Licensed practical nurse (LPN) is the term used in much of the United States and most Canadian provinces to refer to a nurse who cares for "people who are sick, injured, convalescent, or disabled under the direction of registered nurses and physicians.[1] The term licensed vocational nurses (LVN) is used in the U.S. states of California and Texas.
Equivalent professions outside the United States are "registered practical nurse" (RPNs) in the Canadian province of Ontario, "enrolled nurses" (ENs) in Australia and New Zealand, and "state enrolled nurses" (SENs) in the United Kingdom.
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According to the 2010-2011 Occupational Outlook Handbook published by the United States Department of Labor's Bureau of Labor Statistics, licensed practical nurses care for patients in many ways:
Often, they provide basic bedside care. Many LPNs measure and record patients' vital signs such as weight, height, temperature, blood pressure, pulse, and respiratory rate. They also prepare and give injections and enemas, monitor catheters, dress wounds, and give alcohol rubs and massages. To help keep patients comfortable, they assist with bathing, dressing, and personal hygiene, moving in bed, standing, and walking. They might also feed patients who need help eating. Experienced LPNs may supervise nursing assistants and aides, and other LPNs.As part of their work, LPNs collect samples for testing, perform routine laboratory tests, and record food and fluid intake and output. They clean and monitor medical equipment. Sometimes, they help physicians and registered nurses perform tests and procedures. Some LPNs help to deliver, care for, and feed infants.
LPNs also monitor their patients and report adverse reactions to medications or treatments. LPNs gather information from patients, including their health history and how they are currently feeling. They may use this information to complete insurance forms, pre-authorizations, and referrals, and they share information with registered nurses and doctors to help determine the best course of care for a patient. LPNs often teach family members how to care for a relative or teach patients about good health habits.[1]
According to the Occupational Outlook Handbook, while most LPNs are generalists and will work in any area of health care, some LPNs work in specialized settings, such as nursing homes, doctor's offices, or in home care.[1] In some U.S. states, LPNs are permitted to administer prescribed medicines, start intravenous fluids, and provide care to ventilator-dependent patients.[1] While about 18 percent of LPNs/LVNs in the U.S. worked part-time in 2008, most work a 40-hour week. The Occupational Outlook Handbook states that LPNs may have to work nights, weekends, and holidays; often stand for long periods and help patients move in bed, stand, or walk; and may face occupational hazards which include exposure to caustic chemicals, radiation, and infectious diseases; back injuries from moving patients; workplace stress; and sometimes confused, agitated, or uncooperative patients."[1]
In May 2008, the median annual wages of LPNs/LVNs in the United States was $39,030, with the middle 50 percent earning between $33,360 and $46,710, the lowest 10 percent earning less than $28,260, and the highest 10 percent earning more than $53,580. Median annual wages differed by setting:[1]
| Setting | Median annual wages |
|---|---|
| Employment services | $44,690 |
| Nursing care facilities | $40,580 |
| Home health care services | $39,510 |
| General medical and surgical hospitals | 38,080 |
| Offices of physicians | 35,020 |
According to the Occupational Outlook Handbook, in 2008 there were some 753,600 jobs held by LPNs/LVNs in the United States, with about 25 percent working in hospitals, 28 percent in nursing care facilities, and 12 percent in physicians' offices. Other LPNs/LVN worked for home health care services; employment services; residential care facilities; community care facilities; outpatient care centers; and federal, state, and local government agencies.[1] In the United States, employment of LPNs is projected to grow by 21 percent between 2008 and 2018, much faster than average. The growth is expected to be driven by the "long-term care needs of an increasing elderly population and the general increase in demand for healthcare services."[1]
In the United States, training programs to become a LPN/LVN last about one year and are offered by vocational/technical schools and by community colleges. The Occupational Outlook Handbook states that in order to be eligible for licensure, LPNs must complete a state-approved training program. A high school diploma or equivalent usually is required for acceptance into a training program, but some programs accept candidates without a diploma and some programs are part of a high school curriculum. According to the Occupational Outlook Handbook states that most programs include both classroom study (covering basic nursing concepts and subjects related to patient care, including anatomy, physiology, medical-surgical nursing, pediatrics, obstetrics nursing, pharmacology, nutrition, and first aid) and supervised clinical practice (usually in a hospital setting, but sometimes elsewhere).[1]
The National Council Licensure Examination-Practical Nurse (NCLEX-PN), a computer-based national licensing exam developed and administered by the National Council of State Boards of Nursing, is the exam required to obtain licensure as a LPN/LVN. In many states, LPNs/LVNs are required to obtain continuing education credits throughout their career.[1]
In some settings, LPNs/LVNs have opportunities for advancement, including the possibility of becoming credentialed in a certain area (such as IV therapy, gerontology, long-term care and pharmacology) or of becoming a charge nurse, responsible for oversee the work of other LPNs and various unlicensed assistive personnel, such as nursing assistants.[1] Some LPNs/LVNs choose to undergo further education and become registered nurses. LPN-to-RN training programs ("bridge programs") exist for this purpose.[1] These include further classroom study to obtain at least an Associate of Science in Nursing (ASN) and clinical practice followed by another exam, the National Council Licensure Examination-Registered Nurse (NCLEX-RN).
