Licensed Practical Nurse

Definition

Licensed practical nurses (LPNs) work under the direction of physicians and registered nurses to provide wellness, preventive, and other health care services to people of all walks of life, including those who are sick, injured, convalescent, and disabled.

Description

LPNs, or licensed vocational nurses (LVNs), as they are called in Texas and California, provide basic bedside care. They work under the supervision of an registered nurse, physician, or other health care provider. LPNs work as part of the health care team taking vital signs, including temperature, pulse, blood pressure, and respiration. They record patients' progress, including patients' food and beverage intake and output. LPNs help hospitalized, bedridden, and other patients with personal hygiene, assisting with bathing and dressing, as well as caring for patients' comfort and emotional well-being.

LPNs can be scrub nurses. Scrub nurses directly assist surgeons in the operating room. They are responsible for setting up sterile instruments and supplies and handing them to the operating surgeon or surgical assistant during the procedure. LPNs prepare and give injections and enemas. They treat bedsores, apply dressings, give alcohol rubs and massages, care for tracheostomies, apply ice packs and hot water bottles, and insert catheters. Often, LPNs observe patients so that the nurses can report adverse reactions to treatments or medications. They help to prepare patients for testing by feeding them or giving them necessary liquids. LPNs also collect patient samples for testing and perform some routine laboratory tests. In some states, LPNs are allowed to administer prescribed medications or start intravenous fluids. LPNs also help deliver babies, and care for and feed infants.

In some cases, experienced LPNs supervise other health care professionals, including nursing assistants and aides. In addition to clinical tasks, LPNs provide a variety of clerical or administrative services. Especially when they work in doctors' offices and clinics, LPNs often assist the administrative staff by making appointments, keeping records and answering phones. As other types of nurses, LPNs take part in educating patients about health care, preventive health maintenance, and at-home treatment. They help to promote preventive measures in community health and act to safeguard health and life. LPNs who work in private homes, caring for people who are unable to care for themselves fulltime, often help with daily tasks, such as cooking and running errands.

LPNs often assume broad responsibilities when working in nursing homes. In addition to providing general bedside services, LPNs employed in nursing homes might assist the health care team, which general includes registered nurses and physicians, with evaluating residents' needs, initiating care plans and overseeing the activities of nurse aides.

In 1998, LPNs held about 692,000 jobs. It is important that anyone considering a career as a LPN is caring and sympathetic in nature. The job can be emotionally stressful because these nurses often work with the critically or chronically ill. It requires that the nurse exhibit emotional stability and be able to take direction from other types of nurses, doctors and other supervisory staff.

LPNs enjoy flexible work schedules, especially in the hospital setting, where they can work nights and weekends. Most who work full time work a 40-hour week. One in four LPNs worked part time in 1998. Some of the drawbacks of the job are the stress levels, which can be exacerbated by heavy workloads and patients who are confused or irrational due to their illnesses. Most LPNs spend much of their working hours on their feet, and the job can often require heavy lifting. At times, because of the nature of their work, LPNs can be at risk for exposure to caustic chemicals, radiation and infectious diseases, including hepatitis. It is important that LPNs always observe health guidelines.

LPNs earned median annual earnings of $26,940 in 1998. The highest area of reported median annual earnings was in personnel supply services, which was at $30,200 a year. The lowest annual earnings were reported by LPNs working in doctors' offices and clinics, which was $24,500. LPNs who work hourly are reported to make from $12 to $18 an hour.

Work settings

LPNs work in all types of health care settings, including hospitals, clinics, public health environments, home health care agencies, assisted living facilities, rehabilitation facilities and nursing homes. Thirty-two percent of LPNs worked in acute care hospitals in 1998, while 28% worked in nursing homes and 14% worked in doctors' offices and health care clinics. Many others work for temporary help agencies, residential care facilities, schools and government agencies.

Education and training

LPNs must pass a licensing examination once they complete a state-approved practical nursing program. While most state-approved programs require a high school diploma, some do not and will allow someone with a high school diploma or specific GED score to participate in the program. Many programs require that potential students pass an entrance exam and interview with the program's director.

About 1,100 state-approved programs provided practical nursing training in 1998. Nearly six in every 10 of these students went to technical or vocational schools. Three in 10 of these students attended programs in community and junior colleges; while the remaining students graduated from programs in high schools, hospitals, colleges, and universities.

Practical nursing programs prepare students to qualify and pass the National Council Licensure Examination. After their scholastic training, LPNs should be able to utilize the nursing process to care for patients. They learn to teach patients about health maintenance and prevention of disease. Essentially, LPNs learn to function as generalists in practical nursing in a variety of health care settings. Practical nursing programs usually require that students go through about a year of learning in the classroom and supervised clinical practice. In the classroom, these nurses discover basic nursing concepts and patient care. These nurses take classes in such subjects as: anatomy, physiology, medical-surgical nursing, medical terminology, pediatrics, pharmacology, obstetrics, psychiatric nursing, advanced nursing procedures, geriatrics, administration of drugs, nutrition, health and wellness, and first aid. Clinical practice might be in the hospitals in addition to other health care settings, including community health care clinics, schools, nursing homes and rehabilitation settings.

