In recent years, nurses have started speaking out against unsafe staffing ratios and asking their leaders for support. Employees at some facilities have even formed new unions and gone on strike in an effort to affect change.
Staffing problems in healthcare are a major concern among organizations across the nation, and nursing shortages are expected to last until at least 2036.
The nationwide nursing shortage is caused by a high percentage of nurses reaching retirement age, too few new nurses entering the profession, and many nurses choosing to leave the profession due to burnout and stress.
Hiring licensed practical nurses (LPNs) is an excellent option for healthcare organizations to improve their staffing ratios without exceeding budget restrictions.
While LPNs do not have the same scope of practice as registered nurses (RN), they can still perform many patient care tasks. LPNs can check vital signs, administer many medications, perform dressing changes, reposition patients, manage feeding tubes, document procedures, and much more, allowing RNs to focus on more critical tasks.
Let’s take a look at how LPNs can help healthcare organizations provide more efficient and effective care.
The New Care Model: Why LPNs are on the Rise
Nursing shortages have been a threat to patient safety and hospital sustainability for many years, but the problem was exacerbated by the COVID-19 pandemic. Even now, after the pandemic has subsided, hospitals struggle to maintain adequate nursing staff.
A survey published in 2021 by the Journal of Nursing Regulation indicated that over one-fifth of nurses planned to retire within five years. In addition, many registered nurses in the 25-35-year-old age range are leaving the profession to pursue a higher education or leave healthcare completely. They often cite burnout, schedules, feeling unappreciated, and frustration with staffing ratios as reasons for quitting their jobs.
Most healthcare organizations use an RN model, where one registered nurse is responsible for the care of multiple patients. This model Relying on RNs as opposed to LPNs began in 1990 when hospitals started requiring all nurses to obtain higher levels of education in order to reach magnet status. Continuing the RN model of care would require an estimated 1.1 million additional nurses by the year 2030.
Many healthcare organizations are considering or have already changed their model of care to include LPNs. This healthcare model allows the LPN to work under the direction of a physician or registered nurse to care for more stable patients or complete tasks delegated to them. Not only does this lighten the workload of the RN, but it also improves patient care and encourages teamwork across the organization.
How LPNs Can Help Healthcare Organizations Provide Better Care
LPNs have become less common in many hospitals and other acute care areas in the last decade, but now may be the time to invite them back.
There are several proven benefits to utilizing LPNs in addition to RNs and CNAs in patient care areas, including:
1) Alleviate RN Workload
LPNs typically complete one or more years of higher education and have a good understanding of basic physiology, medication administration, and patient care. While they cannot replace RNs, LPNs can make significant contributions throughout the workday.
LPNs can manage more complex tasks than nursing assistants and can complete many time-consuming patient care tasks, such as dressing changes, blood sugar checks, and measuring vital signs.
This frees up the RN to focus on more critically ill patients or patients who need more education.
2) Increase Patient Contact
A study conducted in 2011 showed that nurses typically performed over 70 tasks every hour while they were at work.
Though they were almost constantly moving from task to task, only 37% of their time was spent in direct patient care. Nurses spend large chunks of their day documenting, coordinating care, looking for supplies, and dealing with interruptions.
Adding a few LPNs to handle some of these responsibilities would significantly increase the time nurses can spend in the direct care of patients.
3) Decrease Response Times
Research into the use of call light systems and nursing response times shows that the average call light is answered in about 9 minutes. These long response times are almost always caused by understaffing and nurses with busy workloads.
Since most patients use their call lights when they need assistance with toileting, self-care activities, and comfort, the LPN can often manage requests without the RN's help or supervision.
4) Improve Staff Morale
Many nurses find that the morale of the entire team improves with the addition of LPNs. Not only do they help reduce the workload for other staff members, but they are often excited to have the opportunity to work in more fast-paced acute care environments, and that excitement is infectious.
Many nurses become LPNs during their years in school to become RNs. LPNs in school are often highly motivated to learn, help out, and make a good impression in the hopes of being later hired as RNs.
5) Improve Patient Safety
Adequate staffing levels are strongly associated with better nursing-specific patient outcomes, including length of stay, readmission risk, medication errors, failure to rescue, pneumonia, deep vein thrombosis, infection, and falls.
6) Improve Patient Satisfaction Scores
Adding capable LPNs is a great way to improve patient satisfaction scores. Because having enough nurses is associated with faster call-light response times, less nurse burnout, better outcomes, and more patient contact hours, patients are sure to feel more cared for, heard, and protected.
7) Reduce Costs
While hiring more staff sounds expensive, adding a few LPNs to a team may actually reduce overhead over time.
LPNs should not completely replace RNs in most situations, but organizations may be able to use a combination of LPNs and RNs. The benefits of adding more qualified staff members to your team are well worth the cost.
Staffing hospitals at an average of 4:1 patient-to-nurse ratio could save millions, if not billions, of dollars in healthcare costs each year. Of course, this varies based on patient acuity and the number of LPNs and RNs.
LPN Scope of Practice: What They Can & Can’t Help With
If you choose to hire LPNs, it is important to establish clear guidelines about what you would like the LPNs to help with. Each state varies slightly in its LPN scope of practice laws, and organizations are responsible for ensuring that all of their nurses follow these laws.
The typical scope of practice of an LPN includes performing tasks like:
- Monitoring patient vital signs
- Assisting with daily activities
- Dressing wounds and changing bandages
- Collecting patient health information
- Observing and reporting symptoms
- Preparing patients for procedures
- Maintaining patient medical records
- Supporting RNs and doctors in other ways
While LPNs can perform many of the same patient care tasks as RNs, there are a few that they are typically not allowed to perform. These include:
- Giving IV medications
- Educating patients and family members
- Performing admitting assessments
- Managing central lines
- Giving chemotherapy medications
- Interpreting vital signs
- Delegating tasks to other members of the team
- Administering blood products
Examples of Healthcare Organizations Introducing LPNs
Integrating LPNs into your healthcare team can be a challenge. Looking at examples of how other organizations have made it work can help you make a plan for your organization.
The following are examples of organizations that have successfully introduced LPNs into their healthcare model:
Trinity Health
Trinity Health uses a combination of virtual care, registered nurses, certified nursing assistants, and licensed practical nurses to provide care for their patients.
In their model, onsite RNs, LPNs, and nursing assistants perform tasks and take direct care of the patients while a registered nurse monitors the patient over video and is available to address questions or concerns.
The virtual nurse can also monitor patient vital signs, check laboratory results, and coordinate care. These nurses allow LPNs and new graduate nurses to have the extra support they need while making meaningful contributions to the team.
The Department of Veterans Affairs
The Department of Veteran Affairs has transitioned back to a team model of nursing care where RNs delegate tasks to LPNs and supervise.
Because LPNs have a narrower scope of practice than RNs, leaders at the Department of Veteran Affairs are careful to clarify the responsibilities of each position.
VA hospitals recognize LPNs as valuable members of the team and attract them by offering tuition reimbursement and retention bonuses.
Dartmouth Hitchcock
Dartmouth Hitchcock has partnered with nursing schools like River Valley Community College to educate LPNs and integrate them into their teams.
LPNs at Dartmouth work in the emergency departments, neurovascular units, and inpatient surgery centers. Allowing LPNs to work in some of these more acute settings incentivizes them to choose Dartmouth over other hospitals.
Many LPNs working on these teams work as LPNs while still in school to become RNs. By offering a chance to work as LPNs and offering tuition reimbursement, Dartmouth Hitchcock can use LPNs as support staff while working towards reducing RN shortages in the future.
Canadian Hospitals
Canadian Community Hospitals
Two Canadian Community Hospitals use a ratio of 80% RNs to 20% LPNs during the day shift to ensure safety while reducing the workload of nursing staff. They also widened the scope of practice for their LPNs, giving them more autonomy and the ability to perform higher-level tasks.
While expanding the scope of practice for LPNs is controversial, it solves the problem of having too few nurses working on a unit. Hospitals that implement this caring model must ensure that the LPN feels comfortable asking for help and turning down patient assignments that are more complex than they are able to manage.
Finding Success Integrating LPNs to Your Healthcare Team
Integrating LPNs into your healthcare team may not be easy. Some nurses and other staff members may be resistant to the idea. Successfully making a change and reorganizing your team's structure will require great communication and leadership.
Here are some tips for integrating LPNs into your healthcare team:
1) Emphasize Respect for all Team Members
As a leader of your team, ensure that you enforce a zero-tolerance policy for disrespect or put-downs.
RNs may be tempted to talk down to or dismiss LPNs, which discourages collaboration, negatively impacts team morale, and decreases confidence in the entire team.
Set an example of listening to the opinions and ideas of every team member, regardless of the license or certification they have earned.
2) Clarify the Scope of Practice Laws
Because each State has a different set of rules for LPNs, you will have to do your research and make sure that your nurses are aware of what does and does not fall under their scope of practice.
All LPNs and RNs should be trained to understand how to work within the law and protect their patients and licenses.
3) Define Roles and Responsibilities
Failure to define responsibilities is sure to lead to unmet expectations, disappointment, and resentment.
Before you integrate LPNs into your team, clarify each team member's responsibilities and establish a clear chain of command for dealing with problems that may arise.
Do not expect your nursing team to work together seamlessly without a lot of guidance, especially in the beginning. As relationships develop, nurses will naturally start to divide up tasks in a way that works for them.
However, when establishing a new system, clear definitions of responsibilities make it easier for everyone to work together.
4) Allow Staff to Participate in Planning
Adding LPNs to your team will be a big change for your staff.
Nurses and assistants working on the floor can offer a unique perspective on the challenges your organization may face when changing up the structure of your team.
Allow nurses to share their ideas and voice their concerns before deciding on an action plan.
5) Give LPNs Patient Assignments
LPNs who are not given patient assignments often feel like they are simply highly paid nursing assistants and quickly burn out or look for a new place to work.
Encourage your managers or charge nurses to give LPNs appropriate patient assignments, allowing everyone to practice at the top of their license.
6) Encourage Teamwork
Many units that have successfully integrated LPNs into their healthcare team have done so by using a buddy system. Pairing an LPN with an RN ensures that each person has a partner at work, someone to rely on, encourage, and ask for help.
Having a quick check-in at the end of each work week can help you address problems within the LPN-RN relationship before they fester and lead to hurt feelings. Make sure that everyone knows they are a valued member of the team and that their input is taken into consideration.
7) Offer Incentives
Because LPNs are not paid as much as RNs, it can be a challenge to recruit and retain them. Offering incentives to LPNs like tuition reimbursement can help you hire and keep good employees who are motivated to learn and grow.
Other incentives might include sign-on bonuses, retention bonuses, PTO beginning on the first day of employment, and competitive healthcare benefits.
