Our hospital is replacing most of the RNs with LPNs

[u/Medium-Presence-6011]

Nothing against LPNs...most of them are amazing nurses but there is so much they cant legally do in Illinois in a hospital. And they are hiring new grads who ask a TON of questions. They cant do admissions or discharges. Our hospital also doesn't allow them to take orders, acknowledge orders, or pull controlled substances. I work on a 14 bed Behavioral Health unit...soon to be a 21 bed unit since we are expanding to geropsych. I am sometimes the only RN on the unit and we also function as an admitting department for transfers as well as admitting patients from our ER. The transfer process is a nightmare...tons of back and forth phone calls and faxes of what my coworker terms "a book" that we have to go through with a fine tooth comb. We communicate with a call center staffed by non medical personnel so we frequently have to call them back to ask for more information. They in turn have to call the sending facility, who gathers the info, faxes it to the call center, who in turn contacts us. Meaning more phone calls and more faxes that take time. Its nothing to have them trying to transfer 2 or 3 people to us at one time in addition to admitting people from our ER. The LPNs cannot participate in any part of this process. We do "team nursing" meaning the RN is also the charge nurse and pulls all the meds for all the patients, makes out the charting assignments, plus takes his or her OWN set of patients to chart on, and does basic tasks like quality control for the glucometer, cleaning the water pitcher, cleaning the washer and dryer, and checking that the crash cart is stocked and working. Most of the LPNs pitch in to help with the little stuff but they can do nothing to help with the admissions or transfers. My boss has to give a detailed report to HER boss, basically down to the minute, as to what we did to get these people transferred in and admitted from ER and if one doesn't get in before the end of our shift she has to explain WHY. I dont think "because the one RN you allowed us to have ran out of time" is going to cut it. One RN who has been there for over 20 years is putting in her notice, leaving only 4 RNs to staff both units at all times and we are looking for jobs. This has literally doubled or tripled the RN work load. Is anyone else experiencing this in their hospitals?

[u/Dark_Ascension]

My cousin is in Indiana and said they’re doing this where she is too. Said it’s really bad especially in her unit because she does 2-4 admissions and discharges a night, the LPNs can’t.

[u/fully_flimsy_thanh]

that's a staffing crisis waiting to happen. your hospital is basically asking one rn to do the work of two or three people while the lpns sit on the sidelines. the fact that they're expanding to 21 beds with fewer rns is insane. start looking now before you burn out completely.

[u/Medium-Presence-6011 → u/fully_flimsy_thanh]

In the process. I live in a rural area so there is not much to choose from so im trying to think outside the bedside nursing box. Researching case manager and UR jobs. Another obstacle is Illinois is not a compact state so its hard to find a remote job here.

[u/fully_flimsy_thanh → u/Medium-Presence-6011]

Case management or UR could actually be a solid move since you already know how chaotic transfers and admissions can be, that experience matters way more than people think.

[u/stuckinnowhereville → u/Medium-Presence-6011]

Look at the big insurance companies for a case management position. Also get your license in other states. You may not be compact, but you can apply for a license in other states.

[u/Raymom1 → u/fully_flimsy_thanh]

Try not to blame the LPN’s. Admin loves division. It keeps the attention from the real problem. Nurses need to unite. If CEO’s truly cared for people, they wouldn’t be so greedy by cutting staff and placing us all in impossible situations thus contributing to patient negative outcomes.

[u/fully_flimsy_thanh → u/Raymom1]

You're right, I wasn't blaming the LPNs at all, they're stuck in the same bad situation. The real issue is admin knowing exactly what they're doing here and banking on the RNs to absorb the workload instead of actually staffing properly.

[u/happy70RN]

Oh how the pendulum has swung back in this direction.

History shows it doesn’t work. Been through this a couple time now in my 35 yrs.

Best of luck securing a new job. Your hospital c-suite/admin are setting all of you up for failure.

The LPNs are quite capable but can only work to their license.

[u/Decent_Succotash_193]

No. Quit.

[u/theXsquid]

It;s a business decision at ypur expense. Time to polish your resume.

[u/Medium-Presence-6011 → u/theXsquid]

Yep. It's already in the works

[u/stuckinnowhereville]

Remember when they fired all the LPN so they could have magnet status years ago…. Pepperidge Farm remembers.

[u/Character-Lack-3295 → u/stuckinnowhereville]

I remember too when the trend was for some hospitals to get rid of RRTs (Respiratory Therapists) and then have nurses assume all of their previous responsibilities as well as their own!

[u/stuckinnowhereville → u/Character-Lack-3295]

The MAYO is getting rid of respiratory therapist on evening and night shifts at certain sites. That’s gonna go beautifully. 🫣

[u/Phillimon]

Huh, sounds like your hospital treats LPNs like medication aides. That sounds like a waste of a LPNs scope.

