Hospitals shifting from LPNs to RNs

The baby boomers are coming, and health care representatives know it.

Baby boomers are expected to live longer than their parents and, because of their advanced age, to have more - and more complicated - ailments.

That's one of the reasons WellSpan Health and some other Central Pennsylvania health systems and hospitals are reducing or eliminating their positions for licensed practical nurses (LPNs) in favor of registered nurses (RNs).

RNs perform more complex procedures than LPNs and have more decision-making power.

WellSpan's goal is to reduce its number of LPNs from 10.5 percent of its nursing workforce to 2.8 percent, or 33 positions, said Valerie Hardy-Sprenkle, vice president of patient care services for WellSpan. WellSpan runs York Hospital and Gettysburg Hospital. The health system has set targets on a unit-to-unit basis to determine which positions are slated to become RNs. 

She said research from Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania, and others shows that patient outcomes improve when the ratio of RNs to patients increases, but not when the ratio of LPNs to patients increases.

Pat Saunders, vice president of nursing for Hanover Hospital, said research is squarely on the side of increasing RNs.

"I think for anyone in an acute-care environment, the literature is absolutely clear that the better educated the professional staff, the better patient outcomes are going to be," she said.

Hanover Hospital is hoping to eliminate all of its LPN positions, which comprise about one-quarter of its nursing staff, within five years.

Lancaster General Hospital (LGH) also is gradually converting its 28 full-time, inpatient LPN positions to RN positions.  

These hospitals aren't laying off their LPNs to meet their goals, however.

"The LPNs that are here are going to remain - there's no risk to them," Saunders said.

The three hospitals are relying on a combination of attrition and programs designed to help LPNs earn RN certification.

LGH is not requiring its LPNs in inpatient care to become RNs, said hospital spokesman Kim Payne.

If one of the hospital's LPNs chooses to go back to school, LGH will provide tuition reimbursement of up to $300 per credit for undergraduate courses and up to $400 per credit for graduate courses. The hospital's college of nursing has created an LPN-to-RN curriculum as well.

At WellSpan, if LPNs are in positions slated to become RN jobs, WellSpan will pay their entire tuition as well as their regular salary and benefits while they work toward an RN certification, Hardy-Sprenkle said. LPNs can pick any school to pursue RN certification.

About 58 percent of the hospital's LPNs - 85 people  - are either enrolled or have completed the LPN-to-RN program since it began last January.

Demand for the program was so high, WellSpan had to draw up a schedule for phased enrollment or else some units would have been short-staffed.

"We are extremely pleased with the number of our LPNs who have chosen to go back to school," Hardy-Sprenkle said.

The five-year program will cost WellSpan $3 million, she said.

Since the program began, 9 percent of LPNs also have transferred somewhere else in the WellSpan health system, she said.

At Hanover, LPNs can get reimbursed up to $7,000 per semester for self-paced online RN courses through New York-based Excelsior College.

Hanover began its first cohort of 20 LPNs taking the courses together through Excelsior this past summer, Saunders said.

"There's no pressure," she said. "You're not in a position where if you don't get a degree, you're not going to have a job."

Cohort members meet regularly to compare notes and provide support to each other.
 
The long and shortage of it

So how does converting LPN positions to RN positions play out against the backdrop of Pennsylvania's nursing shortage?

In 2010, Pennsylvania will be short an estimated 12,000 RNs and 6,000 LPNs, according to the Pennsylvania Workforce Investment Board

"I think that different folks can give rationale to support either side of the debate about whether this would exacerbate the shortage," Hardy-Sprenkle wrote in an e-mail.

It takes two to four years of schooling on average to become an RN, versus one to two years to become an LPN, according to the U.S. Bureau of Labor Statistics' 2008-09 data.

RNs earn an average of $47,710 to $69,850, compared with $31,080 to $43,640 for LPNs, according to the bureau.

"We believe that the acuity and complexity of our patient population requires the knowledge and skill set of the RN, as the LPN has a significantly more limited scope of practice ... We also believe that the acuity and complexity will continue to increase, thus requiring even more RNs than we currently have in place," Hardy-Sprenkle added.

Saunders said she doesn't think converting LPN spots to RNs will worsen the shortage.

The economic downturn is encouraging more people to look for jobs in the nursing field, she said. Furthermore, Saunders said Hanover Hospital believes its LPN-to-RN program will improve patient outcomes and, by doing, so create a better working environment that attracts more RNs to the hospital.

Hardy-Sprenkle said WellSpan has roughly a 3.3 percent vacancy rate for RNs, while Saunders said Hanover's RN vacancy rate is less than 5 percent.

Part of WellSpan's low vacancy rate also is due to more nurses who had worked in Baltimore returning to the midstate, said Bonita Trapnell, director of clinical service, medicine for WellSpan.

LGH's RN vacancy rate is "low," Payne said, but he declined to specify a number.

Most of the growth in RN positions from 2006 to 2016 is expected to occur outside hospitals, according to the U.S. Bureau of Labor Statistics' 2008-09 data. That's because patient numbers aren't expected to increase much, the average length of a hospitals stay is decreasing, and people are increasingly choosing to have procedures on an outpatient basis, the bureau's Web site states.

RN positions in hospitals are expected to grow 22 percent from 2006 to 2016 versus 39 percent growth for RN positions in physicians' offices and in the home health care field, according to the bureau. 

Although their numbers in hospitals might be falling, LPNs are far from becoming obsolete.

The demand for LPNs is expected to grow, primarily in long-term care and as home health aides, according to the bureau.

For example, LGH is keeping its LPNs in the Dialysis Unit and IV Team, as well as with the Lancaster General Medical Group, Ambulatory Care Services and at the Lancaster Rehabilitation Hospital and Maple Farm Nursing Center.

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What's the difference?

Registered nurses (RNs) vs. licensed practical nurses (LPNs)

• RNs earn an average of $47,710 to $69,850, compared with $31,080 to $43,640 for LPNs.
• It takes two to four years of schooling on average to become an RN versus one to two years to become an LPN.

Source: U.S. Bureau of Labor Statistics' 2008-09 data

In Pennsylvania:

• LPNs are far more restricted in the procedures they can perform and in their allowed responsibilities. For example: 
• RNs are allowed to perform comprehensive assessments; LPNs only can collect data for the assessments to report to an RN.
• LPNs cannot intravenously administer blood, blood products or titrated medications and intravenous push medications other than heparin flush. RNs are allowed to do all of these things.
• RNs can give chemotherapeutic agents; LPNs cannot.
• RNs, provided they have been trained, can use monitoring, defibrillating or resuscitating equipment; LPNs cannot.
• An LPN works under the direction of an RN or physician, whereas a physician does not have to be present for an RN to provide care.

Source: Pennsylvania State Board of Nursing