Are LPNs being phased out?

Licensed practical nursing (in some states called licensed vocational nursing) has a noble history dating back to the early 1940’s. This category of nursing began as a way to get licensed caregivers into the workforce in a shorter period of time than it took registered nurses. This was particularly important after WWII when many RNs were serving in the military, resulting in a nursing shortage in the U.S. The LPN’s definitely filled a need during that time period, but the question often asked is whether they are still relevant and needed today.

It appears that the supply and demand for LPN’s varies depending on the location, the area of practice, the type of practice and whether unlicensed personnel can be utilized in their place at a lower cost to the employer. Unlike RN’s, the scope of practice for LPN’s is different from state to state, sometimes with a significant difference. Many states have nonspecific guidelines as to what the LPN can and cannot do thus leaving much up to the interpretation of the employer. At times, the supervising RN does not know what should or should not be delegated to the LPN, therefore they may be under or over utilized.

Nurses interviewed by the Knowledge Network have indicated that many times LPN layoffs occur at hospitals because the hospital prefers to have RN’s and other advanced degree nurses that can provide more in-depth patient assessments than the more task-oriented LPN’s. “There is a place for LPNs in long-term care, skilled nursing facilities where patients aren’t so acutely ill, but they are not necessarily prepared to take care of critically-ill patients in a hospital setting,” says Nurse Manager Shelly Van Vianen, RN, BSM, CRRN, who works at Scottsdale Healthcare’s acute rehab unit in Scottsdale, Ariz. LPNs are certainly getting phased out throughout her hospital and especially on her floor due to her patients’ acuity, she says. She says she is hard-pressed to see her hospital deviating from its current hiring pattern of RNs and other advance-degreed nurses at any time in the near or distant future.

Many decisions made to cut LPNs or the programs that educate them are based on tough financial realities. In December, 2009, Connecticut Governor, M. Jodi Rell suspended state adult education programs that would prepare students to become LPNs. The program had been offered at ten state technical high schools and it prepared students to work in nursing homes, group homes, schools and other health care settings throughout the state. The program graduated approximately 350 LPNs every 16 months. Citing a $470 million state budget deficit, Rell has decided to cut the program, saying that it will save approximately 1.7 million.

A similar decision was made in Warwick, Rhode Island at the Kent Hospital where 46 LPN’s were laid off. The hospital plans to hire 12 RNs and some CNA’s to handle the LPN duties. The hospital had made $3.3 million less than expected during the first five months of the fiscal year because fewer patients were coming in for inpatient and outpatient care. The poor economy and changes in insurance coverage have lead to fewer elective surgeries, such as knee surgery. In addition, there was not the expected seasonal flu epidemic and more uninsured people are seeking free care. “The revenue loss has been dramatic,” said Sandra L. Coletta, hospital CEO. The elimination of the LPN program was discussed for months says Coletta but immediate fiscal losses prompted the swift action. The elimination of the program has saved the hospital over $1 million dollars.

The rationale that many hospitals are using to justify the LPN cuts are that LPN’s have less training and cannot perform as many functions as regular nurses. Most acute care hospitals have been phasing them out in recent years because the limitations on what LPN’s are licensed to do lead to some inefficiencies. For example, LPN’s can take patient information but are not considered qualified to assess a patients condition. The essential difference between LPN’s and the RN is not task-related. In many states, LPNs administer IV therapy, communicate directly with physicians, write verbal and telephone orders, etc. However, LPNs are trained to be the bedside caregiver, while an RNs education typically focuses on more supervisory functions. It seems that that a clear articulation between LPN and RN in the educational system would be helpful to both types of nurses to help them decide which level of education to pursue.

It has been an ongoing debate for years, but Licensed Practical Nurses (LPNs) are now facing a serious vocational choice as many traditional hospitals are currently phasing out the position in favor of more qualified nursing colleagues. The U.S. Bureau of Labor Statistics states that the majority of job openings through 2018 will occur in nursing care facilities and home health care settings due to the increased medical attention needed for the nation’s aging population. It is recommended that 25% of all LPNs must now consider leaving traditional hospital and moving to where the LPN jobs are projected to exist.

There does not seem to be an easy answer to this growing problem. It appears that each state has its own employee and employer rights so a displaced LPN might want to consult a legal nursing consultant to make sure that his or her rights are being protected.