Licensed practical nurses (LPN's) help care for the physically or mentally ill and infirm. Under the direction of physicians and registered nurses, they provide nursing care that requires technical knowledge but not the professional education and training of a registered nurse. In California and Texas, licensed practical nurses are called licensed vocational nurses.
In hospitals, LPN's provide bedside care. They take and record temperatures and blood pressures, change dressings, administer certain prescribed medicines, and help patients with bathing and other personal hygiene. They assist physicians and registered nurses in examining patients and in carrying out nursing procedures. They also assist in the delivery, care, and feeding of infants, as well as in the rehabilitation of patients. Some licensed practical nurses work in specialized units such as intensive care or recovery rooms. There they perform special nursing procedures and operate sophisticated equipment to provide care for seriously ill or injured patients. In some instances, experienced LPN's supervise hospital attendants and nursing aides.
LPN's who work in private homes provide day-to-day patient care that may involve nursing treatments and use of technical equipment. In addition to providing nursing care, they may prepare meals, see that patients are comfortable, and help keep up their morale. They may teach family members how to perform simple nursing tasks.
In doctors' offices and in clinics, LPN's prepare patients for examination and treatment, administer medications, apply dressings, assist the physician in selected procedures, do some laboratory work, and teach patients prescribed health care regimens. They also may make appointments and record information about patients.
Licensed practical nurses in hospitals generally work 40 hours a week, but often this includes some work at night and on weekends and holidays. They often must stand for long periods and help patients move in bed, stand, or walk. They must be able to handle the emotional stress involved in working with sick patients and their families.
In private homes, LPN's usually work 8 to 12 hours a day and go home at night. Private duty nursing affords a great deal of freedom in setting work hours and the length and frequency of work assignments.
Licensed practical nurses held about 626,000 jobs in 1989. About half of all L.P.N.'s worked in hospitals and one-fifth worked in nursing homes. The rest worked in a variety of settings, including doctors' offices and clinics and for temporary help agencies.
Some LPN jobs are held by private duty nurses. These LPN's are either self- employed, in which case they are hired directly by patients or their families, or they are employees of a nurses' registry or temporary help agency. About a quarter of all LPN's work part time.
Training, Other Qualifications, and Advancement
All States and the District of Columbia require practical nurses to have a license. To become licensed, applicants must complete a State-approved program in practical nursing and pass the national written examination. Educational requirements for enrollment in State-approved training programs range from completion of ninth grade to high school graduation, but a high school diploma is usually preferred.
Trade, technical, or vocational schools offered more than half of these programs. Other programs were available at community and junior colleges, hospitals, and health agencies. Several programs operated by the Armed Forces for military personnel were State-approved for practical nurse training. Graduates of these programs can apply for licensure.
Practical nurse training programs generally last 1 year and include both classroom study and clinical practice. Classroom instruction covers nursing concepts and principles and related subjects including anatomy, physiology, medical-surgical nursing, pediatrics, obstetrics, psychiatric nursing, administration of drugs, nutrition, first aid, and community health. In addition, students receive supervised clinical experience--usually in a hospital. LPN's should have a deep regard for human welfare and be emotionally stable because work with the sick and injured can be upsetting. As part of a health care team, they must be able to follow orders and work under close supervision.
Advancement opportunities are limited, although in-service educational programs prepare some LPN's for work in specialized areas, such as postsurgery recovery rooms or intensive care units.
Increasingly, however, practical nurse training programs are designed to allow practical nurse graduates to continue their education and eventually satisfy the formal requirements for registered nurse. For example, in over 80 associate degree RN programs, the first year of study satisfies the educational requirements for LPN. After this first year of study, students can apply for licensure as a practical nurse and begin working, or they can complete both years of coursework and seek licensure as a registered nurse.
Employment of LPN's is expected to increase much faster than the average for all occupations through the year 2000 in response to long-term care needs of a growing and aging population (those 75 years and over) and to the general growth of health care.
The emphasis of American medicine on acute care and high technology has already had the effect, over the past decade, of restraining employment growth in practical nursing. This trend is expected to continue. It will shift more and more LPN jobs to nursing and personal care homes, psychiatric hospitals, private duty nursing, and other settings where care and treatment is less technologically oriented.
