Reflection & Dialogue #8 - Recognizing the Vital Contributions of the Licensed Practical/Vocational Nurse, September 2011

Recognizing the Vital Contributions of the 
Licensed Practical/Vocational Nurse
September 2011

Introduction

Consistent with its mission to promote excellence in nursing education to build a strong and diverse nursing workforce to advance the nations health, the National League for Nursing recognizes that the licensed practical/vocational nurse (LPN/LVN) is a valuable member of the nursing community and significantly contributes to improving the health of the nation. In fact the 2011 IOM report, "The Future of Nursing," acknowledges that licensed practical/vocational nurses are especially important to health care delivery because of their contributions to care in long-term care facilities, nursing homes, and community-based settings.

Working toward an inclusive environment and calling for recognition of all nurses who provide culturally sensitive health care in a wide variety of environments is central to the NLNs core values of caring, integrity, diversity, and excellence. Diversity embraces acceptance and respect. Although one often thinks of diversity at an individual level, it also encompasses institutional and system wide behavior patterns, affirming the value of multiple career pathways. A culture of caring, as a fundamental part of the nursing profession, calls for a commitment to the common good and to act always in the best interests of all members of the nursing community. 

The NLN believes that the diversity offered by multiple points of entry into the nursing profession and the variety of progression options available provide an environment for enrichment and professional growth. To produce a more educated and diverse workforce, as called for by the IOM report (2011), it is imperative that nurse educators and clinical practice partners work together to create new models of academic progression that are inclusive of the LPN/LVN, as well as other prelicensure and postlicensure graduates. 

Yet full recognition of the LPN/LVN nurse workforce and the seamless career pathways that consider the LPN/LVN trajectory as key to workforce advancement have not always been central to nursings preferred future. As the nursing community considers the need for the interprofessional education that is essential to health care reform agendas (IOM, 2011), perhaps, the nursing community should also examine the need for intra-professional partnerships. Nurse educators offering learning opportunities for RNs, LPNs/LVNs, and advanced practice nurses to learn side by side could lead the way. Inclusivity would become a learned culture as newly licensed nurses embark on their professional journey to work collaboratively to advance the nations health.

Considerations

• According to the US Bureau of Labor Statistics, 753,600 licensed practical/vocational nurses were employed in the US in 2008; projected job growth for this group of nurses is anticipated to be greater than the average rate, estimated to be 21 percent between 2008 and 2018 (2010-2011 Occupational Outlook Handbook). This job growth is driven by the aging populous and the escalating average age of the LPN/LVN workforce. 
  
  Similar to the RN workforce, the average age of the LPN/LVN in 2008 was 46.6. This fact, coupled with data from the Pew Research Center indicating that 10,000 baby boomers will turn 65 every day in the US from January 2011 through 2030, underscores the need for health care providers (New York Times, 2011). This is particularly true for health care providers dedicated to care of older adults in community based settings, including long-term care. The LPN/LVN is a key member of the workforce to answer this need.
  
  
• A focus on care of the older adult and the need for this type of employment speaks volumes regarding the future of LPN/LVNs (NCSBN LPN practice analysis, 2009). There has been a dramatic shift in national employment facility trends for LPN/LVNs in the last decade. In 2003, 42.4 percent of newly licensed practical nurses were employed in hospital settings. This number has withered to 16.8 percent in 2009 while employment in long-term care soared from 44.5 percent to 56.9 percent (2003 to 2009). 
  
  Community-based care also demonstrated a dramatic increase from 10.3 percent to 19.8 percent. Conversely, RN trends for newly licensed individuals are strikingly different with hospitals accounting for 89.2 percent (85.6 percent in 2005) of placements, whereas long-term care accounts for a mere 5.3 percent. (This number actually reflects a drop from 7.6 in 2005.) 
  
  
• State practice acts address core requirements for the LPN/LVN workforce. The definition of practical nursing varies from state to state but generally includes concepts related to providing basic care; application of principles of medical/surgical asepsis; medication administration, including IV administration in select states; administration of treatments and assessment; and planning, implementing, and evaluating care of clients in collaboration with the RN or physician. 
  
