspect is that she probably used a very similar teaching style. However, I would expect and wish to learn more if I were elevating to another level...wouldn't anyone else?

Jules A, MSN

8,863 Posts

Specializes in Family Nurse Practitioner.
I suspected that the lectures would or should be more detailed. In terms of the autonomy, can you give an example of what you mean (I'm talking about how autonomy is taught to you)?

This might boil down to different schools/instructors and also my interpretation but it seemed to me that in RN school when it came to abnormalities we were taught to rely more strongly on our own detailed assessments, checking diagnostic test results and performing the allowed 'nursing judgement' type actions. Assess, do XYZ and see how that goes. Where in LPN school it felt to me like we were expected to do a quicker assessment and then immediately report to the RN or phone the Physician. As always this is only what I was taught in school and we all know how closely (not) that often mimics reality, lol.

Jules A, MSN

8,863 Posts

Specializes in Family Nurse Practitioner.
However, I would expect and wish to learn more if I were elevating to another level...wouldn't anyone else?

Ooops I got so long winded I missed this and I think it is an interesting thought. I kind of feel like school provides only the very basic foundation and good nurses are made on the floor.

When it comes to clinical experiences I never expected too much in either program. I had some wonderful clinical rotations and some that weren't so great but I just figured it would fall into place when I started working.

I definitely wanted and expected more theory because to me what is in my mind is available, hopefully lol, to be utilized at different times especially during emergency situations. If I have learned it even if I'm not using it I can bring it back to the surface. Other than that, the truth be told, I really just wanted to pay my tuition, put in my 2 semesters, pass NCLEX, get my raise and start signing RN behind my name because I was pretty much doing the same job anyway.



2 Articles; 37 Posts

Specializes in LTC, Med-Surg, ER.

In my state, KY, there is very little difference in the scope of practice of LPN vs RN. We push IV meds (except cardiac drugs), start, maintain and dc IV's, Access central lines for med administration and to draw blood samples, do assessments, initiate care plans, until very recently hung blood products (which I have done as an LPN a million times and I am still not clear on the recent change but I am researching it). I know that we do not pronounce death and I don't think we do chemo. The biggest difference is the paycheck. I work on a med-surg floor in a small, rural sister hospital in a world famous, cutting edge hopital system. Perhaps I am afforded opportunities there that are approved by the Board of Nursing, but still against other hospital policy (some are slow on the uptake). I am planning to bridge to RN in the fall mostly because of the difference in pay. I am proud to be an LPN and I have plenty of latitude and resposibility in my current position...and most importantly, I am never made to feel invaluable or second class because I have three letters after my name instead of two!

t.l., ASN, RN

27 Posts

Has 28 years experience.

I am proud to be an LPN because LPN stands for Licensed PRACTICAL Nurse, Which means I can do almost anything an RN can do, some an RN can't/ doesn't know how ( insert a foley ) Yes, I know that sounds ridiculous, but I have taught RN's to do that ! I have held management positions ( Unit Manager in LTC, Care Plan Director , etc), and personally liked it, but the aggravation of the longer hours and taking the blame for other nurses' goofs didn't sit well with me.:banghead: I have a daughter that's an RN:heartbeat and she tells me herself there are LPN's she knows that can work circles around her, because of the PRACTICAL knowledge we have, as LPNs. With more responsibility goes more headaches. I love my job, and I get as much respect as I want. Give it, get it you know ?


147 Posts

Specializes in Cardiac, Med-Surg, ICU. Has 11 years experience.

I'm also an RN who was an LPN. I live in Ohio, which is one of the more restrictive states in terms of scope of practice. One of the major reasons I bridged from LPN to RN is because I was very frustrated by my lack of autonomy. I did my own assessments, had my own patient load, but I was still dependent on the charge RN to call doctors for me (where I work, LPNs are not permitted to take physician orders) and administer all my IV meds except for antibiotic piggybacks. I know to some people this wouldn't be a big deal, but I wanted full responsibility for my own patients! I really felt bad when I would have a patient with chest pain and I couldn't give an IV Nitro bolus or push some Morphine, I had to go track an RN down to do it. It would have been so much faster just to do it myself, and in terms of knowledge and skill set, I could have done it, but it wouldn't have been legal.

I wanted to go into critical care, so staying an LPN was not an option. I like being able to make decisions about my patients without having to consult anyone if I don't need to. If I think my vent patient needs a bolus of Propofol, I do it. Full well knowing what the possible ramifications of that are and how to intervene if something goes awry. That's not to say that I don't bounce ideas with other nurses.

In essence, I guess the differences to me are much more autonomy, authority, and responsibility. All of which can be scary as much as they are exciting and fulfilling.

mama_d, BSN, RN

1,187 Posts

Specializes in tele, oncology. Has 10 years experience.

I'm back in school to bridge to my RN b/c I'm tired of other people having to do my pushes. Oh, and the money.

Seriously, as far as I can see on my floor (and I've worked on it for five years), the biggest difference is pay. I know that I'm lucky that I'm allowed to be as autonomous as I am as a LPN, especailly in a hospital setting; I know that many other facilities in my area are much more restrictive and I'm glad to work where I'm considered an asset instead of a liablility. Our fill in charge nurses have been RN's for significantly less time than I've been a LPN, so whenever they're in charge, I'm one of the people they come to for clinical questions the most often (thank God, my LPN means I can't charge - who really wants that job?). I get the same number of patients with the same variability of acuity as the RNs do. I'm ACLS certified, just like all the other nurses on my floor. Anyway, I guess the real difference between RN and LPN is actually defined by where you work and how they interpret the difference.

As far as scope of practice in my state, I can't initiate blood or chemo (although I can monitor, go figure), can't place central lines or ports (but again, I can maintain, draw from, etc.), can't initiate care plans, and can't do IV pushes (but, again, I am perfectly fine to watch the cardiac monitor while a RN administers cardiac meds). I can take orders, do assessments, interpret strips, hang piggybacks, etc.

The job opportunities are vastly different as well...there's currently a hiring freeze on LPNs in all of the major hospital systems in my area, so new LPNs are stuck do LTC in general.

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