Nursing Notes

October 27, 2009

Seeking RN expertise at LPN prices |

Below is an article I read with some dismay.  I find it untenable that the general population does not even understand what a nurse does and what a nurse is held legally accountable for.

In today’s economy, we frequently hear of cost cutting, or streamlining budgets.  Nursing is really not an area where it is cost effective to cut costs.  You really do get what you pay for.

I love working with LPNs, and I love working with my team.  However, I frequently find myself in the role of teacher with my peers.  I see, quite distinctly, the differences in education as it pertains to patient care.  I also see the lack of understanding for legality and civil rights issues.

I think this article points out some of the potential problems to be faced if LPNs are allowed to do the work of RNs.  Please do not think I am anti-LPNs because I am not.  I really am trying to be an advocate for my fellow nurses who would then be put in a dangerous position if the legal system ever were to become involved.

Registered nurses (and subsequently patients) are threatened by cost-cutting.
Last update: October 18, 2009 – 5:18 PM


Twenty-five years ago, Twin Cities registered nurses made history with the nation’s largest strike. Over 6,000 RNs stayed out for six weeks, without a strike fund, against a coalition of most Twin Cities-area hospitals.

Many of these highly trained professionals used food shelves and borrowed money to survive. They went on strike for numerous reasons, including respect for seniority when laying off staff instead of cutting the most experienced nurses first.

The strike highlighted the worrisome new hospital practice of sending patients home “quicker and sicker” in order to avoid losing money. Medicare’s new Diagnosis Related Group program reimbursed hospitals for the expected stay of patients with certain diagnoses, instead of paying for the actual stay. This threatened revenue if patients stayed longer than their DRG called for.

Similar to private managed care, the policy implicitly encouraged hospitals to send patients home when their time was up, not when they were ready. Concerns that people too sick to go home would end up right back in the hospital were well-founded.Payers now want to save money by reducing the expensive inefficiency of rapid rehospitalization. Nurses then and now say, “Duh.” When it comes to the big picture of meeting health care needs, cutting corners rarely cuts costs.

Registered nurses, whom the law calls “professional nurses,” won the seniority battle, keeping more wisdom at the bedside. They now face a new corner-cutting threat to their professionalism. The Minnesota Board of Nursing, charged with licensing all levels of nurses, seeing that they meet state educational requirements and protecting the public from unsafe care, is under pressure to allow less-educated licensed practical nurses (LPNs) to do what RNs do now. The chair of the subcommittee drafting the board’s proposal is himself an LPN.

Only legislators may define nursing practice, but instead of taking this issue to them, the board is putting a new spin on the law to appease those who would benefit if organizations that deliver health care can get an RN at an LPN price.

Vulnerable populations, especially in rural communities with fewer resources, are often the canary in the mine of health care corner-cutting. If LPNs do more than the job they are educated for, the effects will be suffered by patients who are least likely to understand what’s missing, who are not inclined to complain, and who are found where LPNs usually work: in home and institutional long-term care.

If there’s anyplace that needs an RN’s better-trained ability to assess what is going wrong in a person with multiple problems, to decide what is needed, to connect that patient with the right problem-solver and to judge if the solution is working, it’s exactly where corner-cutters would like to replace RNs with less-expensive caregivers.

The differences among the rungs of the nursing career ladder all come down to education. Certified nursing assistants (CNAs) take a basic technical course, are the backbone of basic nursing care and have the aching backs to prove it. They report to RNs and LPNs. LPNs have more education than CNAs, can give some medications if trained to do so, and know more of what problems to look for. They report to an RN. RNs have college degrees, more in-depth education in the science, specialties and basic law of health care, ethics and care management. When they can’t independently solve a problem, they call on doctors or advanced practice nurses. Advanced practice nurses, like nurse practitioners, are RNs who get at least master’s degrees to specialize in areas like pediatrics, midwifery, geriatrics and more.

Additional education brings additional independence, accountability and pay. The answer to someone on the nursing ladder who wants to do more has always been to go back to school.

Instead of cutting corners to get around this safeguard of quality care, the Board of Nursing should be pressuring the Legislature and nursing schools to do what is necessary to produce more of all the kinds of nurses needed to assure excellent care of a growing, aging, diverse population with increasing acute and chronic health care needs.

Eileen Weber is a nurse attorney serving on the board of directors of the Fourth District Minnesota Nurses Association. She lives in Washington County.

Next page

Seeking RN expertise at LPN prices |

Blogged with the Flock Browser


  1. […] Read the original here: Seeking RN expertise at LPN prices | […]

    Pingback by Seeking RN expertise at LPN prices | | College Education, Books and Loans — October 27, 2009 @ 3:15 am | Reply

  2. I just discovered this post and this article is really hitting home with me. I’m an RN who moved to Texas a little over a year ago from Arizona. As an Administrator in Home Care, we used LPNs only minimally in Arizona. In Texas, I am surprised to see almost every traditional RN position filled with LVNs. What surprises me the most as a nurse recruiter is hearing RN managers requesting LVNs because “they are cheaper”. I’ve observed some situations in long-term care and assisted living where LVNs were performing assessments and in management positions. Now, I love LVNs and think they are a valuable clinical resource when used in appropriate settings. But I have found that the quality of judgement of the LVN is much more closely related to the quality of judgement of that particular individual . . . much more so than with RNs. I think the longer educational process of the RN actually weeds out many of those who are not a good fit for nursing. (Not all, of course). Many LVNs are educated in private vocational programs where there is an incentive for the schools to produce graduates. These schools will lose government funding for every dropout they have in the program. So even if a student is not a good fit for nursing, the administrators at the vocational school are under considerable pressure to keep their graduation rates high. Contrast that to a university nursing program. In my RN program, our class was told on the first day that at least 50% of us would be eliminated before graduation! I’m not sure that kind of pressure is the healthiest thing either, but it does tend to give those who are not completely committed to nursing an opportunity to explore other career options!

    Please don’t think I’m bashing LVNs, I’m not. There are good LVNs and bad RNs everywhere. But LVNs and RNs are not interchangeable, just as I am not interchangeable with a nurse practitioner or an MD. While I may think that I’m smart enough to make diagnoses and prescribe medications ( :-D) , the fact is that I haven’t gone through the educational process to validate that and it is inappropriate for me to fill that role without the proper education, despite the fact that I would be less expensive than an NP or MD! For the safety of our patients, I think we need to keep it that way!

    Comment by kitchrn — January 7, 2010 @ 7:12 pm | Reply

    • Heidi, as usual you leave a really good comment. I agree 100% with your assessment of the state of patient care as it is now. I also love working with LVN’s and think some of the LVN’s I know are better nurses than anyone else–however–I am talking mainly about technical patient care skills. I find that the majority of LVN’s have difficulty with assessment and identifying potential risk issues. I know that these are areas of critical thinking, and I am not saying that LVN’s lack this ability, but I do believe that to utilize it correctly there needs to be some type of educational process and practice. This is the area I find lacking.

      Please feel free to continue to leave comments. I always enjoy them and I hope others do also.

      Comment by Shirley Williams — January 8, 2010 @ 2:55 am | Reply

RSS feed for comments on this post. TrackBack URI

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s

%d bloggers like this: