Chapter 4:  Education of LPNs

Background

The scope of practice and job roles of practical nurses depend, in large measure, on education and training programs.  As with curricula for RNs, the approval of training curricula for LPNs rests with the governing board in each State or territory.  The governing boards’ responsibilities include approving new training programs, reviewing existing training programs, issuing and re-issuing licenses, monitoring practice, administering disciplinary actions, and providing information regarding practice. Boards define curricular requirements in a variety of ways.  As with practice acts and scopes of practice, substantial similarities and some variation in legislation, wording, and actual practice exist in curricular requirements, faculty requirements and other areas of the education process.  This chapter will summarize major similarities and differences in the education of LPNs and provide data on national and State trends in LPN education. 

Method

In order to examine the education of LPNs, we collected data from a number of sources.  Data sources include: (1) U.S. Bureau of Health Professions’ Area Resource Training File (February 2003 Release), (2) National Center for Health Workforce Analysis, Bureau of Health Professions, Health Resources & Services Administration, Department of Health & Human Services, (3) National Council of State Boards of Nursing (NCSBN), and (4) primary data from individual Board Web sites and telephone interviews. 

Findings

Curricula

Many State and territory boards use the model developed by the National Council of State Boards of Nursing to guide the language of their regulations related to education and curriculum for practical nursing programs.  Most boards have similar ways of describing the administration of the program, the faculty requirements, how to open and close a program and the curricular content.  However, curricular requirements vary in specificity, as do the scopes of practice.  For example, Arkansas describes specific content to be taught in theory and clinical courses.  California and Delaware have detailed faculty qualifications.  Arizona and Missouri specify the NCLEX pass rate required in order for the program to remain in good standing with the Board.  Some States, such as California, Alaska, Arkansas, Illinois, and the District of Columbia, have continuing education requirements and describe what can and cannot be approved.  Arizona and Delaware’s documents discuss the requirements for refresher courses.

Each board tries to provide guidelines for the programs and schools to ensure adequate training of the student.  The greatest degree of variation in LPN education is in the required length of the educational programs.  Although most programs can be completed in a calendar year, there are exceptions. North Dakota has an associate of science degree for practical nursing that requires 2 or more years of study.  California States that programs must be greater than or equal to 1,530 hours or 50 semester units, with theory accounting for 576 hours and clinical training accounting for 954 hours.  Connecticut requires that programs last for 230 days.  Indiana specifies that programs must last two semesters and one summer, or four quarters.  Louisiana sets a specific number of hours for given topics of study.  Missouri requires no less than a 10-month program.  Oklahoma requires that programs last between 1300 and 1600 clock hours or 32-40 semester hours.  Each board has mechanisms to evaluate LPN programs, for both the establishment of a new program and re-approval of an existing program.

Trends in LPN Education

Figure 4.1 illustrates the number of graduates, enrollment, and admissions in U.S. practical nursing schools from 1976 to 1998.  Specific information by State and school are in the appendix.  Over the 22 years shown, there have been cycles of growth and decline, but the decline has been persistent since 1994.  After 1994, there was significant downsizing of U.S. hospitals, as a result of the growth of managed care health insurance plans and other cost-containment programs, which was accompanied by lower demand for nursing personnel.  Appendix D1 presents the detailed information shown in the figure.

[D]

Figure 4.2 illustrates the number of programs and schools in the U.S. over the years 1976 to 1997.  Since the 1990s, the number of LPN programs has remained relatively stable.  Thus, since 1994, there has been a decline in the number of students each program has enrolled and graduated.

[D]

Table 4.1 presents information about active licenses of both registered and practical nurses in the U.S. between 1987 and 2000.  There has been a gradual increase in the number of active licenses of both registered and practical nurses since the late 1980s.  Even though the number of new graduates has been declining since the early 1990s, the size of the LPN workforce has been rising.  This suggests that the flow of LPNs out of the workforce is smaller than the inflow of new graduates, even though the inflow is dropping.  The age distribution of LPNs is skewed toward older ages, and as these older LPNs retire greater numbers of new graduates will be needed to maintain the LPN supply.

Table 4.1:  Total Number of Active RN & LPN Licenses, 1987-2000

Table 4.2 provides the number of LPNs who have taken the NCLEX-PN, and the percent passing the exam.  The data are available from 1997 through 2000.  Based on these data, in 1997 43,352 U.S.-educated LPN candidates took the examination for the first-time.  This number is much larger than the 24,522 graduates reported that year in the Area Resource File.  According to the user documentation for the Area Resource File (February, 2003 release) (Bureau of the Health Professions, 2003) the Area Resource File is likely to underState the number of graduates because some schools withheld data.  We anticipate that the number of U.S.-educated LPN candidates taking the exam for the first time most accurately represents the number of graduates from LPN programs.

Type of Candidate	1997		1998		1999		2000
	# took exam	percent passed	# took exam	percent passed	# took exam	percent passed	# took exam	percent passed
First-Time, U.S.-Educated	43,351	88.6	40,195	87.2	37,372	86.4	35,572	85.1
Repeat, U.S.-Educated	6,082	43.5	6,947	43.5	7,378	42.4	7,712	41.6
First-Time, Foreign-Educated	1,572	49	1,406	47.9	1,357	47.2	1,306	44.2
Repeat, Foreign-Educated	1,657	24.9	1,688	22.9	1,779	19.7	1,687	20
Invalid Program Codes					93	61.3	95	66.3
TOTAL	52,662	80.2	50,236	77.9	47,979	75.9	46,351	74.3

Source: The NCLEX-RN® and NCLEX-PN® Examination Statistics Database, copyright 1996-2001 (http://www.ncsbn.org/)

Summary

Since the 1990s, the number of LPN programs has remained relatively stable but there has been a decline in number of graduates.  Therefore, since 1994, there has been a decline in the number of students each program has enrolled and graduated.  The total number of active licenses of LPNs increased slightly through the 1990s.  This suggests that LPNs are remaining in the workforce or keeping their licenses active.  The number of first time U.S. educated graduates who are taking the NCLEX-PN has dropped, but the percentage of those passing the examination has remained relatively consistent.

LPN educational curricular requirements vary among the States and territories.  Most States specify the content and number of hours of training, some more detailed than others.  However, most curricula teach similar basic nursing skills training, such as vital signs, patient data collection, patient care and comfort measures, and medication administration.  Additionally, most have added requirements for more advanced skills, such as IV infusion and IV medication administration.  Even though requirements vary, endorsement of LPNs from one State to another is generally done smoothly.  Therefore, the States recognize the similarities of the training programs, even though they have differences.

References

Bureau of the Health Professions. (2003). Area Resource File (February 2003 Release). Washington, D.C.: Department of Health and Human Services.

National Center for Health Workforce Analysis. (2004). 2004, from http://bhpr.hrsa.gov/healthworkforce/

National Council of State Boards of Nursing. (2004). Home page, from http://www.ncsbn.org/about/index.asp