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… And what about the LPN?
. . . And What
F
OUR workable solutions exist to eliminate “nurse shortages”: (1) Increase the supply of nurses, (2) Decrease the demand for nurses (3) Import nurses from other countries, and (4) Delegate nursing responsibilities to other providers. It is this fourth category, delegation to other categories of nurse providers, that is of particular concern during this nurse shortage. In contrast to previous periods of nurse shortage, the current imbalance in nurse supply and demand cannot be readily resolved by delegation of the nurse role to other nurse providers. The Secretary’s Commission (1988) clearly documented that the current nurse shortage is a crisis in demand for nursing care rather than a decrease in the supply of nurses. The demand for “care” rather than “cure” is, by definition, within the nurse role and expected to increase. Hospitals have substituted RNs for LPNs because the RN is basically independently licensed, requires relatively little supervision, and can be hired at a low wage. The wage difference between an RN and LPN in 1987 was approximately $6,000, with the LPN making 73 per cent of RN wages (Aiken & Mullinix, 1987). The National Commission on Nursing Implementation Project (1987) described trends in employment of LPNs throughout the United States and suggests that education of additional LPNs will be phased out by 1992. Thus, the demand for care by RNs is increasing, the market is substituting the RN for the LPN in order to meet cost-containment requirements, and the long-term trend is for a decline in the use of LPNs delivering care. Yet, at each evidence of nurse shortage, informed groups of health care providers and human resources experts call for delegation of the nurses’ role to nonnurses. The American Medical Association proposed and relinquished the registered care technologist as a solution for the crisis in caring. Support was given for expansion of the LPN role as a solution to this shortage of nurses. In 1982, LPNs had difficulties finding positions and the National Sample of Licensed Practical Vocational Nurses (1983) reported that only 50 per cent were employed full time. One must question the ethics of relying on the LPN in times of shortage and discounting the role during periods of excess.
CONNIE FLYNT MULLINIX,PHD, RN Clinical Assistant ProfesJor School of Nursing University of North Carolina CB7460
Cawington Hall
Chapel Hill, NC 27599-7460
Copyright 0 1991 by W.B. Saunders Company 8755-7223/91/0701-0005$3.0010
6
About the LPN? If indeed the demands for care giving exceed the skills of the current LPN, and if care giving is moving toward two levels of practitioner-the ADN- and the BSN-prepared nurse-a policy agenda must be established and steps taken to transition the LPN into future roles rather than discounting the fine contributions LPNs have made to health care. Two groups are providing leadership in this arena: The Division of Nursing, US Department of Health and Human Services, funded an innovative LPN-BSN educational mobility program at Madonna College from January 1987 to December 1989 (Smith, 1990). The Teagle Foundation has recently funded six bachelor’s degree programs to establish innovative programs for LPNs to become BSN-prepared nurses. This program emphasizes the commitment of the LPN to care giving. Other efforts to help LPNs become RNs have focused on attaining an associate degree, when in fact, the need is for BSN-prepared RNs (AHA, 1986). The efforts by the Division of Nursing and the Teagle Foundation recognize that approximately 12 per cent of the LPN population has been mischanneled into LPN programs rather than RN programs. Additional educational dollars and encouragement by the professional nurse educator community is needed to support the highly committed and competent LPN to attain the baccalaureate. In this day of shortage of all health care providers, not just RNs, one solution for the crisis in caring is facilitating the highly committed LPN to attain the advanced education and license to assume leadership positions in providing care. The crisis in care giving can only get worse; the LPN is one solution.
References Aiken L., & Mullinix, C. (1987). The nurse shortage: reality. New England Journal of Medicine, 3 17, 64 l-646.
Myth or
American Hospital Association. (1986). Report of the 1986 hospital nursing supply survey. Chicago: Author. National Commission on Nursing Implementation Project. (1987). Timeline for transition into the future nursing education system fir two categoriesof nurses. Milwaukee, WI: Author. Secretary’s Commission on Nursing. (1988). Final Report (Vol. 1). Washington, DC: Department of Health and Human Services. Smith, M. L. (1990). An LPNIBSN educational mobility program. Livonia, MI: Madonna College. US Department of Health and Human Services, Public Health Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. (1985). National sample survey of licensed practicaNvocational nurses, November, 1983, Washington, DC: Author.
