 |
|
|
November 1, 2004
Table of Contents
(for on-line viewing) Entire
report in Adobe/pdf
Executive
Summary
Chapter 1: Introduction
Chapter 2: The LPN Workforce
Chapter 3: Scope of Practice and Practice Acts
Chapter 4: Education of LPNs
Chapter 5: Factors Affecting the Supply and Demand
for LPNs
Chapter 6: Perspectives of the Employers, Educators,
State Boards, and Nurses
Chapter
7: Summary, Conclusions, and Recommendations
Appendices
Appendix A
Appendix
B
Appendix C
Appendix D
Appendix E
Appendix F
Appendix
D
D1.
LPN Training Data Totals for U.S.: 1976-1998
D2.
Graduates of LPN/LPN Schools by State: 1976 -1997
D3.
Total Enrollment in LPN/LPN Schools by State: 1977-1998
D4.
Fall Admissions to LPN/LPN Schools by State: 1977-1998
D5.
Admissions to LPN/LPN Schools by State: 1976-1997
D6.
LPN/LPN Programs by State: 1976-1997
D7.
LPN/LPN Schools by State: 1976-1997
D8.
Total Number of Active Licenses by State: 1997-2000
| 845 |
737 |
740 |
827 |
| 17,161 |
16,906 |
19,086 |
16,676 |
| 16,890 |
16,953 |
16,807 |
16,917 |
| a |
a
|
96 |
72 |
| 9,385 |
9,548 |
8,812 |
9,271 |
| 66,150 |
65,766 |
65,830 |
65,383 |
| 9,735 |
9,800 |
9,276 |
10,206 |
| 11,641 |
11,078 |
11,061 |
11,135 |
| 3,093 |
2,560 |
2,675 |
2,675 |
| 1,827 |
1,770 |
1,832 |
2,079 |
| 55,162 |
52,904 |
48,312 |
51,899 |
| 2,611 |
28,321 |
30,042 |
30,042 |
| a |
140 |
277 |
277 |
| 3,225 |
3,598 |
2,357 |
2,699 |
| 9,772 |
9,573 |
9,506 |
9,429 |
| 3,658 |
3,512 |
3,616 |
4,007 |
| 27,422 |
29,526 |
26,864 |
28,742 |
| 23,361 |
25,102 |
25,102 |
25,997 |
| 8,921 |
8,519 |
8,039 |
8,718 |
| 14,083 |
13,285 |
14,393 |
13,231 |
| 22,149 |
22,028 |
21,170 |
22,369 |
| 23,186 |
18,195 |
22,170 |
22,445 |
| 8,584 |
8,871 |
9,603 |
8,426 |
| 3,895 |
3,750 |
3,591 |
3,463 |
| 32,871 |
31,763 |
32,626 |
28,047 |
| 22,489 |
22,388 |
22,442 |
22,342 |
| 18,715 |
21,750 |
23,683 |
22,296 |
| a |
28 |
28 |
50 |
| 11,979 |
11,214 |
12,227 |
11,315 |
| 3,211 |
3,226 |
3,321 |
3,223 |
| 21,483 |
22,658 |
21,854 |
21,578 |
| 3,007 |
3,059 |
3,073 |
3,031 |
| 6,966 |
6,417 |
6,847 |
6,413 |
| 3,165 |
3,023 |
3,340 |
2,989 |
| 25,308 |
25,151 |
24,443 |
22,855 |
| 3,482 |
3,437 |
3,268 |
3,240 |
| 2,408 |
2,263 |
2,523 |
2,945 |
| 76,919 |
71,730 |
73,877 |
69,820 |
| 41,741 |
44,411 |
40,468 |
42,720 |
| 14,515 |
16,942 |
17,018 |
16,732 |
| 4,766 |
4,377 |
4,299 |
4,225 |
| 59,694 |
57,968 |
56,396 |
50,714 |
| a |
12,550 |
12,550 |
12,550 |
| 3,031 |
2,935 |
2,998 |
3,057 |
| 11,331 |
15,252 |
11,007 |
11,559 |
| 2,250 |
2,241 |
2,211 |
2,176 |
| 26,425 |
26,439 |
25,738 |
26,421 |
| 73,648 |
74,496 |
74,648 |
77,044 |
| 3,816 |
3,394 |
3,727 |
3,470 |
| 25,808 |
26,453 |
26,747 |
26,694 |
| 182 |
195 |
129 |
178 |
| 2,146 |
1,946 |
2,136 |
1,884 |
| 14,184 |
15,761 |
13,984 |
13,869 |
| 16,581 |
15,694 |
14,585 |
14,521 |
| 7,132 |
6,592 |
6,789 |
6,091 |
| 1,093 |
1,045 |
1,093 |
1,120 |
| 883,102 |
919,240 |
911,332 |
902,154 |
a = no information
available
D9:
Summary of Licensing Activities
| RN |
151,982 |
| LPN/LPN |
47,171 |
| Total |
199,153 |
| RN |
3,103,981 |
| LPN/LPN |
902,154 |
| Total |
4,006,135 |
| RN |
2,512 |
| LPN/LPN |
23 |
| Total
* |
2,535 |
D10.