Advanced education and training

LPNs can continue their educations to become registered nurses, or RNs. RNs have expanded roles, working collaboratively with physicians and other health care providers. They often oversee the work of LPNs. RNs must graduate from a nursing program and pass a national licensing examination to become licensed. They must periodically renew their licenses and, depending on which state they work, must also take continued education courses for license renewal. There were more than 2,200 entry-level RN programs in the United States in 1998. RNs can pursue one of three educational options. They can achieve an associate degree in nursing, which is usually offered at community and junior colleges and is about two years long; a bachelor of science degree in nursing, taken at colleges and universities and usually taking from four to five years; or a diploma program, which is given in hospitals and lasts about two to three years. Licensed graduates of any of these levels usually qualify to start work at the staff nurse level. Most RNs graduate with either an associate's or bachelor's degree. There has been talk of the requirement for an RN changing to a bachelor's degree or higher; however, this would not affect current associate degree RNs and would probably take place on a state-bystate basis. Most agree that there are more opportunities for advancement for RNs with bachelor's degrees in nursing. A bachelor's often is necessary for administrative positions and is required for admission to graduate nursing programs of all types, including research, consulting, teaching and clinical specialization. Today an increasing number of nurse executives are saying that they want a majority of their hospital staff nurses to have bachelor's degrees because of the more complex demands of patient care. In 1996, 27 percent of RNs reported having a diploma, 31% had a bachelor's degree and 32% held an associate's degree.

Students in RN programs take courses in anatomy, physiology, microbiology, nutrition, psychology, chemistry, nursing, and other behavioral sciences. In addition to classroom instruction, nursing students receive supervised clinical experience in hospitals and other health care facilities. Nursing students received a variety of clinical experience in settings such as hospital maternity, psychiatric, pediatric, and surgical wards. They also gain experience in public health departments, home health agencies and ambulatory clinics.

Once they become RNs, nurses can go on to become advanced practice nurses, which include nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse-midwives. Advanced practice nurses generally have master's degrees or certificates. Nurse practitioners deliver front-line primary and acute care. They can prescribe medications and diagnose and treat common acute illnesses and injuries. Nurse practitioners provide immunizations, conduct physical exams and provide care to manage chronic diseases, such as diabetes. Certified nurse-midwives are trained to provide prenatal and gynecological care to healthy women. They also deliver babies in all types of settings, including at the patient's home, and provide postpartum care. Clinical nurse specialists specialize in areas such as cardiology, oncology and pediatrics. Certified registered nurse anesthetists administer anesthetics to patients in in-patient, outpatient and in-office settings. They are often the sole providers of anesthesia.

RNs can also go on to careers in teaching, research or administration. These areas require master's in nursing degrees or Ph.D. or other doctorate level degrees. Doctorally-prepared RNs tend to go into education or research.

Future outlook

The future looks good for LPNs. Job growth in this area of nursing is expected to grow as fast as the average for all occupations through 2008. The job growth can be attributed to a rapidly aging population, which will require long-term care. The area that appears to be not as promising for LPNs is in the acute care hospital setting, where the number of openings for LPNs is expected to decline. This is due to an expected decrease in the number of admitted patients. Nursing home employment for LPNs is expected to grow; in fact, geriatric care is where LPNs will find the most opportunity. The growth is nursing home employment of LPNs is not only attributed to the growth in the aging population but also to an expected increase in the number of patients who are released early from hospitals but cannot yet take care of themselves at home.

Home health care looks promising for LPNs. Many of the aged and ill will prefer to stay at home rather than be admitted to a nursing home. Technological advances will make it possible for more people to live out much of their remaining years at home.

Employment also is expected to grow much faster than average in settings that will benefit from advances in health care technology, including outpatient surgery centers, emergency medical centers and some physicians' offices and clinics. Here, too, LPNs will find more opportunity in the future.

KEY TERMS

Registered nurse— A nurse who has graduated from a nursing program, including an associate degree, bachelor of science degree or diploma program, and passed a national licensing examination.

Scrub nurse— Scrub nurses directly assist surgeons in the operating room. They are responsible for setting up sterile instruments and supplies and handing them to the operating surgeon or surgical assistant during the procedure.

Resources

ORGANIZATIONS

Central School of Practicing Nursing, 4600 Carnegie Avenue, Cleveland, OH 44103. 〈www.cspnohio.org〉.

OTHER

Occupational Outlook Handbook, U.S. Department of Labor, Bureau of Labor Statistics, Division of Information Services, 2 Massachusetts Ave. NE, Room 2860, Washington, DC 20212. (202) 691-5200. 〈http://stats.bls.gov〉.