  There is widespread consistency among state practice acts that the LPN performs selective tasks and works under the direction of the RN, advanced registered nurse practitioner, physician, or dentist. However there is less consistency related to critical decision-making skills that are necessary to the LPN/LVNs daily job responsibilities, especially in skilled care and home care settings. Though some state practice acts address teaching and counseling responsibilities and delegation in collaboration with the RN, there is a need for more consistency between state board regulations and practice requirements. 
  
  
• Home health aides and personal and home care aides are projected to be the third and fourth fastest-growing occupations in the country between 2008 and 2018, increasing by 50 percent and 46 percent, respectively. Nursing aides, orderlies, and attendants are expected to increase by 19 percent (US BLS, 2008). These health care workers are traditionally supervised by LPN/LVN nurse colleagues; integration of concepts related to delegation and case management are currently considered an emerging mandate in LPN/LVN curricula nationally, based on this national trend.
  
  According to 2009 NCSBN job analysis, 47.3 percent of newly licensed LPN/LVNs responded to the practice analysis survey that they have administrative responsibilities within their job role. LPN/LVNs working in long term care facilities were nearly six times more likely to have administrative abilities than those working in hospitals (65.8 percent versus 11.7 percent in hospitals)
  
  
• "The Future of Nursing: Leading Change, Advancing Health" (IOM, 2011) and theNLN Vision, "Academic Progression in Nursing Education" (2011) clearly state that in order to respond to the increasing demands of health care reform, nurses must achieve higher levels of education and training through an innovative education system that promotes seamless academic progression. The IOM report also notes that nurses who enter the profession with either an associates degree or baccalaureate degree, on average, seek one more degree over the course of their career. This finding relates to LPN/LVN graduates as well. According to the NCSBN practice analysis (2009), approximately 25 percent of LPN/LVN responders reported enrollment in an RN education program. Of this group, 80.5 percent were in associate degree programs, 13.7 percent in baccalaureate programs, and 4.9 percent in diploma programs. At this time, one quarter of the LPN/LVN graduates seek RN licensure; new models of academic progression that consider LPN/LVN to BSN and higher degrees are strongly needed in order to move all prelicensure nursing graduates to advanced degrees more efficiently and with less cost. 
  
  
• LPN/LVN programs contribute to diversity of the nursing workforce. A one-year program provides an open door for many community members who may have difficulty gaining entrance to an RN program or affording the initial step. According to the National League for Nursing (2009), African-American enrollment in LPN/LVN programs is 21.8 percent. This percentage exceeds all other prelicensure minority access data: African-American enrollment in BSN programs are 14.0 percent; diploma programs, 17.8 percent; ADN programs, 13.9 percent; BSRN, 13.6 percent; masters programs, 12.7 percent; and doctoral programs, 11.3 percent. Additionally, medics returning from active duty can initiate a civilian nursing career as an LPN/LVN in some states. These data support the need for LPN/LVN career pathways to contribute to the diversification of the nursing workforce.

Recommendations

For the Nursing Education Community

• Facilitate discussions among faculty, students, practice partners, and other stakeholders across the nursing education and health profession communities to model a culture of inclusivity, mutual respect, and collaboration.
  
  
• Create seamless cost effective career pathways (LPN/LVN to BSN, LPN/LVN to MSN) by aligning with RN and postlicensure programs creating dual enrollment opportunities and using the NLN Education Competencies Model (2010) to promote academic progression.
  
  
• Refocus the LPN/LVN curriculum to concentrate on gerontology; supervisory concepts in skilled care and community-based settings (independent, assisted, and skilled care); and enhanced assessment skills, particularly related to commonly occurring hospital readmission rates from skilled care and home care.
  
  
• Create opportunities for interprofessional and intraprofessional educational opportunities.
  
  
• Create strategies to increase diversity in practical nursing schools enrollment; mentor this group to continue on the career pathway to RN.