Number of Graduates of Foreign Nursing Programs Licensed by State
| |
|
|
|
| |
2 |
12 |
|
| 0 |
1 |
0 |
|
| |
|
|
|
| |
3 |
|
|
| |
|
|
|
| 25 |
|
|
|
| |
|
|
|
| |
|
|
|
| 0 |
|
|
|
| |
11 |
|
|
| |
|
|
|
| |
9 |
15 |
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| 0 |
|
|
5 |
| 1 |
0 |
1 |
|
| |
0 |
|
|
| |
|
|
|
| |
2 |
|
|
| 0 |
0 |
0 |
|
| |
|
|
|
| |
3 |
1 |
1 |
| 5 |
1 |
3 |
4 |
| |
1 |
|
13 |
| |
|
4 |
|
| |
|
|
|
| |
14 |
|
|
| |
0 |
0 |
|
| 0 |
|
|
|
| |
|
|
|
| |
|
|
|
| |
3 |
2 |
|
| |
|
|
|
| |
|
|
|
| 3 |
6 |
2 |
|
| 18 |
|
0 |
|
| |
13 |
|
|
| 6 |
14 |
|
|
| |
|
|
|
| |
2 |
|
|
| |
|
|
|
| 1 |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
|
| 1 |
|
0 |
|
| |
|
|
|
| |
|
|
|
| |
4 |
|
|
| 3 |
0 |
|
|
| |
|
|
|
| 63 |
89 |
40 |
23 |
D11.
New in State Functions by Jurisdiction: 1997-2000
D12.
Maintenance Functions by Jurisdiction: 1997-1998
D13.
Total Licenses Processed by Jurisdiction: 1997-1998
D14.
Number of Candidates Taking NCLEX-PN® Examination and% Passing for First-Time
Candidates Educated in Member Board Jurisdictions: 1997-2000
D15.
Number of First-Time Candidates Not Educated in Member Board Jurisdictions
Taking NCLEX-PN® Examination and% Passing: 1997-2000
| Afghanistan |
1 |
0.0 |
1 |
100.0 |
|
|
|
|
| Albania |
1 |
0.0 |
|
|
1 |
100.0 |
|
|
| Algeria |
|
|
2 |
0.0 |
|
|
|
|
| Andorra |
|
|
|
|
|
|
2 |
50.0 |
| Angola |
|
|
1 |
0.0 |
1 |
0.0 |
|
|
| Argentina |
1 |
0.0 |
1 |
0.0 |
1 |
0. |
3 |
66.7 |
| Armenia |
|
|
|
|
|
|
3 |
0.0 |
| Australia |
|
|
|
|
2 |
100.0 |
2 |
50.0 |
| Austria |
|
|
|
|
|
|
|
|
| Azerbaijan |
|
|
|
|
|
|
1 |
100.0 |
| Azores |
|
|
1 |
100.0 |
|
|
|
|
| Bahamas |
2 |
50.0 |
|
|
1 |
100.0 |
1 |
0.0 |
| Bahrain |
|
|
|
|
|
|
3 |
66.7 |
| Bangladesh |
|
|
1 |
0.0 |
1 |
100.0 |
|
|
| Barbados |
|
|
|
|
1 |
100.0 |
|
|
| Belgium |
1 |
100.0 |
|
|
|
|
|
|
| Belize
(British Honduras) |
3 |
33.3 |
|
|
2 |
50.0 |
|
|
| Bermuda |
|
|
|
|
|
|
1 |
0.0 |
| Bolivia |
|
|
|
|
1 |
0.0 |
|
|
| Bosnia
and Herzegovina |
|
|
|
|
1 |
0.0 |
7 |
42.9 |
| Botswana |
|
|
|
|
|
|
1 |
100.0 |
| Brazil |
1 |
100.0 |
4 |
25.0 |
3 |
33.3 |
|
|
| British
West Indies |
|
|
|
|
2 |
0.0 |
|
|
| Bulgaria |
2 |
50.0 |
1 |
0.0 |
1 |
0.0 |
2 |
50.0 |
| Burma |
2 |
0.0 |
1 |
100.0 |
|
|
|
|
| Cambodia |
