The debate is as old as the professions themselves, and in a society where success is most often measured by “climbing the corporate ladder” the choice between becoming an LPN/LVN or an RN is not always easy. While an RN license provides more opportunities for promotion, an LPN/LVN license can be earned more quickly with less time needed in school. Nurses at all levels face the challenge of balancing work with school, family obligations and other external commitments, and often, these factors play a large role in determining available finances and time available for educational pursuits. For people considering a nursing career, RN programs are sometimes excluded as most classes are daylight programs. Accelerated and evening programs exist, but clinicals and preceptorships are generally offered during the day. LPN training programs, being shorter to begin with, are much more flexible and usually offer part-time, night, and weekend hours.
As people evaluate the career choice that’s right for them, educators must work to match the student with the best career fit, and it’s equally important for future nurses to understand the requirements and potential benefits of careers and an LPN/LVN and RN.
Licensed practical and licensed vocational nurses, known as LPNs or LVNs, depending on the state in which they work, provide basic nursing care under the supervision of a registered nurse or physician. Typically tasks such as changing dressings, checking blood pressures, helping patients bathe or dress all fall within the scope of practice of a practical/vocational nurse. LPNs/LVNs also routinely provide bedside care, perform sterile procedures, and they may or may not administer medication, start IVs or administer IV medication. They should also be able to recognize normal from abnormal findings in their patients. Although medical care is regulated, and LPNs/LVNs may be limited to doing certain tasks depending on their state, opportunities for employment are varied, and today nurses at this level can be found working in nursing homes, extended care facilities, doctor’s offices, and private homes, as well as acute care hospitals. Many procedures that were once done in hospitals are now being done outside of hospitals, creating a demand for LPNs/LVNs in other settings such as outpatient care centers.
According to the US Bureau of Labor Statistics, the median pay for an entry-level LPN/LVN is about $20/hour, or $42,000 per year. The job outlook from 2010 to 2020 shows the growth rate for the profession at 22%, which is faster than average for all occupations. It is predicted that over the coming decade a large number of current LPNs/LVNs will be retiring so job prospects for new nurses will be excellent.
The Education Path of a Licensed Practical or Vocational Nurse
To apply to a Practical or Vocational Nursing program, applicants must hold a high school degree or degree equivalent. LPNs and LVNs must complete an accredited program, usually in a technical school or community college, which takes about one year and sometimes up to 15 months. This nursing program will combine classroom learning in subjects such as biology, nursing, and pharmacology with supervised clinical experience. Upon completion of the requirements these programs give certificates in practical/vocational nursing at which point the candidate is eligible to sit for the National Council Licensure Examination, or NCLEX-PN®. They must pass this exam to practice as an LVN/LPN in all states.
Transitioning From LPN/LVN to RN
For many LPNs/LVNs, the scope of practice and time commitment needed for education is a great fit, but once people are in the profession for a while, they may want to take on more responsibility and look to advance their careers. According to Alliedhealthworld.com “The expectations of performance are much higher for registered nurses than they are for licensed practical nurses. On the floor, LPNs and RNs may have similar duties, but an RN usually has more medical responsibilities.”
Bedside care is the primary scope of practice for a LPN/LVN. LPNs tend to be more task-oriented, while RNs must focus on the big picture. RNs must analyze issues more deeply and consider underlying conditions and how they relate to a patient’s status.
Registered nurses usually perform the initial assessment of a patient. LPNs can also perform their own assessment, but the initial assessment must be performed by a RN. LPNs may also work in conjunction with RNs in patient assessment. The RN is responsible for formulating the diagnosis of the patient, establishing a care plan, and initiating the nursing actions to provide care. LPNs/LVNs will be primarily responsible for seeing that the patient care plans formulated by the RN are put into action. Registered nurses can delegate nursing measures to LPNs, but LPNs can only accept those tasks which are within their scope of license/practice in the state they work.
Depending on the place of employment, LPNs are often under the direct supervision of a RN, and the two often work cooperatively. Even in instances of home care, LPNs may have to call and report or get approval from a RN prior to making changes to a patient’s healthcare plan. Overall, the job of a RN is more medically comprehensive medically than the LPN scope of practice.
LPNs/LVNs can transition to an RN role through either an ADN (Associate Degree in Nursing), or a BSN (Bachelor of Science in Nursing) degree which typically takes 1 -2 years. These programs enable people who are currently practicing as an LPN/LVN to obtain their ADN or BSN and take the NCLEX-RN® exam to become a registered nurse resulting in a significant increase in salary and employment options.
The mean hourly wage for an RN, according to the Bureau of Labor Statistics, is $33/hour, or $69,000 annually. Employment of registered nurses is expected to grow 26% from 2010 to 2020, faster than the average for all occupations. Growth will occur primarily because of technological advancements; an increased emphasis on preventative care; and the large, aging baby-boomer population who will demand more healthcare services as they live longer and more active lives.
Transition programs can be titled “LPN to RN” programs, “Bridge” programs, or “LPN Transition,” and normally include courses in nursing theory, nursing science, professional nurse practice, and nursing pharmacology. Students will also be required to take general education courses in communication, sociology, and mathematics to qualify for an associate degree. Many schools offer bridge programs that allow LPNs/LVNs to gain their RN status through a combination of credits for their previous experience and their new education. These programs are designed to build upon already existing knowledge and expertise. The more a nurse trains as an LPN/LVN, developing skills and gaining experience, the easier it will be for the nurse to obtain a license as an RN.
Differences between the NCLEX-RN® and NCLEX-PN®
When it comes to preparing for the NCLEX-RN®, LPN/LVN experience will help only to a certain degree. When we meet with nursing students at PN schools, we often find that LPN/LVN students are not as accustomed to the idea of NCLEX preparation. In the case of bridge students, students think that because they’ve taken the NCLEX-PN® they are ready for the NCLEX-RN®.
What students don’t always realize is that the scope of practice is very different on the NCLEX-RN®, and critical thinking skills become even more crucial. When combined with the fact that the NCLEX-RN® is written at a higher reading comprehension level (10th grade vs. 8th grade proficiency for the NCLEX-PN®) and that the NCLEX-RN® exam could be up to 60 questions longer than the NCLEX-PN®, proper preparation for this exam is even more vital.
As educators we have the task of matching the candidate with the skill set. Not every LPN/LVN is an automatic RN candidate. People have different career goals, abilities and interests. Rewarding careers work best when they meet all the needs of the health care professional. Now more than ever, there are varied opportunities that can make all members of the nursing field valuable contributors to health care. “Educators in Nursing” has dedicated much time to highlighting careers available to LPNs and RNs. Please let us know if there’s a topic you’d like to see addressed in the future, and in addition, if you have any feedback or comments.
