Why can't RN take LPN positions?

[jjjoy]

RN and LPN role differentiation is so confusing! In some areas the LPN does almost everything an RN does but in that case why can't an RN take an LPN position if he/she is willing to take the lower pay? Or at least, why can't an RN also take the NCLEX-PN in addition to the NCLEX-RN?

I wanted to work at an inpatient hospice but the only RN positions were as charge nurse, the only RN in the building. As a newbie, I wasn't comfortable with shouldering that much responsibility. But they couldn't hire me into any other nursing position there because those were for LPNs.

Also, if I find team leading with a LPN too difficult to manage along with my own responsibilities, as an RN I don't have the choice of being team-led by another RN.

On the one hand, I can see where LPNs would want to protect their role, but on the other hand, many LPNs insist that they have just as much responsibility as RNs and almost all the same skills. If I'm willing to accept the same pay as an LPN, why can't I work in that role? It's not like a doctor wanting to work as a nurse. They are very different roles. The doctor won't know all that nurses do in a shift.

I do know there are reasons... I guess I'm just looking for sympathy over feeling overwhelmed by RN responsibilities and wishing there were more steps to assuming more responsibility as opposed to pushed to the deep end so quickly.

[NicoleRN07, RN]

I can't understand why you would want to work as an LPN if you have a license to practice as an RN. If Hospice nursing is what you truly want to do, you should develop nursing skills by working in an acute care setting for a few years and then try Hospice. You shouldn't settle for taking a LPN position and less money!! Remember.....you worked hard to obtain your license to practice as an RN.....use them!

[lupin]

The reason an RN can't take the LPN exam and work as an LPN is because once you have that RN license you cannot hold the other license legally. In every state there is a line of separation between what an LPN and an RN can do. It may not be easily seen in one facility but very well defined in another. For instance, before getting my RN I had an LPN license. In the state I first got my license in, LPNs could work in doctor's offices, dental offices, LTC/SNF, and group homes. They could not work in a hospital because all the hospitals had gone to RN only. LPNs could start IVs if they had gone through an IV certification class, they could hang premixed bags for IVs, such as NS and Anitbiotics, and if they had taken a pharmaceutical IV class they could push certain meds. However, they could not push Antihypertensives, Antiepileptics, and anticoagulants. Now in a LTC/SNF that may not be a problem because anyone receiving those medications through an IV is perceived as having a higher acuity and needs transfer to a hospital. In your state it could be different. But once you hold that RN title, you cannot hold another nursing license nor can you practice in the scopes of any other licenses unless you give up the RN and become say, a doctor. There would be too much conflict between scopes of practices.

For instance, you work as an LPN at facility A and you work as an RN at facility B. While at Facility A, a patient becomes ill and you receive an order for an IV push of an Anihypertensive. The RN in charge of the building is busy with a death or can't be found, whatever, so you push the Antihypertensive since you also carry the RN license. FOr some reason something goes bad and the patient dies. If it came up to court, you could be held liable because you were practicing in the scope of an RN when you were hired to work as an LPN, even though you also hold the RN license. Plus your malpractice insurance agency will not cover you for both licenses and I would hate to be without that.

I don't know how this would be different in other countries, but that's what I know about that states I'm licensed in.

Basically as far as the pay goes, you worked hard to get your RN and as an RN you are responsible for a lot. You deserve that pay!

[nj1grlcrus]

Please give an example.

If I'm on a plane and someone stops breathing, if I don't perform rescue breathing/cpr (and no one else can or does), am I liable for neglect because I do have the training? Good question. If I do, then fine. If a CNA with an RN sees that a patient has stopped breathing, they need to tell the nurse. If the nurse can't be found and no one is running to help, perhaps the person with the RN should then jump in until help arrives. I don't know the legal ramifications.

What if I were just visiting an inpatient and saw the roommate wasn't breathing and couldn't find any staff to take care of it? Would it be neglect if I didn't perform rescue breathing/cpr because of my RN licensure?

I was told during CPR training that only an MD is legally required to assist in an emergency, but that if we did volunteer, we had to maintain control of the situation until a handoff to the EMTs.

[NurseyBaby'05, BSN, RN]

Ummmm . . . . because you don't have a LPN license. You're not a LPN. You're a RN. That's like saying why can't I work as a cosmetoligist if I'm willing to take the pay cut and I know how to cut hair? Because that isn't the license you hold.

And why shouldn't an MD be able to work in a PA role if they're willing to take the cut in pay and are willing to accept the reduction in autonomy?

Because he/she's not a PA.

[SN bbgrl]

Thanks Wolf - that makes perfect sense!!!!