|
|
1 |
0.0 |
|
|
|
|
| Cameroon,
Free Republic of |
2 |
100.0 |
2 |
50.0 |
|
|
|
|
| Canada |
75 |
65.3 |
42 |
69.0 |
50 |
58.0 |
33 |
48.5 |
| Cayman |
|
|
3 |
66.7 |
|
|
|
|
| Central
African Republic |
|
|
|
|
1 |
0.0 |
|
|
| Chile |
|
|
|
|
1 |
100.0 |
|
|
| Colombia |
3 |
33.3 |
|
|
2 |
100.0 |
1 |
0.0 |
| Commonwealth
of States-USSR |
94 |
40.4 |
60 |
38.3 |
|
|
|
|
| Costa
Rica |
2 |
50.0 |
|
|
1 |
100.0 |
1 |
0.0 |
| Croatia |
|
|
|
|
1 |
0.0 |
|
|
| Cuba |
7 |
0.0 |
3 |
0.0 |
2 |
50.0 |
8 |
50.0 |
| Denmark |
|
|
1 |
100.0 |
|
|
1 |
0.0 |
| Dominica |
1 |
100.0 |
1 |
100.0 |
1 |
100.0 |
|
|
| Dominican
Republic |
3 |
33.3 |
|
|
4 |
50.0 |
1 |
0.0 |
| Ecuador |
|
|
1 |
0.0 |
|
|
|
|
| Egypt,
Arab Republic of |
1 |
100.0 |
2 |
0.0 |
1 |
100.0 |
1 |
100.0 |
| El
Salvador |
4 |
25.0 |
4 |
25.0 |
|
|
|
|
| England |
18 |
55.6 |
15 |
73.3 |
9 |
77.8 |
14 |
64.3 |
| Eritrea |
|
|
|
|
1 |
100.0 |
|
|
| Estonia |
1 |
100.0 |
|
|
|
|
|
|
| Ethiopia |
6 |
33.3 |
10 |
70.0 |
10 |
70.0 |
8 |
37.5 |
| Falkland
Islands |
|
|
|
|
1 |
0.0 |
|
|
| Fiji
Islands |
|
|
|
|
2 |
0.0 |
2 |
0.0 |
| France |
|
|
4 |
75.0 |
|
|
|
|
| Finland |
1 |
100.0 |
|
|
1 |
100.0 |
1 |
100.0 |
| French
Polynesia |
|
|
|
|
3 |
100.0 |
2 |
100.0 |
| French
Terr of Afars & |
|
|
|
|
|
|
1 |
100.0 |
| Gabon |
|
|
|
|
3 |
66.7 |
|
|
| Gambia |
5 |
60.0 |
7 |
14.3 |
|
|
|
|
| Georgia |
|
|
|
|
|
|
1 |
0.0 |
| Germany
United |
4 |
100.0 |
5 |
100.0 |
7 |
85.7 |
7 |
100.0 |
| Ghana |
15 |
66.7 |
20 |
60.0 |
17 |
52.9 |
22 |
50.0 |
| Greece |
|
|
|
|
1 |
0.0 |
|
|
| Grenada
and the Grenadines |
|
|
7 |
71.4 |
1 |
100.0 |
1 |
100.0 |
| Guadeloupe |
1 |
0.0 |
|
|
|
|
|
|
| Guatemala |
|
|
1 |
100.0 |
|
|
3 |
66.7 |
| Guinea,
Republic of |
1 |
100.0 |
|
|
|
|
|
|
| Guyana |
24 |
70.8 |
30 |
30.0 |
19 |
31.6 |
10 |
70.0 |
| Haiti |
76 |
23.7 |
91 |
37.4 |
45 |
4.4 |
67 |
9.0 |
| Honduras |
2 |
50.0 |
|
|
1 |
0.0 |
1 |
0.0 |
| Hong
Kong |
5 |
60.0 |
3 |
100.0 |
2 |
50.0 |
2 |
0.0 |
| Hungary |
2 |
50.0 |
|
|
1 |
0.0 |
|
|
| India |
227 |
51.1 |
135 |
49.6 |
143 |
46.2 |
130 |
39.2 |
| Indonesia |
3 |
33.3 |
10 |
30.0 |
6 |
33.3 |
4 |
0.0 |
| Iran |
15 |
46.7 |
7 |
28.6 |
15 |
66.7 |
6 |
66.7 |
| Iraq |
|
|
|
|
1 |
0.0 |
|
|
| Ireland |
3 |
100.0 |
1 |
100.0 |
3 |
100.0 |
|
|
| Israel |
2 |
50.0 |
3 |
33.3 |
5 |
40.0 |
4 |
50.0 |
| Italy |
|
|
4 |
25.0 |
1 |
0.0 |
|
|
| Ivory
Coast |
|
|
|
|
1 |
0.0 |
1 |
100.0 |
| Jamaica |
10 |
40.0 |
5 |
60.0 |
6 |
83.3 |
3 |
33.3 |
| Japan |
6 |
83.3 |
6 |
50.0 |
6 |
83.3 |
2 |
50.0 |
| Jordan |
2 |
50.0 |
1 |
0.0 |
|
|
|
|
| Kazakhstan |
|
|
|
|
1 |
0.0 |
|
|
| Kenya |
8 |
50.0 |
12 |
75.0 |
9 |
66.7 |
10 |
70.0 |
| Korea |
13 |
69.2 |
5 |
20.0 |
12 |
66.7 |
8 |
37.5 |
| Korea
(North) |
1 |
0.0 |
8 |
12.5 |
1 |
100.0 |
|
|
| Lebanon |
2 |
100.0 |
|
|
|
|
2 |
100.0 |
| Liberia |
2 |
100.0 |
1 |
100.0 |
1 |
0.0 |
1 |
0.0 |
| Lithuania |
1 |
0.0 |
3 |
33.3 |
1 |
0.0 |
|
|
| Macao |
|
|
2 |
50.0 |
2 |
100.0 |
1 |
0.0 |
| Macedonia,
Former Yugloslav |
|
|
|
|
|
|
2 |
50.0 |
| Malagasy
Madagascar |
|
|
|
|
|
|
1 |
0.0 |
| Malawi |
|
|
|
|
|
|
3 |
0.0 |
| Malaysia |
1 |
0.0 |
|
|
|
|
|
|
| Marshall
Islands |
|
|
|
|
1 |
100.0 |
|
|
| Mexico |
20 |
45.0 |
13 |
7.7 |
10 |
30.0 |
8 |
25.0 |
| Moldova |
|
|
|
|
1 |
100.0 |
2 |
100.0 |
| Nepal |
|
|
2 |
50.0 |
3 |
33.3 |
|
|
| Netherlands |
|
|
|
|
|
|
1 |
100.0 |
| New
Zealand |
|
|
1 |
100.0 |
|
|
|
|
| Nicaragua |
2 |
0.0 |
23 |
52.2 |
1 |
0.0 |
1 |
0.0 |
| Niger |
|
|
|
|
1 |
0.0
|
1 |
100.0 |
| Nigeria |
122 |
62.3 |
82 |
63.4 |
103 |
57.3 |
74 |
51.4 |
| Northern
Ireland |
|
|
|
|
|
|
1 |
100.0 |
| Norway |
|
|
|
|
1 |
0.0 |
|
|
| Pakistan |
7 |
28.6 |
8 |
50.0 |
2 |
0.0 |
4 |
75.0 |
| Panama,
Republic of |
1 |
0.0 |
11 |
54.5 |
1 |
0.0 |
|
|
| Peoples
Republic of China |
36 |
52.8 |
16 |
68.8 |
23 |
43.5 |
20 |
75.0 |
| Peru |
8 |
12.5 |
190 |
50.0 |
7 |
71.4 |
2 |
0.0 |
| Philippines |
648 |
46.5 |
452 |
45.1 |
617 |
45.4 |
655 |
47.0 |
| Poland |
10 |
70.0 |
31 |
61.3 |
13 |
53.8 |
11 |
36.4 |
| Portugal |
|
|
1 |
0.0 |
|
|
|
|
| Russia |
|
|
3 |
0.0 |
72 |
40.3 |
41 |
46.3 |
| Rumania
Romania |
4 |
25.0 |
2 |
50.0 |
8 |
50.0 |
3 |
33.3 |
| Rwanda |
|
|
1 |
0.0 |
|
|
|
|
| Saudi
Arabia |
1 |
100.0 |
|
|
|
|
|
|
| Scotland |
|
|
|
|
1 |
100.0 |
|
|
| Sierra
Leone |
5 |
20.0 |
5 |
40.0 |
8 |
37.5 |
9 |
11.1 |
| Senegal |
|
|
|
|
|
|
1 |
0.0 |
| Singapore |
|
|
|
|
1 |
100.0 |
|
|
| South
Africa |
|
|
1 |
0.0 |
2 |
100.0 |
|
|
| Spain |
|
|
2 |
50.0 |
|
|
|
|
| St
Thomas & Principe |
|
|
|
|
|
|
1 |
0.0 |
| St.
