Just last week, local media reported that Schuylkill Medical Center-South Jackson Street, located in Pottsville, PA, decided to phase out all LPN roles within the next six months. LPNs will be encouraged with the aid of existing tuition reimbursement programs to pursue education to become RNs. Another option for the LPNs is to move into nursing aide positions with lower pay.
Across the country, organizations are wondering whether the LPN meshes with the direction acute care delivery is headed. In some areas of the country, staff shortages mean the LPN in acute care cannot be abandoned. However, as healthcare delivery changes and hospitals streamline care delivery models, organizations are acutely aware they will need staff with higher levels of education to provide the nursing care needed by hospital patients.
Moving away from LPNs must be handled with care. Depending on the number of LPNs an organization employs, the move could be contentious if not handled with tact. Some organizations have faced the threat of age discrimination suits from LPNs angry at being pushed out.
Others believe that pursuing designation as an ANCC Magnet Recognition Program® (MRP) facility—a designation of nursing excellence—involves doing away with the LPN. The popular nursing website Allnurses.com has featured discussions where LPNs believed pursuing MRP designation would get them fired. In fact, the MRP program has no requirements for RN-only care models.
“What MRP requires is that there is a role definition for all nursing staff members the hospital utilizes,” says Barbara J. Hannon, MSN, RN, CPHQ, MRP director in the department of nursing at the University of Iowa Hospitals & Clinics. “If you utilize LPNs in a caregiving role in your institution, you must define how this level of provider fits into your care delivery system. MRP hospitals use all kinds of health delivery models, but each one must be laid out in your documentation, along with how each role is filled and how you utilize the State Board of Nursing to define the health delivery roles.”
“As our patients get sicker and medical care, nursing care, and treatment get more complex, this mid-level provider (LPN) role is not cost effective because there are so many things the state boards of nursing restrict them from doing,” Hannon says. “Because there are so many things they cannot do, our LPNs are included in the unlicensed personnel count. We have to have a full complement of RNs anyway, so it becomes difficult to find a role for them in a hospital with such complex patients as ours to find them something they can do independently.”
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.
One organization that has successfully moved away from LPNs is North Shore-LIJ, a 15-hospital health system in New York, which dispensed with them in the late 1990s.
“We realized that the acuity of patients in the acute care setting was increasing and that those patients required much more assessment,” says Maureen White, RN, senior vice president/CNO. “We would not be able to rely on LPNs for delivery of those care needs. We assessed it and felt that hiring LPNs in acute care settings would not be advantageous to the delivery of care that we need to deliver.”
North Shore-LIJ planned ahead and let its staff know that within 10 years, it would phase out the role. LPNs were offered the opportunity to pursue their RN degrees, which would be paid for by the organization, or to be placed in non-licensed positions.
“Roughly 75% of the LPNs decided to take us up on the offer to go back to school,” says White. “They achieved their licensure for RN and many of them are currently working with us as RNs.”
“There were some that were toward the end of their careers and we allowed them to stay in their position as LPN knowing that RNs on their floors would have to watch over their patients as well, doing the assessment, diagnostics, interventions etc. As those people retired, we filled those positions with registered nurses.”
The small portion who didn’t fit that category and who did not want to go back to school were helped to find other roles within the organization. White said no one lost a job as the result of the decision and that there were roles that could easily be performed by LPNs, such as dialysis technicians or OR technicians, which are unlicensed roles.
Despite the move away from the LPN in acute care, the role as a whole is in no danger of going away. U.S. Department of Labor Bureau of Labor Statistics predicts LPN ranks will grow by 21% from 2008 to 2018. The bulk of this growth is post-acute care, where patients do not require the skilled assessment and complex critical thinking needed from RNs.
“I don’t know that it will completely die out because there are areas such as long-term care facilities that can utilize their skill sets,” says White. “In acute care facilities in the foreseeable future, I don’t see the LPN role as being a viable role. There will be smaller numbers required.”
Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits www.StrategiesForNurseManagers.com and manages The Leaders' Lounge blog for nurse managers. Email her at rhendren@hcpro.com.