For Practice Partners

• Begin dialogue with LPN/LVN regional faculty to initiate access to clinical sites, including specialty sites such as maternal and child health and psychiatry, and community-based health care settings.
  
  
• Create and engage in professional development and educational progression opportunities inclusive of all levels of nursing education, when applicable.
  
  
• Help to establish work environments that are conducive to positive collegial relationships among all nurses and interdisciplinary staff.

For the National League for Nursing

• Engage in nursing research, inclusive of LPN/LVN-related issues, specifically to advance the science of nursing education to increase retention of LPN/LVN students and promote academic progression. 
  
  
• Provide opportunities for educators from all types of nursing education programs to work collaboratively on projects aimed at transforming nursing education. Promote the development and validation of new educational approaches, emphasizing critical decision-making in response to the LPN/LVNs emerging role in sub-acute, skilled care and home care. 
  
  
• Promote research and development on intraprofessional and interprofessional education of nurses and projects that evaluate the impact of skill mix and the impact on quality care.
  
  
• Explore with the National Student Nurses Association (NSNA) the option of including LPN/LVN students in their organization)

Colleagues, these are our thoughts at this point, please join us in this dialogue and of course, the reflection…

1. How can faculty across the nursing education academic spectrum create a culture of inclusivity and respect within our profession that includes the LPN/LVN as a vital member of the nursing community, serving as a model for others in health care?
   
   
2. In what ways can the nursing education community develop seamless career pathways for LPNs/LVNs to move to professional practice models?
   
   
3. What will it take to build more collaborative bridges among all types of nursing education programs for the purpose of advancing the nations health?

A related news release can be found atwww.nln.org/newsreleases/pnvn_refl_dial_090711.htm

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References

Barry, D. (2010, December 31). Boomers hit new self-absorption milestone: Age 65.New York Times. Retrieved from www.nytimes.com/2011/01/01/us/01boomers.html?_r=1&pagewanted=all

Institute of Medicine. (2011). The future of nursing: leading change, advancing health. Washington, DC: Author.

Jencks, S., Williams, M., & Coleman, E. (2009). Rehospitalizations among patients in the Medicare Fee-for-Service Program. New England Journal of Medicine, 360(14), 1418-1428. 

National League for Nursing. (2010). Outcomes and competencies for graduates of practical/vocational, diploma, associate degree, baccalaureate, masters, practice doctorate, and research doctorate programs in nursing. New York: Author.

National Council State Board of Nursing. (2010). 2009 LPN/VN practice analysis: Linking the NCLEX-PN examination to practice. Retrieved fromwww.ncsbn.org/359.htm

National Council State Board of Nursing. (2010). Member board profiles. Retrieved from www.ncsbn.org/983.htm.

National League for Nursing. (2009). A commitment to diversity in nursing and nursing education [Reflection and Dialogue]. Retrieved fromwww.nln.org/aboutnln/reflection_dialogue/refl_dial_3.htm

National League for Nursing. (2010). Percentage of minority students enrolled in nursing programs: 1989-90 to 1994-95, 2004-05, and 2008-09. Retrieved fromwww.nln.org/research/slides/topic_nursing_stud_demographics.htm

National League for Nursing. (2011). Academic progression in nursing education [NLN Vision Series]. Retrieved fromwww.nln.org/aboutnln/livingdocuments/pdf/nlnvision_1.pdf

National League for Nursing. (2011). Caring for older adults [NLN Vision Series]. Retrieved from www.nln.org/aboutnln/livingdocuments/pdf/nlnvision_2.pdf

Seblega, B., Zhang, N., Unruh, L., Breen, G., Seung C., & Wan T. (2010). Changes in nursing home staffing levels, 1997 to 2007. Medical Care Research and Review,67(2), 232-246.

US Department of Labor Bureau of Labor Statistics. (2008). Employment Projections Program, 2008-18 National Employment Matrix. Retrieved fromwww.bls.gov/emp/empiols.htm

US Department of Labor Bureau of Labor Statistics (BLS). (2010). Occupational outlook handbook (OOH), 2010-11 edition. Retrieved from www.bls.gov/oco