Vincent |
3 |
66.7 |
|
|
2 |
50.0 |
2 |
50.0 |
| Sweden |
2 |
50.0 |
|
|
3 |
66.7 |
1 |
100.0 |
| Taiwan
(Republic of China) |
13 |
38.5 |
11 |
54.5 |
11 |
54.5 |
7 |
28.6 |
| Tajikistan |
|
|
|
|
1 |
100.0 |
2 |
50.0 |
| Tanzania,
United Republic of |
|
|
1 |
0.0 |
1 |
0.0 |
|
|
| Thailand |
|
|
3 |
33.3 |
6 |
66.7 |
1 |
0.0 |
| Tonga |
1 |
0.0 |
|
|
|
|
|
|
| Tunisia |
1 |
0.0 |
|
|
|
|
|
|
| Trinidad
& Tobago |
3 |
66.7 |
3 |
66.7 |
2 |
100.0 |
6 |
66.7 |
| Turkey |
2 |
50.0 |
1 |
100.0 |
|
|
|
|
| Uganda |
2 |
100.0 |
1 |
0.0 |
1 |
100.0 |
1 |
100.0 |
| Ukraine |
|
|
|
|
10 |
40.0 |
8 |
25.0 |
| United
Arab Emirates |
| Uruguay |
| Uzbekistan |
| Vatican
City State |
| Venezuela |
| Vietnam |
| Windward
Islands |
| Yugoslavia |
| Yugoslavia/Former |
| Zaire |
| Zambia |
| Zimbabwe |
| TOTAL |
Copyright 1996-2001,
National Council of State Boards of Nursing, Inc. (http://ncsbn.org)
From: 1997 Licensure
and Examination Statistics
D16.
Summary Statistics for First-Time, U.S.-Educated Candidates Taking NCLEX-PN®
Examination: 1997-2000
| |
| -0.51 |
-0.51 |
-0.51 |
-0.47 |
| 0.92 |
0.91 |
0.9 |
0.9 |
| 111 |
113 |
118 |
114.7 |
| 60% |
58% |
53% |
56% |
| 14% |
15% |
18% |
16% |
| 1
hr 58 min |
2
hr 0 min |
2.24 |
2.11 |
| 0.7% |
0.6% |
1.7% |
1.2% |
* These statistics
are in units, called logits, on the Rasch measurement scale
** Estimated
Decision Consistency calculations include only U.S.-Educated, First-Time
Candidates Taking NCLEX-PN® Examination
Copyright 1996-2001,
National Council of State Boards of Nursing, Inc. (http://ncsbn.org)
D17.
National Passing Rate: Licensed Practical/Vocational Nurses: 1989-1994
| Apr-89 |
0.87 |
0.70 |
| Oct-89 |
0.90 |
0.79 |
| Apr-90 |
0.90 |
0.74 |
| Oct-90 |
0.87 |
0.76 |
| Apr-91 |
0.86 |
0.68 |
| Oct-91 |
0.89 |
0.78 |
| Apr-92 |
0.89 |
0.69 |
| Oct-92 |
0.91 |
0.78 |
| Apr-93 |
0.91 |
0.76 |
| Oct-93* |
0.89 |
0.75 |
| Apr-Jun94 |
0.91 |
0.83 |
| Jul-Dec
94 |
0.90 |
0.82 |
| Jan-Mar
95 |
0.89 |
0.77 |
| Apr-Jun
95 |
0.91 |
0.80 |
| Jul-Sep
95 |
0.92 |
0.87 |
| Oct-Dec
95 |
0.90 |
0.82 |
| Jan-Mar
96 |
0.91 |
0.82 |
| Apr-Jun
96 |
0.90 |
0.80 |
| Jul-Sep
96 |
0.92 |
0.87 |
| Oct-Dec
96 |
0.88 |
0.80 |
| Jan-Mar
97 |
0.90 |
0.80 |
| Apr-Jun
97 |
0.88 |
0.77 |
| Jul-Sep
97 |
0.90 |
0.84 |
| Oct-Dec
97 |
0.86 |
0.77 |
| Jan-Mar
98 |
0.86 |
0.75 |
| Apr-Jun
98 |
0.87 |
0.75 |
| Jul-Sep
98 |
0.89 |
0.82 |
| Oct-Dec
98 |
0.85 |
0.76 |
| Jan-Mar
99 |
0.87 |
0.76 |
| Apr-Jun
99 |
0.85 |
0.72 |
| Jul-Sep
99 |
0.88 |
0.81 |
| Oct-Dec
99 |
0.84 |
0.73 |
*Last paper-and-pencil
examination
Copyright 1996-2001,
National Council of State Boards of Nursing, Inc. (http://ncsbn.org)
D18.
