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Top 3 challenges for an LPN

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Licensed practical nurses (LPNs) are some of the most important people in the nursing care schema. They pass meds, perform rounds and help the RN in his or her job. A great LPN makes an RN’s life a little easier and brings a great set of skills to the care of the patient. Some facilities would be lost without their LPNs pulling the weight of the care.

Unfortunately, LPNs do face certain challenges when they attempt to perform their jobs. Some of these challenges are surmountable with good communication among all members of the care team, and some are consequences of the legalities of nursing. LPNs are limited in what they can do, and that sometimes presents challenges to an LPN who has to depend on the RN for so many things. With some persistence, though, an LPN can find a way to overcome these challenges and care for patients with skill.

1. Restrictions on job opportunities
One of the challenges for LPNs, especially in this tight job economy, is finding a place to work. Many hospitals restrict their hiring for floor nurses to RNs, and this can be frustrating for LPNs who want to work in acute care settings. Some hospitals do hire LPNs, but usually in roles that have less authority and are task-oriented. For instance, some hospitals can hire LPNs for the IV team or to draw blood for the lab.

LPNs can find jobs in nursing homes, but they often will not be the one in charge of the floor. They will have to answer to an RN and will not have the autonomy that a registered nurse has. Again, the LPN could be reduced to roles such as medication nurse or treatment nurse instead of having full care of the patients. Some centers, such as dialysis facilities, will only hire RNs to work the dialysis machine and care for patients. For some LPNs, this lack of diversity in job opportunities can be a challenge that propels them back to school.

2. Delegation issues
LPNs are often restricted in what they can do because, legally, they are faced with the challenge of delegation. An LPN cannot assess, diagnose or evaluate care because this is the realm of the RN. Sometimes, this can be frustrating for an LPN who may know what needs to be done and cannot actually do it. An LPN can even disagree with his or her supervising RN, but will be powerless to change the tasks he or she is delegated to complete.

This challenge is surmountable, though. You cannot change the laws regarding patient care, but you can develop a good working relationship with the RN in charge to provide the best care for the patient. Just because an LPN is delegated a certain task such as med pass doesn’t mean that he or she can’t notice that a patient is having difficulty breathing. If the charge RN does nothing or ignores the situation, the LPN can follow the chain of command upward to help the patient. Even though LPNs are technically below the RN in the chain of command, they can still impact a patient’s care.

3. Experience vs. education
In some situations, an LPN with 20 years of experience might find that a new grad nurse is his or her supervisor. This is a challenging situation because the LPN likely knows much more about patients, their illnesses and how to react than an RN who has only limited experience. Again, it is a legal anomaly that requires the RN to delegate to the LPN. If an RN does not have a great deal of experience, an LPN needs to know how to approach the situation.

Communication between the RN and LPN is vital to the proper care of the patient. An LPN who assumes the RN knows what he or she is doing—or stubbornly does only what he or she is told to do—can cause harm to the patient. An LPN needs to be an expert communicator and a nurse who knows how to work with people. It is often the realm of the LPN to act as a bridge between the patient and the overextended RN. This is where teamwork becomes the solution to this very common problem.

Reference:

“Remedying role confusion: Differentiating RN and LPN roles” by Lisa M. Shaffer, BSN, RN; Kathy Johnson, BSN, RN; and Carolyn Guinn, MSN, RN; American Nurse Today, March 2010
http://www.americannursetoday.com/article.aspx?id=6382&fid=6276

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Lynda Lampert

Lynda Lampert is a registered nurse and a certified third shift worker. She has worked with many different patient populations, including post-op open heart, post-op gastric bypass, active chest pain, congestive heart failure, poorly controlled diabetics and telemetry 'wonders'. She now focuses all of her effort on educating the populace -- both the nursing world and the normal folk -- through her web writing. She hopes one day to publish another romance novel, travel to England and become a web rock star. She feels she is on her way . . . mostly. You can learn more about Lynda and her work at lyndalampert.com.
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16 Responses to Top 3 challenges for an LPN

  1. poorruss RN

    Nursing will never gain the respect it deserves as a profession until there is consistency in the manner in which nurses are educated. As long as we have LPN’s, Certificate Nurses, Associates degree nurses and Bachelors’ degree nurses, all expecting the same level of responsibility and pay, there will be a roadblock to reaching the level of common ground that is necessary for us to move on. There are many people in various fields who know more about their job than their boss does, but that doesn’t make them qualified to own the company. If someone is unhappy with being an LPN, they should go back to school.