Widespread use of sophisticated medical technologies has produced a demand for highly skilled support staff. In academic medical centers, teaching hospitals, and other institutions where the most advanced technology is in place, registered nurses, physician assistants, and health technologists are sought for the additional training these positions generally require; LPN's are being phased out.
Efforts to restrain the increase in health care costs are likely to limit job growth for LPN's. The trend toward less costly outpatient care is expected to affect staffing patterns in hospitals, for example, dampening demand for both LPN's and nursing aides. In addition, opportunities for LPN's in the rapidly growing outpatient care sector may be fairly limited, since health maintenance organizations, clinics, and urgent care centers generally prefer to hire registered nurses.
In addition, home health agencies are expected to call upon the skills of personnel more highly trained than LPN's. Home delivery of complex treatments such as kidney dialysis, chemotherapy, antibiotic therapy, and intravenous nutritional therapy is expected to heighten demand for registered nurses--but not for LPN's--in many home health agencies. In addition, reimbursement policies favor use of registered nurses in formal home health care programs. A growing number of licensed practical nurses specialize in home care, but they generally work on a private duty basis, contracting directly with patients (or their families), or working through a nursing registry or temporary help agency.
The number of elderly and disabled persons in need of long-term care is rising rapidly. This will produce exceptionally rapid growth in the nursing home sector during the coming decade, spurring job growth for LPN's. Nursing home regulations encourage utilization of LPN's: States typically require specified levels of staffing by licensed nursing personnel in nursing homes, but do not distinguish between LPN's and RN's, except in the position of nursing director. This encourages facilities to hire LPN's since they are paid less than RN's. Taken together, industry growth and facility staffing patterns are expected to generate a substantial number of LPN jobs in nursing homes. Very rapid growth also is expected in the number of nonlicensed personal care facilities, which should produce additional job opportunities for LPN's. The number of LPN's in private duty nursing is growing rapidly as well. Overall, the 1990's will see the emergence of long-term care as a major area of employment for LPN's.
As in most other occupations, replacement needs will be the main source of jobs, despite the fact that LPN's show an unusually strong attachment to their field. Compared to workers in other occupations requiring a similar amount of training, LPN's are much less likely to transfer to other jobs. Individuals who stop working as practical nurses tend to stop working altogether. LPN's not currently active in the field thus augment the supply of approximately 40,000-45,000 persons who complete formal training programs each year.
Median annual earnings of LPN's who worked full time in 1990 were about $18,500. The middle 50 percent earned between $15,600 and $22,475. The lowest 10 percent earned $12,500, the top 10 percent earned more than $27,025.
LPN's in nursing homes had median annual salaries of $15,900 in 1990, according to a survey by the Hospital Compensation Service.
Starting salaries of LPN's employed in hospitals, medical schools, and medical centers averaged about $16,850 a year in 1990, according to a national survey conducted by the University of Texas Medical Branch. Experienced LPN's averaged about $22,700.
Many hospitals give pay increases after specific periods of satisfactory service. Paid holidays and vacations, health insurance, and pension plans are typical benefits provided by hospitals.
Other jobs that involve working closely with people while helping them include: Emergency medical technician, social service aide, and teacher aide.
Sources of Additional Information
A list of State-approved training programs and information about practical nursing is available from:
Communications Department, National League for Nursing, 10 Columbus Circle, New York, N.Y. 10019.
National Association for Practical Nurse Education and Service, Inc., 10801 Pear Tree Lane, Suite 151, St. Louis, Mo. 63074. For information about a career in practical nursing, contact:
National Federation of Licensed Practical Nurses, Inc., P.O. Box 11038, Durham, N.C. 27703.
Information about employment opportunities in Veterans Administration medical centers is available form local V.A. medical centers and also from:
Recruitment and Placement Service, Veterans Administration, 810 Vermont Ave. NW,, Washington, D.C. 20420.
For information on nursing careers in hospitals, contact:
American Hospital Association, Division of Nursing, 840 North Lake Shore Dr., Chicago, Ill. 60611.
For a copy of Health Careers in Long-Term Care, write:
American Health Care Association, 1200 15th St., NW., Washington, D.C. 20005.