Number of Candidates Taking NCLEX-PN® Examination and% Passing by Type
of Candidate: 1994-2003
Appendix
E
E1.
Means of Variables, 1994-2001 – Supply of Licensed Practical/Vocational
Nurses
E2.
Means of Variables, 1990-2000 – Hospital Demand for Licensed Practical
Nurses
Appendix
F
F1.
Findings From Focus Groups
Patient
care is the major role for both RNs and LPNs
Despite the differences
in their licensure and employer, LPNs and RNs Stated that direct patient
care is their main responsibility. While LPN and RN licenses specify different
scopes of practice, and LPNs predominate in the long-term care setting
with RNs more prevalent in acute care facilities, the focus group respondents
cited similar overall duties in their current jobs. Specifically,
direct patient care is the most often-mentioned responsibility with most
of the participating LPNs and RNs claiming this duty. In descending
order of importance, both groups also Stated responsibility for: patient
education, supervision of other nurses, education of other staff members,
and supervision of non-nursing staff.
When LPNs and RNs
work side-by-side in a particular facility or department, the actual patient-care
duties performed by each differ, with LPNs serving in a more hands-on,
technical capacity and RNs more likely to supervise and to perform specific
highly skilled tasks. However, when RNs greatly outnumber the LPNs
in a particular setting, their duties may be fairly similar, except for
those activities the LPN is not licensed to perform. When LPNs greatly
outnumber the RNs in a setting, usually in long-term care, the LPNs report
to an RN, but may take on broader responsibilities.
Relationships
between RNs and LPNs are positive
The relationships
between the LPNs and RNs in the focus groups and the other nursing staff
members with whom they work are generally positive. LPNs Stated that the
RNs with whom they interact are, for the most part, supportive and respectful,
while the RNs Stated that they appreciate the contributions of the LPNs
and rely on them to get the job done. In the acute care setting,
some LPNs resent their lower pay and perceived lower status, although
not all hospital LPNs felt this way. The few specific instances
of friction cited by focus group respondents were believed to be isolated
examples of personality clashes or the occasional frustrated or overworked
individual.
There
are significant barriers for LPNs in obtaining RN education and licensure
If it were easier
for LPNs to get their RN license, more LPNs would be interested in doing
so. Although some of the focus groups’ LPNs are not interested in
obtaining an RN license, many would like to obtain the more advanced license.
In each of the LPN focus groups, at least one individual was currently
enrolled in an RN program, and several others Stated an intention to enroll
in the future. Still others in each group claimed to have been interested
in an RN license in the past, but to have shelved their aspirations for
a variety of reasons. The major obstacles to LPNs obtaining an RN
license appear to be:
- The need to take
prerequisite courses such as math and science
- The difficulty
of finding time off from work to take courses
- The expense of
financing additional education
Some LPNs who Stated
that they are not interested in obtaining a RN license said that they
would be paid less as a newly licensed RN than as an experienced LPN.
Some LPNs said that they perceive RNs to have more non-patient-care responsibilities,
such as paperwork, and that they personally did not want to leave bedside
nursing.
The following ideas
were proposed by the group to help LPNs address barriers in gaining RN
licensure were suggested by focus group participants:
- Have RN programs
that give substantial credit for the expertise and knowledge of an experienced
LPN
- Offer employer-sponsored
programs that provide financial assistance and scheduling flexibility
to LPNs interested in pursuing the RN license
- Offer LPNs who
meet certain criteria an opportunity to challenge the RN boards without
further course work
- Offer more LPN–RN
ladder programs such as those offered at most Iowa Community Colleges
Most
participants agree with the LPN scope of practice in their State
The four States visited
varied in LPN scope of practice. The majority of focus group participants
were generally familiar with their State’s scope of practice for LPNs.
In each group, several individuals were able to articulate the LPN scope
of practice and could specify how it differed from the RN scope of practice.
Even many respondents who did not feel comfortable articulating the guidelines
appeared knowledgeable about what RNs and LPNs are and are not permitted
to do in the workplace. In each focus group, a few individuals seemed
unsure about what the regulations specify.