    • oldlpn LPN

      Went to school at 40 to be LPN. At 74 stii working. I started out working in OB at a small hospital, did everything and was very much appreciated for 10.5 years. also floated to Med Surg,hospice and where ever else was needed. Clinic nurse, 10.5 years. Long term care. and past 8 years working with adults on vents. I have always earned the respect of all of my co workers, even though, I was only an LPN. I am stil working rings around the new RN’s and continue to be the go to person for all of the RN’s. Poorruss needs to go back to school to learn respect and humility. Would not want her taking care of me. I will take an LPN over her anytime.

      • coupondiva

        dear oldlpn

        I currently work in a assisting living home, as a cna just wanted to type in a thank you to you for your encouraging words, I will turn 42 in two weeks, so I guess don’t give up and pursue my dream on being a lpn;)my orientation is this Saturday for the wv lpn 11 month program so hopefully I can be accepted, there is a standardized test next march but I am willing to change for the better and study! wish me luck oldlpn.

        from elisa

    • link955 LPN

      You proceed from a false assumption. The article said nothing about anyone being “unhappy with being an LPN.” Most of us are happy at this level. Maybe we looked at the RN job and figured out the extra pay (incidentally, I make more than many RNs) wasn’t worth the extra heartache. I’d rather be at the bedside with the patient than at the desk shuffling charts. You can have it.

  2. Pingback: Top Three Challenges for an LPN : HealthCare Professional Digest

  3. JKLPN LPN

    Just a thought for poorruss who feels all nurses should be equally educated so nursing can finally get the respect it deserves..I’m assuming poorruss feels all nurses should hold a degree. Would an RN like to work in a physician’s office making $13/hr or a nursing home making $17/hr or make a home visit to check a blood sugar and take a B/P for $15/hr? The list could go on. Lets even go as far as to demand that LPN’s be fazed out completely (so nursing can finally get the respect it deserves). Who’s going to pay for this “professional upgrade”? It would bankrupt an already financially precarious health care system. Replacing LPNs with RNs would be financially devastating for most health care provider institutions. Will you take up the slack poorruss… say, work in a physicians office for 1/3 of your current salary? I think not. I don’t know where poorruss works but in the places I’ve been employed as an LPN there was never an issue as to responsibility and pay among the LPNs, ADNs, or BSNs. Everybody knew their role, appreciated one another’s help, and accepted their pay schedule. I’ve been an LPN for 30 years and at 52 yrs. old I don’t want the responsibility of an RN at this phase in my life. I just want to go to work everyday, take care of my patients with compassion and skill, report to my RN if I suspect one of my patients is declining, and do it all with a good attitude. Um…just one other thought poorruss…regarding your first sentence in your blog…are you saying LPNs (and/or certificate or ADN nurses for that matter) don’ tall deserve the same level of respect? Just wondering….

    • JKLPN: Couldn’t have said it any better myself. It seems like SOME RN’s are always trying to “put LPN’s in their place”. Well dang it! I’ve seen some RN’s that I wonder HOW they ever got their license! I’m not saying I’m wonder nurse, far from it. But I do have common sense and even tho I’m older like you JK, I do know how to respect an RN that’s younger than me IF she’s not trying to 1) throw her/his weight around 2) place blame on anyone but themselves. I will respect anyone of ANY age as long as they not only respect me, but my CNA’s, CMA’s, Housekeeping, Maintainance & Dietary staff as well.

      I seriously doubt Poorruss would EVER consider working for a lesser wage, but I Poorruss has their way, RN’s will be. I have no problem w/the “pecking” order. I know my place and I accept it.

      That being said, I’m tired of nursing. I’m tired of the BS that’s spouted by nurses like Poorruss. So I’m now looking at a career change. LPN’s are good if not GREAT nurses sometimes. I wonder how Poorruss would feel if they were in a life threatening situation and the only one there to help them was an LPN who made $15 an hr. Would Poorruss be so pompus then?