The origins of the practical/vocational nurse can be traced back to the practice of self-taught individuals who worked in home care in the past, assisting with basic care (such as bathing) and light housekeeping duties (such as cooking). Licensing standards for practical nurses came later than those for professional nurses; by 1945, 19 states and one territory had licensure laws, but only one state law covered practical nursing. By 1955, however, every state had licensing laws for practical nurses. Practical nurses who had been functioning as such at the time new standards were adopted usually granted a license by waiver, and exempt from new training requirements.[2]
The first formal training program for practical nurses was developed at the Young Women's Christian Association (YWCA) in New York City in 1892. The following year this became the Ballard School of Practical Nursing (after Lucinda Ballard, an early benefactor) and was a three-month-long course of study concerned with the care of infants, children and the elderly and disabled. The curriculum included instruction in cooking and nutrition as well as basic science and nursing. The school closed in 1949 after the YWCA was reorganized. Other early practical nursing education program include the Thompson Practical Nursing School, established in 1907 in Brattleboro, Vermont (still in operation today) and the Household Nursing School (later the Shepard-Gill School of Practical Nursing), established in 1918 in Boston. In 1930, there were still just 11 schools of practical nursing, but between 1948 and 1954, 260 more opened. The Association of Practical Nurse Schools (APNS) as founded in 1942, and the next year the name of the organization was changed to the National Association was changed to National Association for Practical Nurse Education and Service (NAPNAS), and the first planned curriculum for practical nurses as developed. [3]
In Ontario, there are two basic types of nurses; The RN must have a BScN in nursing, 4 years of university for entry to practice. Registered practical nurses (RPNs) must have a 2 year diploma program for entry to practice. A lot of registered nurses were "grandfathered" in when this change occurred and have 2 and 3 year diploma programs. In Ontario RPNs have a greater scope of practice than most provinces, they can do most skills that an RN can do, however the complexity of the client's condition determines if they are the nurse in charge of care, or receiving direction from an RN if the care is complex and the condition of the client is very unstable.
The state enrolled nursing qualification can no longer be gained in Britain. Prior to the implementation of Project 2000 which radically altered the face of nurse education in the mid 1990s, SEN students used to follow the first twelve months training of the state registered nurses (SRNs, now known as level one nurses), and then had another twelve months of training before sitting SEN exams and becoming registered. Some auxiliary nurses with many years of experience used to be allowed to sit the SEN exams and enter the register without requiring further training. People training to be SRNs who failed their exams at the third attempt were also able to enter the nursing register as a SEN. No new SENs are trained in the UK, the Nursing and Midwifery Council (the regulatory body for nurses in the UK) previously used to allow people to be added to the register as level two nurses if they are moving from a similar position from within the European Union, however this has now stopped. Level two nurses from the EU wishing to gain entry to the Register in the UK must be willing to train as a first level (staff) nurse. This is by two different means: starting their training from scratch as a pre-registration student nurse, or by joining an existing cohort of student nurses starting their second year of training, and completing years 2 and 3 with them [4]
Formerly, there was a large segregation between the "green" SENs and "blue" SRNs, which were the colour of uniform typically worn. SENs were very much complementary to the nursing team, however did not have the status of SRNs and were ineligible to be promoted, e.g. to ward sister. Many SENs sat or re-sat the SRN exams, however a large number did not and were quite content being a SEN. Nowadays, the divide between level one and two nurses is diminishing due to the small number of SENs still in practice. The demise of the SEN is lamented by many who saw it as a balanced way to staff a ward. However, the divide also meant that potentially, the gap in clinical excellence could be too wide.[5]. In many areas, ENs and SENs are beling replaced with lesser qualified healthcare assistants educated to S/NVQ Level 3 or 4, being awarded titles such as Senior Healthcare Assistant, Senior Auxilary Nurse, Senior Clinical Support Worker, Care Team Leader or Senior Care Assistant. Although highly educated, they are no substitute for the length and breadth of experience of a second level registered nurse, sadly missed from the wards.
Although originally viewed as a lesser qualified nurse, ENs and SENs are now able to hold the rank of Deputy Charge Nurse in the NHS and Deputy Home Manager in the private sector, as well as unit manager, both within the NHS and the private sector, and in some instances higher, technically out ranking a staff nurse (1st Level RN).
Auxiliary nurses draw blood samples, change bandages, and record ECGs. At present, they work under the direct supervision of a registered nurse.
Enrolled nurses (EN) in Australia usually spend twelve months training, consisting of fourteen (14) weeks theoretical component at TAFE colleges, followed by practical experience in hospital wards for the remainder of the time. The majority of ENs eventually move on to attend university and become registered nurses, although a substantial number remain as ENs in public and private hospitals, and nursing homes. Trainee enrolled nurses (TENs) become employees of the hospital for the twelve month training period, meaning that, as well as gaining practical experience on the wards, they are paid for hours worked. This attracts a substantial number of applicants, who may wish to pursue nursing as a career, but are unable to afford to become full-time university students. As of 2009, however, the government has stopped working with the NSW Department of Health, and those wishing to become enrolled nurses are not being paid. The enrolled nurse programme also allows people to ascertain whether or not they are suited to nursing before they make the decision to study it at university level.
The role of enrolled nurses in Australia has greatly increased in recent years in response to the continuing shortage of registered nurses in the Australian public health care system. In 2004, a medication endorsement certificate was introduced, allowing ENs to administer some oral medication (excluding schedule 8 drugs of addiction) upon completion. Endorsement also permits the administration of some intravenous (IV) medications and fluids (intravenous therapy or IVT), as well as intramuscular (IM) and subcutaneous (SC) injections. Endorsed enrolled nurses (EENs) are also permitted to check & give S4D and S8 medications with a registered nurse. Most enrolled nurses working in public hospitals are permitted to conduct ECGs, collect pathology specimens, and routinely take a patient load under the direct supervision of a registered nurse.
Despite the fact that the role of the EN in Australia has been greatly expanded in recent years, opportunities for career progression remain somewhat limited, and for this reason, many choose to go on and study to become registered nurses. In terms of financial remuneration, the earning capacity of an enrolled nurse is capped at five (5) years of service, whereas registered nurses continue to eight (8) years before salary capping is applied.