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.


“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

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