Expert: Margot RN BScN GNC - 1/31/2005

Question
    My question is simple: What LPN got under your skin so badly?
    After reading an answer of yours in the question archives section, I was left with the distinct impression that you dislike LPN's with a passion.  I don't know if anyone else responded- the question was dated 12/1/03, from Enna- but I can't hold myself back.
    Enna asked the difference between RN's and LPN's, as she was thinking about going to school to become an LPN.  Your answer was hostile in that you replied cleaning 'poop' was basically all you've ever seen LPN's do.  You did'nt answer her question, you let go with a barrage against LPN's.  Contrary to your opinion, I am a Nurse- a Licensed Practical Nurse- LPN, no 'aide' anywhere in the title.
    Of course LPN's don't go through as much schooling as RN's, but it is'nt exactly a cake walk.  We are as intelligent and professional as you.  Reading your answers to questions, I know you won't agree, as you seem to have a slight air of superiority about you. Confidence would probably suit you better.
    In your profile you say that you are happy to encourage others who are considering the profession.  That is what you should do, then.  Encourage people towards the profession, be it RN, LPN, or Aide.  Don't play the 'RN's are superior' game.  We all contribute to the profession in our own manner.
    It may interest you to know that as an LPN, my job never included cleaning 'poop', as you say.  I'm sure my skills are comparable to yours.  I even know why I'm doing what I'm doing when I'm doing it.  Just so you know that logic backs the skills.  This all may be helpful to you in the future should anyone else ask you the difference between RN's and LPN's.  Instead of belittling LPN's, you will have a basic idea of what it is that LPN's actually do.
    I have worked in hopitals, nursing homes and Dr's offices.  In the hospital, I did all that the RN did, aside from pushing IV meds.  Our hopital policy allowed LPN's to take Dr's orders over the phone.  I start IV's, do EKG's, IDC's, NG tubes- I do it all!  Of course I make less than the RN, but she has more legal responsibility, and I can appreciate that.  However, as a Licensed Nurse, I am responsible for my own actions.  I am no less professional than you are.
    That you don't consider LPN's to be 'real nurses' is evident.  Unfortunately many other RN's feel the same way.  I've found that the more secure an RN is, the more she appreciates the LPN. Sadly, some people just like to feel superior over others.
    I do hope you reply to this- I'm curious to know if you recieved other emails regarding this same topic, and if maybe you've reconsidered your harsh analysis of LPN's.  Is it true that you've only seen LPN's in the 'poop scooping' capacity?  Are you living and working in Canada- and maybe there is a difference in nursing between Canada and the U.S of A?  I heard that LPN's in Canada are called RNA's (Registered Nurse Assistant's).
    It does upset me when RN's are so derogatory towards LPN's.  We, too, work hard for our license and deserve respect.  Less time should be spent on deciding who is superior to whom, as we all have the common goal of helping people.
    Thank you for taking time out to read this.
              Naomi

Answer
Hello Naomi and thank you for writing,

I am sincerely sorry if I said anything that offended you. As I did take the time to read your entire question, I hope you will allow me the same opportunity to explain why I say what I say.

As you reviewed some of my historical answers you may have observed that I answer questions as honestly as I can, and you may have noticed I receive an wonderful variety of topics. As a volunteer I try to help people who seek my assistance by giving the best answer I can.

You may have also noticed that my typical response to people inquiring about nursing is quite detailed and hopefully encourages people to join our wonderful vocation. I do not go into detail about RNs verses LPNs unless specifically asked, but when I am, I answer based on my knowledge and experience from MY personal experiences as a nurse.

In the twenty-something years I have been nursing, I have seen the LPN's role change dramatically depending on many social-economic factors (changing governments, fluctuating economic conditions, nursing shortages and/or over-supply, healthcare budgets, etc…) as I am sure you have.

When I began working in Acute Care, LPNs were used on some of the heavier floors and their role was to assist with some of the heavier and more time-consuming tasks. The Head Nurse would review the daily assignment and assign one LPN to help 4-5 RNs – their tasks were typically doing the enemas, bathing the heavier patients, and answering call-bells for patients who wanted their bedpans emptied. At that particular time their was a surplus of RNs and LPN jobs were few and far between; most LPNs in fact worked as Long Term Care Aides or Community Home Support Workers.

As the nursing shortage grew, hospitals expanded the roles and duties of the LPNs and created more true LPN positions – at this time, RNs and LPNs worked together. What I and the majority of my colleagues observed was that there was a huge discrepancy in the skill level and knowledge base with  LPNs. Like any profession, some LPNs were spectacular, and some were simply dangerous. Many LPNs had maintained their license as they worked as a Care Aide when LPN jobs were scarce, and it seems many didn't really have a good knowledge base to begin with. Unfortunately, this made employers hesitant to incorporate LPNs into existing systems. Now that the nursing shortage is over, LPNs are once again being phased out of, or having their responsibilities severely reduced, in both Acute Care and Long Term Care.

I have a couple of good friends who are or were LPNs, and I have seen how they have struggled the past two decades. These are intelligent, professional women who are extremely well respected in our community, and they give people the exact same advice I do “if you want to go into nursing, go for the RN program to protect yourself and to give yourself options”.

Please understand Naomi, I say this to encourage people to spend a little more time and get their RN diploma based on the poor way LPNs have been treated throughout my career, not because I feel RNs are superior to anyone. I do not say this to disrespect you or any other LPN, or the LPN institution.

Sadly this is not the same world our parents or grandparents grew up in, people don't work for the same company for 40 years and then retire with a gold watch and a golden pension any more. Today people loss jobs due to cutbacks and out-sourcing, large hospitals can close down almost over-night, terrorism can ruin traditionally strong industries, and the government pension plan and social security sounds like they will be dissolved in a few years. It is a much scarier and less predictable world today, this is sad for all of us. So please understand that when a young person asks me about becoming a nurse, I believe in my heart and soul that a RN diploma will give that young person more options in the very unpredictable world, that is why I said “RNs have much better training, better work conditions and much more job security and career choices through their whole life”.

I do appreciate your feedback though Naomi as you have helped me to see how I can be more tactful in the future, and for that I thank you. As lifetime learners, we can all learn from each other and with any luck we will keep learning until the day we leave this beautiful earth.

Thank you again for writing and for taking the time to express your point of view and sharing with me how my poor choice of words affected you; looking back on that answer, I think I must have been quite tired when I wrote that as it does sound quite insensitive. I hope you understand where I was coming from and forgive my poor choice of words – or perhaps, we just need agree to disagree.

I wish you all the best in your future, and please feel free to write again any time (on any topic - good or bad).

Respectfully,

Margot