While focus group
members generally understood the LPN scope of practice in each of the
four States, there are a few differences between what the regulations
State and what members believed that LPNs are permitted to do. Those
areas of discrepancy mostly centered on patient assessment, IV therapy,
and treatment with blood products.
Most focus group participants
were in agreement with their State’s scope of practice, although a few
respondents, particularly LPNs, felt that the scope is too restrictive.
Those who support the current scope of practice believe that it appropriately
captures the level of training and skills possessed by LPNs. Those
who felt that the scope of practice is too limiting expressed the following
perspectives:
- Some LPNs mentioned
that they are not permitted to perform all the activities outlined in
the scope of practice. LPNs Stated that they are guided more by
employer-specific policies and procedures stating their specific job
tasks and responsibilities than by everyday knowledge of the State’s
scope of practice. Employers have the prerogative to establish
internal practice guidelines that are more limited than the legal scope
of practice.
- In reality LPNs
often perform many RN tasks, with the RN signing off on their completion.
- Many LPNs with
experience have greater technical abilities than junior RNs
- LPNs are more practiced
at the technical, hands-on aspects of nursing while RNs spend more time
doing administrative work.
- Another limiting
factor in LPN scope of practice is that of what RNs are allowed to delegate
to other health professionals, including LPNs. For example, in
the State of Louisiana, the RN scope of practice limits the tasks that
an RN may delegate to an LPN, thereby de facto reducing the LPN
scope of practice.
Some
LPNs felt that they have responsibilities that go beyond the State’s regulations.
According to the focus
group participants, when the LPNs functioned outside the scope of practice,
it was usually for one of the following reasons:
- In some units/department
(e.g., ER, ICU, cardiac catheterization lab), the pace is so hectic
that everyone must pitch in and do what is required, regardless of regulatory
boundaries.
- If an RN has confidence
in a particular LPN’s knowledge and skills, that LPN may be permitted
to bend the rules.
- In long-term care
facilities and on night and weekend shifts, there may be few or no RNs
available, so LPNs must perform tasks outside of the scope of practice.
- In emergency situations
LPNs may perform tasks outside their scope of practice.
- A relatively junior
RN may have a lower skill level than a more senior LPN, who therefore
is asked to perform a task in his/her stead.
Several LPNs who had
knowingly practiced outside their scope of practice expressed discomfort
with this both because of legal liability and because they are paid less
than RNs and should therefore not be expected to take on RN tasks.
Many
LPNs are interested in earning an RN license
In each LPN group,
one or more individuals are either currently studying for their RN license,
or are very interested in doing so. Still others considered getting
an RN license at some time in the past, but were unable to complete the
process. Among the reasons LPNs cited for wishing to become an RN
are:
- Higher pay
- Greater respect
from patients, physicians, other staff members
- Ability to supervise
other and less hands-on work
- Already do everything
RNs do, but not paid as much
- RNs work at a
slower pace with more paperwork to do
- Greater opportunities
for advancement
- To gain more knowledge
and skills
- Priority in scheduling
work-shifts (acute care)
Several LPNs also
Stated that they were not interested in becoming RNs. Among the
reasons they wished to remain an LPN were:
- Because of seniority,
earn more than most RNs
- Not a risk-taker
- Not sure I have
what it takes to get the RN license
- LPNs today have
more opportunities than they did in the past
- Can’t afford to
quit work to pursue the RN license
- Would have to take
the various prerequisite courses (math, science, history)
- LPNs have less
responsibility and lower legal liability
- RNs don’t do as
much direct patient care
Barriers
to LPN education and licensure are fewer than for RN licensure
The LPNs in the focus
groups cited few barriers to earning their LPN license, saying they found
it fairly easy. The obstacles mentioned by individual respondents
included difficulty in the following areas:
- Finding information
about LPN programs in the area
- Fulfilling prerequisites
- Attending the
program as a single mother or when raising a family
- Lack of employer
tuition reimbursement
- Obtaining paid
time off from work to attend school
- Competing with
other students for prerequisite courses
Once initial barriers
such as finding a program and completing prerequisites were completed,
most of the LPNs Stated that they had few barriers to completing LPN educational
programs. The major barrier cited was the need to work and attend
school as well as juggle family responsibilities.
