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A Modest Proposal

Willis, Jennifer LPN

AJN, American Journal of Nursing: December 1999 - Volume 99 - Issue 12 - p 9

Jennifer Willis is a staff nurse at Chestnut Hill Rehabilitation Hospital, Windmoor, PA.

FIGURE I am a licensed practical nurse. I've had a minimum of 12 months of schooling; you've had at least 24. I'm not in the same league as unlicensed personnel-I'm in yours. But there's a conflict dividing our profession: Can an LPN be professional in manner and nursing practice, even if not in credentialing?

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You and I have been specifically trained in nursing diagnosis, care planning, patient assessment, and intervention pathways. We've each studied anatomy and physiology and spent 10 months in clinical rotation. Whereas you may practice directly under a physician, I must always work under your supervision or under that of a physician. Under your tutelage, I initiate care plans and patient assessments, insert nasogastric tubes, and administer IV medications.

Our roles and responsibilities, and those of all nurses, continue to expand and overlap. An October 1998 survey conducted by the National Council of State Boards of Nursing found that 63% of LPNs and 78% of RNs delegate care to unlicensed assistive personnel (UAPs), and the council is moving to expand its regulatory scope to perhaps license or certify UAPs.

The survey revealed that 26% of LPNs perform assessments, 27% perform analysis and planning, and 15% evaluate care. These duties were once restricted to RNs but are now part of the LPN curriculum. In fact, the NCLEX-PN passing standard was raised in 1996, and the test was revised in 1998. It's time that LPNs and RNs get friendly with each other and observe this type of legislative change. Do you understand the practice limits and abilities of the LPNs that you supervise?

As an RN with a background in chemistry and microbiology, you see patients at a molecular level, while I see them at a systems level. You're therefore permitted to administer blood, total parenteral nutrition, and IV push medications. LPNs understand volume shift and third spacing but not hydrogen and sodium-ion exchange. We know the machines, the collection tubes, the body cavities, and how to take a good wound culture.

But you are my supervisor, and, ultimately, you're responsible for my expertise. If I show a lack of competence within the limits of my educational requirements and practice act, it's your responsibility to train me. You may have a requirement for yearly continuing education, while I do not. In critical care or emergent care facilities, the JCAHO prefers a high or exclusively RN environment, but cost cutting often opens the door to LPNs. As an RN supervising LPNs, you should review the LPN practice act in your state. Managed care dictates have caused both RN and LPN practice acts to accommodate new demands, technologies, and techniques.

Shouldn't we rejoice in this challenge? We need mutual recognition not only among states but also among nurses. We are a team-BSN, ADN, RN, LPN, LVN-all trained and licensed within our states. We're all advocates, not only for our patients but also for our profession. Obstacles to decent patient care are nursing's enemy. Rather than whining about supervising UAPs, let's train and license them with competency requirements. Let's all demand education reimbursement from employers, peer review forums, and certifications specific to all levels.

Nursing is a noble profession, and I'm proud to be an LPN. I may be "assistive personnel," but you'd be glad to have me on your unit. It's a modest proposal: Let's work together under the single, proud banner of nursing.

© 1999 Lippincott Williams & Wilkins, Inc.