Marie Manthey’s Nursing Salon

The Role of LPNs January 16, 2006

For years, we’ve expanded or contracted the role of LPNs based on the supply of RNs (and the money to pay them). As a group, few have contributed as much, or been valued as little as these folks. In my opinion, there is no doubt that we need skilled technicians to act as assistants to RNs. Why? Logic dictates that with today’s acuity levels we need more skilled technicians than patient care aides. When RN energy is consumed with clinical activities, it is not available for the professional work of nursing: making decisions about the amount degree and kind of nursing care a patient will receive, in the context of a therapeutic relationship with the patient.

This is what RNs are licensed to do. The license does not say RNs have to give 100% of the care tasks patients receive, but is does say we are the only care providers in the whole system with specific responsibility to make decisions about nursing care. And yet, this is the activity most often given up in order to perform tasks. This is the activity most often given up in order to “fix” a system problem with dietary, or with lab, or with pharmacy … etc. etc. This is the activity most often given up in order to do almost anything else.

Albeit some care tasks require the high skill level of an RN. Others however are routine or require a lower skill level. And yet, often regardless of staffing levels, the exercise of professional authority regarding the amount, degree and kind of nursing care a particular patient will receive is on the lowest rung of any RN’s work-priority rating.

The pressure to perform tasks and to “fix” system problems is almost overwhelming. The pressure to accept professional responsibility for managing the care of a patient is totally underwhelming. No one asks about nursing decisions. Everyone asks if the tasks were performed and documented.  Job descriptions are even silent about decision-making!
You may ask “What does this have to do with LPNs?” My answer is “If I were a chief nurse today, I would hire well-trained LPNs to work in partnerships with experienced RNs!” When this is the arrangement, LPNs can safely contribute high-quality, highly-skilled bedside care to the maximum of their ability within the framework of effective delegation. RN’s as senior partners can contribute to deliver bedside care, and have the time and energy to evaluate individual patients and decide on the amount and kind of nursing care they will receive. We have seen the benefits of well-designed and well-executed partnership systems. We have also seen that often logistical problems exist in terms of union rules, schedule preferences or employment practices. These are problems that need to be solved in order to create staffing paradigms that will benefit patients today and the profession tomorrow. As long as RN’s are running around performing countless tasks in high-pressured environments, nursing will not develop as a profession.