Most
RNs and LPNs were satisfied with their career and job
Focus group participants
were generally satisfied with their choice of nursing as a career and
certain aspects of their current jobs. In the written survey of
the participants, over half of LPNs (56 percent) and three-fourths (74
percent) of RNs say that they Strongly Agree that they are satisfied with
nursing as a career, while over half of LPNs (56 percent) and two-thirds
(67 percent) of RNs Strongly Agree that they are not considering leaving
the field. Three-fourths of LPNs (73 percent) and half of RNs (50
percent) strongly agree that they like working with a mix of different
types of nurses. However nearly half of each group believed that
their supervisors value their opinions. The most negative scores
were given to salary level. Just 2 percent of LPNs and 12 percent
of RNs strongly agree that their pay is satisfactory for their work.
Most
RNs and LPNs preferred to work in acute care settings if pay was equal
The written survey
results showed that LPNs are more than twice as likely as RNs to work
in the long-term care setting, while RNs are more than twice as likely
as LPNs to work in acute care hospitals. Part of this is due to
the fact that in the 1990s, many acute care hospitals reduced or eliminated
LPN positions in an attempt to increase the percentage of RNs in their
work forces. In addition, the typically lower skill set of the LPN
is adequate to meet the needs of the less acutely ill long-term care patient
population.
Nurses who work in
the acute care setting Stated that they preferred that setting for several
reasons:
- Acute care is
a more exciting, fast-paced and challenging
- Use more skills
and uses a wider variety of skills
- Greater variety
of patient cases
- Pay is generally
higher
- Employee benefits
are better
- Opportunities for
travel and per diem positions
The participants who
preferred the long-term care setting cited the following reasons for their
views:
- Longer lengths
of stay allow staff to get to know the patient and family
- Work hours often
shorter and usually more regular
- Mandated overtime
rarely exists in long-term care.
- LPNs pay is usually
higher in long-term care than in acute care hospitals.
- Pace of work is
generally slower
F2. Key Informant
Interview Questions
Interview
Questions for employers
Questions to be asked
in the employer interviews include, but are not limited to:
- To what extent
do you employ LPNs in your facility?
- What factors make
LPNs attractive to you?
- What factors make
LPNs unattractive to you?
- How do LPNs work
with other personnel in your facility?
- To what extent
do you substitute LPNs for other personnel in your facility?
- Do you believe
LPN education is adequate?
- What changes to
LPN education would you recommend?
- Do you believe
the scope of practice of LPNs in your State is appropriate?
- What changes to
the scope of practice would you recommend?
Interview
Questions for educators
Questions to be asked
in the educator interviews include, but are not limited to:
- What factors help
students complete their LPN education?
- What factors are
barriers to the completion of LPN education?
- What positions
do your LPNs obtain after completion of your program?
- Do you believe
LPN educational requirements are adequate in your State?
- What changes to
LPN educational requirements would you recommend?
- Do many of your
students want to pursue RN education after completing LPN education?
- How difficult
is it to pursue RN education after LPN education?
- Do you believe
the scope of practice of LPNs in your State is appropriate?
- What changes to
the scope of practice would you recommend?
Interview
Questions for Boards of LPN/LPN
Questions to be asked
in the Boards of LPN/LPN interviews include, but are not limited to:
- What is the philosophy
behind the scope of practice of LPNs in your State?
- Do you believe
the scope of practice regulations for LPNs in your State are effective?
- What changes to
the scope of practice are under consideration?
- How do you accredit
LPN educational programs in your State?
- Is adequate LPN
education available in your State?
- How difficult
is it to pursue RN education after LPN education?
- Where do LPNs
work when they complete their education in your State?
- Does there appear
to be a shortage of LPNs?
F3. Focus Group
Questions
Focus
Group Questions for RNs
Questions to be asked
in the RN focus groups include, but are not limited to:
- How do LPNs work
with other personnel in your facility?
- Do you supervise
LPNs?
- What difficulties
do you experience working with LPNs?
- To what extent
do LPNs substitute for other personnel in your facility?
- Do you believe
LPN education is adequate?
- What changes to
LPN education would you recommend?
- Do you believe
the scope of practice of LPNs in your State is appropriate?
- What changes to
the scope of practice would you recommend?
Focus
Group Questions for LPN/LPNs
Questions to be asked
in the practicing LPN focus groups include, but are not limited to:
- How do LPNs work
with other personnel in your State?
- To what extent
do LPNs substitute for other personnel in your State?
- What factors are
barriers to the completion of LPN education?
- Do you believe
LPN education is adequate?
- What changes to
LPN education would you recommend?
- How difficult is
it to pursue RN education after LPN education?
- Do you believe
the scope of practice of LPNs in your State is appropriate?
- What changes to
the scope of practice would you recommend?
|