Journal of Professional Nming,
Vol 7, No
1 (January-February),
199 1: p
6
F
OUR workable solutions exist to eliminate “nurse shortages”: (1) Increase the supply of nurses, (2) Decrease the demand for nurses (3) Import nurses from other countries, and (4) Delegate nursing responsibilities to other providers. It is this fourth category, delegation to other categories of nurse providers, that is of particular concern during this nurse shortage. In contrast to previous periods of nurse shortage, the current imbalance in nurse supply and demand cannot be readily resolved by delegation of the nurse role to other nurse providers. The Secretary’s Commission (1988) clearly documented that the current nurse shortage is a crisis in demand for nursing care rather than a decrease in the supply of nurses. The demand for “care” rather than “cure” is, by definition, within the nurse role and expected to increase. Hospitals have substituted RNs for LPNs because the RN is basically independently licensed, requires relatively little supervision, and can be hired at a low wage. The wage difference between an RN and LPN in 1987 was approximately $6,000, with the LPN making 73 per cent of RN wages (Aiken & Mullinix, 1987). The National Commission on Nursing Implementation Project (1987) described trends in employment of LPNs throughout the United States and suggests that education of additional LPNs will be phased out by 1992. Thus, the demand for care by RNs is increasing, the market is substituting the RN for the LPN in order to meet cost-containment requirements, and the long-term trend is for a decline in the use of LPNs delivering care. Yet, at each evidence of nurse shortage, informed groups of health care providers and human resources experts call for delegation of the nurses’ role to nonnurses. The American Medical Association proposed and relinquished the registered care technologist as a solution for the crisis in caring. Support was given for expansion of the LPN role as a solution to this shortage of nurses. In 1982, LPNs had difficulties finding positions and the National Sample of Licensed Practical Vocational Nurses (1983) reported that only 50 per cent were employed full time. One must question the ethics of relying on the LPN in times of shortage and discounting the role during periods of excess.
CONNIE FLYNT MULLINIX,PHD, RN Clinical Assistant ProfesJor School of Nursing University of North Carolina CB7460
Cawington Hall
Chapel Hill, NC 27599-7460
Copyright 0 1991 by W.B. Saunders Company 8755-7223/91/0701-0005$3.0010
6
About the LPN? If indeed the demands for care giving exceed the skills of the current LPN, and if care giving is moving toward two levels of practitioner-the ADN- and the BSN-prepared nurse-a policy agenda must be established and steps taken to transition the LPN into future roles rather than discounting the fine contributions LPNs have made to health care. Two groups are providing leadership in this arena: The Division of Nursing, US Department of Health and Human Services, funded an innovative LPN-BSN educational mobility program at Madonna College from January 1987 to December 1989 (Smith, 1990). The Teagle Foundation has recently funded six bachelor’s degree programs to establish innovative programs for LPNs to become BSN-prepared nurses. This program emphasizes the commitment of the LPN to care giving. Other efforts to help LPNs become RNs have focused on attaining an associate degree, when in fact, the need is for BSN-prepared RNs (AHA, 1986). The efforts by the Division of Nursing and the Teagle Foundation recognize that approximately 12 per cent of the LPN population has been mischanneled into LPN programs rather than RN programs. Additional educational dollars and encouragement by the professional nurse educator community is needed to support the highly committed and competent LPN to attain the baccalaureate. In this day of shortage of all health care providers, not just RNs, one solution for the crisis in caring is facilitating the highly committed LPN to attain the advanced education and license to assume leadership positions in providing care. The crisis in care giving can only get worse; the LPN is one solution.
References Aiken L., & Mullinix, C. (1987). The nurse shortage: reality. New England Journal of Medicine, 3 17, 64 l-646.
Myth or
American Hospital Association. (1986). Report of the 1986 hospital nursing supply survey. Chicago: Author. National Commission on Nursing Implementation Project. (1987). Timeline for transition into the future nursing education system fir two categoriesof nurses. Milwaukee, WI: Author. Secretary’s Commission on Nursing. (1988). Final Report (Vol. 1). Washington, DC: Department of Health and Human Services. Smith, M. L. (1990). An LPNIBSN educational mobility program. Livonia, MI: Madonna College. US Department of Health and Human Services, Public Health Services, Health Resources and Services Administration, Bureau of Health Professions, Division of Nursing. (1985). National sample survey of licensed practicaNvocational nurses, November, 1983, Washington, DC: Author.
Journal of Professional Nming,
Vol 7, No
1 (January-February),
199 1: p
6