Licensed practical nursing (called in some states licensed vocational nursing) has a noble history. This category of nurse began to emerge in the early 1940’s as a way to get licensed caregivers into the workforce in a shorter period of time than it took registered nurses. This was important after WWII when many RNs served in the military, which resulted in somewhat of a nursing shortage in the US. While the LPNs filled a definite need during that time period, the question is often asked whether they are still relevant and needed today.
In the spirit of full disclosure, I must reveal that I am the Executive Director of a Board of Nursing which licenses LPNs. My instinctual response to this question is a resounding “Yes!” At the risk of sounding self-serving, I have taken a step back to look more objectively at the issue. I think that the answer actually is “It depends.” The supply and demand data for LPNs is variable depending upon the location, area of practice, scope of practice, and whether unlicensed personnel can be utilized in their place at a cheaper cost to the employer. Unlike RNs, the scope of practice for LPNs varies from state to state, sometimes with significant differences. There are, in many states, nonspecific guidelines as to what the LPN can and cannot do, leaving much up to interpretation by the employer. There is at times a lack of knowledge by the supervising RN as to what should and should not be delegated to the LPN, therefore they may be under or over utilized.
According to the Health Resources and Services Administration (HRSA), the number of LPN educational programs has remained stable in the US since the 1990s. The number of graduates has declined over this time period, and yet the number of actively licensed LPNs has increased over the same time period. Possibilities for this scenario are that these nurses are remaining in practice for a longer period of time. It is also important to note that the number of LPN graduates who pass the NCLEX-PN exam has remained stable. Data collected by the National Council of State Boards of Nursing (NCSBN) from January through March 2010 indicates that LPNs pass the licensure exam at a slightly higher rate than RN graduates on their first attempt.
The essential difference between the LPN and the RN is not task-related. LPNs in many states engage in IV therapy, communicate directly with physicians and write verbal and telephone orders, etc. LPNs are trained to be the bedside caregiver, while nursing education typically focuses on more supervisory functions. Establishment of a clear articulation between LPN and RN in the educational system could be beneficial to both levels of licensure for those who wish to pursue a higher level of nursing education. LPNs have a wonderful base knowledge upon which RN education can be added.
Many facilities including those in long term care could not function without the LPNs. They are often the backbone of the nursing staff, at times managing the building on evening and night shifts when no RN is on site. HRSA data states that LPNs could be used more fully in acute care settings. This is not to say that an LPN can replace an RN; clearly that would be inappropriate even in times of an RN shortage. The fact is, however, that many of the tasks that the RNs perform could be done by the LPN in many jurisdictions. This is clearly demonstrated by a research study conducted by NCSBN which obtained information from newly licensed LPNs. The tasks that these individuals routine perform include such things as organizing and prioritizing client care, following up with clients after discharge, and using data from different sources to make clinical decisions.
Standardization of nursing education and practice for LPNs across the states could benefit the profession, as clearer guidelines could be created which could potentially result in employers being more comfortable with utilizing these licensed nurses. The number of LPNs in the US is less than RNs, but they still have influence and, given the right set of circumstances, can be more than relevant and needed; they are indispensable.
