Where Do LPNs Fit in the Evolving Nurse Profession?

History of the LPN Designation

Formal nursing began based on the foundation introduced by Florence Nightingale during the Crimean War and was internationally adopted by 1870. World War II brought about more evolution of the nursing practice. Many RNs served during WWII which led to a nursing shortage in the US. The LPN designation was created in 1940 as a way to get licensed caregivers into the workforce as quickly as possible. LPNs were taught basic medical knowledge, with a focus on the delivery of hands-on nursing care. LPNs working under the supervision of RNs made it possible for the RNs to take care of more patients.

Standardization of LPN training was introduced in 1917 by the National League for Nursing. Formal testing for licensure began to appear in 1952 with all states producing licensing laws by 1955. During this time, the American Nurses Association published its first position paper on entry into practice recommending that the baccalaureate degree be the minimum required for registered nursing practice. This suggestion was never successfully accomplished in any state.

LPN Career Evolution

Changes in the Nursing Profession

Many healthcare fields now require a minimum of a Bachelor’s degree and some are well on the way to requiring a Master’s degree. These fields include occupational and physical therapist, speech and language pathologists, audiologists, and genetic counselors. In this regard, nurses are the least educated of all. The position that a Bachelor’s degree should be a minimum requirement for nurses has been around for decades. The implementation of the Magnet designation has continued this trend. It would seem that there is no place for LPNs in this evolution.

It does not help that the Scope of Practice for LPNs varies from state to state, and in some cases there is not one at all. This makes healthcare employers reluctant to invest money into an employee with a limited scope of practice. This restriction of practice is the biggest reason LPNs are being cut at acute care hospitals. State boards of nursing decide the scope of practice for RNs and LPNs, restricting who may provide nursing assessment and nursing diagnostic decisions. Many states restrict LPNs from dispending medication.

Economics Will Save LPNs

The changing economics of healthcare and the healthcare needs of an aging population will ensure that there is a role for the LPN. Studies have shown that raising the ratio of RNs to LPNs to the 75th percentile pays for itself, avoids 1.5 million hospital days in US hospitals, and prevents 5000 deaths. It seems the focus is on acute care hospitals that are trending towards degreed RNs as patients are sicker and medical techniques are becoming more advanced. But that view is ignoring the many other places that patients receive care. With hospital costs rising, outpatient services, intermediate care facilities, and home health options will become even more necessary.

Where are the LPN jobs?

The job prospects for nurses seeking employment in nursing care facilities and home health agencies look good for the next ten years. Per the Bureau of Labor Statistics, licensed practical and licensed vocational nurses held about 738,400 jobs in 2012. The industries that employed the most licensed practical and licensed vocational nurses in 2012 were as follows:

  • Nursing care facilities (skilled nursing facilities)    29%
  • Hospitals; state, local, and private    20%
  • Offices of physicians    12%
  • Home health care services    11%
  • Residential care facilities    8%

What’s Next for LPNs?

As a profession, LPNs need to lobby for standardized scopes of practice and education across all states. When clear guidelines exist employers may be more comfortable with LPNs in their workforce.  LPNs need to embrace their role of bedside caregiver as an integral part of the healthcare team, particularly in light if the aging population of the US.

What do you think about the current state of the LPN nursing career?

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