      • link955 LPN

        I can tell you how some of those RNs got their licenses: They’re really good at taking tests. Schools don’t seem to screen candidates anymore; it’s all about butts in the chairs and money in the bank. They’ll let anyone through the doors these days. When I applied to my program, I went through two interviews — with NUNS, yet — and a criminal backround check (and this, mind you, was 1976). I had to take two standardized entrance exams. We’re so desperate for nurses these days we push people through programs who have no business being nurses. It’s catching up with us. As one of the 74 million Baby-Boomers who’s going to have to depend on current nursing school graduates for his care, I can tell you I’m more than a little concerned.

    • Melissa Donahue

      OMG I LOVE U N AGREE WITH EVERY WORD U SAID!!!!

  4. Rxnurse1955 LPN

    When I graduated as a LPN 27 yrs ago in Denver there was a big push to do away with LPN’s. Hospitals were requiring all LPN to get a AD and diploma RN’s to get a degree. The job market was bleak. I wondered why I wasted time, but since I was already 29 and had 3 kids more college wasn’t practical. Low and behold a massive nursing shortage hit Denver and BOOM us unwanted LPN’s could find work everywhere! That lasted a good long time. In that time I learned how to be a good LPN. I worked in hospitals, rehabs, offices then finally in LTC. I found my own confidence and learned how to be a good team member. No matter what our role in the nursing setting is each one of us is important. And 27 years after I was being phased out, I am still a working LPN.

  5. link955 LPN

    I’ve been an LPN for 35+ years. One can always tell what kind of people are on a state nursing board by what LPNs are allowed to do. If the board had former floor nurses, who spent their carreers in the trenches and know what experienced LPNs are capable of, our role expands. If the board is populated by MSNs and PhDs who never worked in a hospital in their lives, and who’ve sat in offices wallowing in theory, our role shrinks. You’ll excuse me if I have little respect for a “nurse” who spent seven or eight years in school and stepped right into management or education and never spent time at a bedside. Especially these days, given how little practical experience schools offer their students. Book knowledge is fine (I went to college, too) but that isn’t the way to produce competent nurses.They like the title; they obviously hate the work, otherwise they’d be doing it. I’d rather have people on a nursing board who love the practice of nursing rather than a lot of idealistic theories about nursing. I think my 35 years of acute care experience trumps anyone’s four years in college.

  6. sjoyce995

    I was working pre op on contract yesterday. Like I have done many many times in last 2 yrs on contract. The charge nurse looked at me and “what good are you to us here”..very hurt by these words. .I had gained many friends here.but will never go back. Unprofessional and disrespectful

  7. MrsShippy

    When are we going to stop fighting amongst ourselves?

  8. Susan Bagnoli

    I have to disagree with almost this entire article. I am an LPN with 35 yrs. experience. I have worked in 2 different states in my career Florida and Massachusetts.Each state was as different as night and day. Florida allowed LPN’s to do everything except take a telephone order, and Mass. was just the opposite.
    It is true that hospitals no longer utilize LPN’s (their loss) but they are utilized in nursing homes, assisted living, and rehab facilities and DO function as charge nurses AND supervisors.
    From what I’ve seen of graduate RN’s is scary-they didn’t know the first thing about inserting a foley catheter!

  9. americansow

    This analogy of LPN’S is off base at best!!!!!

  10. Melissa Donahue

    You know I’m a LPN N I DON’T MEAN TO COME OFF LIKE LPNI’S R BETTER..BUT LPN’S HAV WAY. MORE FLOOR EXPERIENCE N IT pisses me off bc our education was so condenced n fast forward n THERE IS NOT MUCh of a difference that Lpn’s can’t do tthat RN’s CAN which are 1.SIGN A DEATH CERTIFICATE…2.HANG BLOOD.3.PUSH NARCS THROUGH AN I.V …which to me makes NO SENSE AT ALL Bc WE CAN ADMINISTER PAIN MEDICATIONS ETC….IT’S JUS CRAZY N I HATE THAT LPN’S DON’T GET THE CREDIT THAT WE DESERVE!!!…N ONE MORE THING I ALSO was a CNA BEFORE becoming a Lpn! N I FEEL IT SHOULD B A REQUIRMent THAT U B A CNA BEFORE ATTENDING NURSING SCHOOL!!!!! BC I NEVER FORGOT WERE I STARTED I STILL ANSWER CALL Bells as well as HELP MY CNA’S with there changes ETC….

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