Licensed Practical Nurses May Be Able to Fill Gap in the Nursing Shortage

Laurie Barclay, MD

July 20, 2006

July 20, 2006 --- Licensed practical nurses (LPNs) may be able to fill the gap in the nursing shortage, according to the results of a study reported in the July issue of the American Journal of Nursing.

"LPNs may be able to help fill some of the gaps caused by the nursing shortage, but little research has been conducted on the demographic characteristics of LPNs, their education and scope of practice, and the demand for their services, all of which vary from state to state," write Jean Ann Seago, PhD, RN, from the University of California, San Francisco, and colleagues.

In 2002 and 2003, the authors conducted a comprehensive national study, Supply, Demand, and Use of Licensed Practical Nurses, which showed that RNs and LPNs are similar in age and tend to have similar numbers of children. However, racial and ethnic minorities, particularly African Americans, and those who are single, widowed, divorced, or separated are better represented among LPNs.

"Expanding LPN educational programs could draw more people into nursing," the authors write. "Some LPNs would like to become RNs, so expanding LPN to RN 'ladder' programs could also be beneficial. Although LPNs are unable to replace RNs entirely, they could perform much of the work now performed by RNs."

Long-term care facilities already depend heavily on LPNs, but the authors suggest that hospitals could benefit from employing more LPNs, and they make several specific policy recommendations to improve the education and employment of LPNs.

Usually LPNs obtain a license after 12 to 18 months of postsecondary education compared with the 2 to 4 years of education RNs complete before licensure. While responsibilities and scopes of practice vary substantially by state, LPNs usually work under the supervision of an RN or a physician. Their responsibilities typically include basic hygienic and nursing care, measurement of vital signs, and administration of prescribed nonintravenous medications. In some states, LPNs can administer intravenous fluids absent medication, and they can withdraw blood.

Because new LPNs are drawn from a different demographic pool than are RNs, expanding LPN education can recruit a more diverse group of people into the nursing profession. In turn, LPN-to-RN programs can help LPNs advance into RN jobs.

Specific recommendations are as follows:

  • Before making changes to LPNs' scope of practice, states should determine whether easing practice restrictions would negatively affect patient care.

  • Employers should distribute the work of LPNs safely and reasonably, so that RNs are not overwhelmed and LPNs can perform all of the nursing tasks permitted under existing scope-of-practice regulations.

  • Employers should provide educational incentives to LPNs.

  • Nurse educators should facilitate the matriculation of LPNs in RN educational programs.

"More efficient 'laddering' of workers from lower-skill to higher-skill health care jobs would benefit both workers and employers and, ultimately, would decrease the total cost of educating nurses," the authors conclude. "At present, the LPN workforce is not being used to its fullest capacity. Employers, state boards of nursing, and educators should strive to ensure that all types of licensed nurses are part of the effort to alleviate the nursing shortage."

The Bureau of Health Professions, Health Resources and Services Administration, US Department of Health and Human Services, supported this study. The authors report no relevant financial relationships.

In an accompanying perspective, Carol S. Brewer, PhD, RN, from the State University of New York at Buffalo, and Christine Tassone Kovner, PhD, RN, from New York University in New York City, express their concern that the substitution of LPNs for RNs could have a negative impact on the quality of care, despite the potential to decrease costs.

"The research and data needed to make distinctions in the quality of care provided by variously composed teams of RNs, LPNs, and nursing aides are, so far, unavailable," Drs. Brewer and Kovner write. "Such research is essential to evaluating the quality of care provided by various mixes of nurses, as well as to establishing the total quantity of personnel needed in multiple health care settings."

Am J Nurs. 2006;106:40-49

Reviewed by Gary D. Vogin, MD

 

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