[withasmilelpn]

In my state I could hold both LPN and RN (if I got it), just have to pay for both! (licensures) I think you are just worried about charge. Not every place will require you to do this until you are comfortable. Also some are just happy to have a nurse and aren't that strict with the ratios. I'll let you in on something in LTC sometimes LPNs are charge in name and not in name. For example I ran a unit for a year 2 LPNs. LPN quit, new DON decided she wanted 1 RN charge each unit. My new RN 1 year experience to my 5 and in peds office. Guess who DON came to for everything. The theory was I would train her. (She was great, if she hadn't been would've resented it probably). My advice, find a place more flexible and keep your pay!

[jjjoy, LPN]

I've also HEARD people say not to work below one's licensure but I've never heard substantial reasons why not to. I've only heard vague warnings about "liability," "standards," and such.

The example with the RN working both as RN and LPN and giving a push medication while working in the role of LPN... if someone with RN-training is working in a non-RN position, how can they be held responsible for RN duties? In fact, they need to extra careful to NOT cross the line and only stay within their proscribed job description. Isn't it the facility's responsibility to staff enough RNs (versus LPN who also happens to have RN training) to take care of its patients?

And it's not like all RNs have the same skills in practice. An experienced LTC RN will be less equiped to work in acute care than an experienced acute care LPN. Nontheless, they still "meet the standards" of being an RN.

If holding dual nursing licensure isn't legal, then why can't an RN "downgrade" to LPN if they so choose? There are many RN jobs that don't require the RN to practice all of their skills so that person should be able to "upgrade" back to RN at a later point.

Honestly, the training and roles for LPN and RN overlap so and blur so. Some jobs, either an LPN or RN can fill the role (eg nursing positions in some LTC facilities), yet in others there's a strict delineation.

And I don't see the legal problem of a licensed person holding a job "below" their licensure. Again, I've HEARD it's a problem and I can imagine a facility trying to take advantage of someone with more skills. But some facilities try to take advantage of unlicensed staff by, as in one example, 'turning a blind eye' to incidents where they act beyond their training and job description.

[CHATSDALE]

i have know several nurses who became rns and renewed their lpn license maybe for sentimental reasons not sure why

one reason why a employer might hesitate to hire a rn for lpn designated post is that with a little experience that nurse would quit and go to another job for more money and widened experience..then there would be another lpn to hire and train

in lousiana you will be required to know the basics of cpr no matter what your your position, cna, dietary, housekeeping etc because you never know who is going to find a patient in need

[withasmilelpn]

Actually, I think you are safer working as an RN, where your practice is more defined. There are a lot of misconception as to what a LPNs scope of practice is, and it varies state to state. I also think you might just be overwhelmed with your new responsibilty as a nurse. Trust me, my first year as an LPN was pretty terrifying, I felt like an imposter! I just ran everything by everyone with more experience. My first review- excellent clinical and assessment skills, just needs more confidence. Just hold your head up high, ask tons of questions, thats how you learn. Not everyone will be supportive, having forgotten what it is like to be a newbie, but those who do, latch on to them. I'm sure you'll do great!

[ukstudent]

RN's also do inital assessments, iv pushes and discharge teaching. Say you were working as a LPN with an RN licence and your patient needed a med that was given via iv push and the RN team leader above you was busy with a code and the med was forgotten or late. Who's med error would it be? Yours, because you had an RN license and had a duty to perform at that level even if it wasn't in your job description. Say you patient was being discharged and the RN team leader did a bad job of teaching. The patient took the wrong dose of drug at home, overdosed and died. Who's license would be on the line? Again it would be yours, you are an RN. I hope this has helped you see why it would be not in their best intrest for any hospital to hire you as an LPN when you are a RN. The liability issues of what you should or should not do would be too great.

[jjjoy, LPN]

Does that mean that a charge nurse (also an RN) would be charged in a case of bad discharge teaching because an RN working under them didn't do THEIR job? If there's an RN-case manager on the floor reviewing a chart and sees a missed med, notifies the nurse but the busy nurse doesn't do it, is the RN-case manager held liable for the missed med?

As an RN or LPN, if you saw that an IV push hadn't been given, then it's your responsibility to make sure that it is given. If it's not in your scope (LPN), then you make sure that the appropriate parties are notified. And they don't tell just any hospital employee with an RN. What if the hospital nurse recruiter who also has an RN license but hasn't practiced in 10 years is on the floor showing prospective employees the unit? The LPN can't find any unit RN to give the IV med push so she asks the nurse recruiter to give it. Can the nurse recruiter refuse?

I hope I don't come across as just being ornery. This discussion has made me curious about the legalities of working below one's license.

[Jo Dirt]

I'm an RN working in an LPN role. I make a little more than the LPNs, though.