RPNs/LPNs versus RNs

This seems to go in cycles. Someone, usually some health care bureaucrat with no actual experience of nurses or the realities of hospital care, decides the skill mix is too rich, RNs make too much money, so the solution is to hire cheaper RPNs/LPNs — because they “basically have the same competencies” or some such nonsense.* Then five thousand studies come out that show patient morbidity and mortality drops with RNs doing patient care versus RPNs/LPNs, which actually ends up costing the system more. This is besides killing people, which in the end analysis, is probably more important. And then RNs are back in fashion, and the cycle begins anew.

Funny how the same arguments get trotted out every few years. And how come I know the literature, a lowly humble staff RN, and when I trot out all the usual arguments in the Parade of the Blindingly Obvious, managers look at me like I’m speaking Swahili?

__________

*Memo to senior health care leaders suits managers: it’s not about whether about RPNs or LPNs can insert IVs more cheaply than RNs. That’s a skill any monkey can do.  It’s about whether an LPN/RPN will recognize you’re about to go into septic shock and die. Which requires hands-on, bedside nursing by RNs.

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  1. #1 by Chris on Monday 21 December 2009 - 2348

    I think you are doing a great disservice to many LPNs, of which I am one. I’ve been an LPN for 19 years, working most of those in ER and ICU. I’ve got excellent bedside and critical thinking skills and picked up on many potentially life-threatening conditions hours before many of my fellow RNs and have been told by all of the nurses and physicians I’ve had the honors to work with that they would rather have me care for them than anyone else. I’ve had 2 doctors offer to pay for me to go to med school. I do have more college education and trauma certifications than most other LPNs, but also more than many RNs. i have always believed that it isn’t the letters behind someones name that makes the nurse, but rather their drive and caring to excel at their profession. Never underestimate a co-worker simply due to their title or neglect to learn from your peers or you will be losing the oppurtunity to advance your knowledge and may eventually make yourelf look like a fool. We’ve all had the joy of working with incompetent CNAs, LPNs, RNs, and doctors.

  2. #2 by torontoemerg on Tuesday 22 December 2009 - 0928

    Chris

    1. I have know many excellent RPNs (as they are called here in Ontario) myself, and they are effective with stable patients with predictable outcomes. But I think the point is that with unstable patients with unpredictable outcomes, RPNs haven’t been trained in the same way to make appropriate clinical decisions. It’s not saying some will catch the incipient sepsis — they will— but rather as rule, it’s better to have RNs in that role. The literature bears this out.

    2. “Never underestimate a co-worker simply due to their title or neglect to learn from your peers or you will be losing the oppurtunity to advance your knowledge and may eventually make yourelf look like a fool.”

    Excellent advice for anyone.

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