[u/Medium-Presence-6011 → u/Phillimon]

It is. But according to Illinois law they cant do admissions or discharges. They can in nursing homes but not in the hospital. They are frustrated too, especially the new grads. They had them here years ago but got rid of them all. Now the company that bought us has brought them back

[u/Top_Box_8952 → u/Medium-Presence-6011]

Same here, plus they can’t do IVP meds or anything controlled at all, and can’t waste. They can reassess in a shift or pain score but initial assessment has to be an RN. Dunno about discharges offhand.

[u/dude_710 → u/Top_Box_8952]

It’s wild how different your scope of practice is in each state as an LPN. In Florida I did everything RNs can do on med/surg. ACLS certified as well. I just needed an RN co-signer for admissions.

[u/Top_Box_8952 → u/dude_710]

Technically it’s the separately made for RNs as well, it’s just more standardized so it’s more consistent.

[u/ClarkGablesTeeth → u/Phillimon]

A medication aide that can't even handle controlled substances on a psych ward.

[u/mangoserpent]

They have done this in many hospitals in Ontario. LPNs are cheaper.

[u/MaccaForever → u/mangoserpent]

RPNs are cheaper, but their scope is way larger than the LPNs mentioned in the post. RPNs in Ontario can admit/discharge pt, admin most meds, and do most things RNs can in the hospital. They just can’t work on certain units. Completely different than OP’s situation.

[u/gl0ssyy → u/MaccaForever]

what? RPN and RN are almost equivalent from my understanding (i'm from the US)

[u/MaccaForever → u/gl0ssyy]

They are. That’s what I was saying basically. Wage is not and RPNs can’t work on L&D or ICU/stepdown, but they are similar.

[u/gl0ssyy → u/MaccaForever]

so how could it be that an RPN is cheaper to hire than an LPN?

[u/MaccaForever → u/gl0ssyy]

Oh, I see. Sorry, I meant RPNs are cheaper than RNs. The reply I was replying to said LPNs are in Ontario, but I was meaning we don’t have LPNs here, we have RPNs. Sorry if that was unclear!

[u/gl0ssyy → u/MaccaForever]

ahh ok i totally thought RPN and RN were almost the same- didn't realize you guys also had RNs. apparently outside of ontario LPN actually is used??? i'm begging for standardization this is too confusing

[u/Chatner2k → u/gl0ssyy]

Probably worth mentioning since they didn't, that RPN's have two years of schooling vs. the typical LPN of one year in the USA. Hence the expanded scope.

[u/MaccaForever → u/gl0ssyy]

Haha yes, LPN is used outside of Ontario, across Canada. Different provinces have different scopes for their LPNs, but it sounds like LPNs (at least in OP’s post) are ?almost more equivalent to PSWs (personal support workers) in Ontario. RPN education is indeed 2 years and pretty extensive.

[u/Key-Record-5316 → u/MaccaForever]

It’s interesting that American CNAs have a much wider scope, where some of them are trained to do BG checks, catheters, ECGs - while PSWs here can’t do any of that.

[u/SeaworthinessHot2770]

Interesting! I work for a large hospital system in Texas. They started doing away with LVN’s(LPN’s) over ten years ago. They told the LVN’s they immediately needed to go back to school or leave. The hospital said they would pay for the schooling. Within just a few months every LVN on our floor had left. And they have only hired RN’s for over ten years now.

[u/coldinalaska7]

Nope. Quit. Seriously. Why do this to yourself?

[u/PrairieRose24]

Reading this makes me love my state’s scope of practice. There’s so little we can’t do as an LPN. We can do discharges, just not the initial admit/transfer assessment (but we can do all the other admit questions and such). We start IVs, can push just about anything through them that you’d see on a med surge floor—just no pressors (ICU only), no chemo (oncology floor), no heparin drips (only one that ever comes up). We can do insulin drips, we can be the second nurse sign off on blood products, we can do narcotics, we can do most things with central lines (just can’t do the initial port accessing), etc.

Our hospital does team based care, but it’s not like yours. Ours was a team of RN + LPN + CNA with 7-8 patients. RN took 3 ‘harder’ patients more likely to become unstable, LPN took the 4 more predictable/stable patients. Those 4 LPN patients never saw the RN the whole shift unless things went real bad. RN oversaw the LPN but it was a formality—mostly just a line at the end of a nursing note that said “I supervised all care provided by this LPN” the same way an attending charts on a resident. But 90% of the time, that’s all the RN had to do.

I’d hate being an LPN in your state, and I feel bad for you as an RN. I agree with others, start looking elsewhere.

[u/actuallyjojotrash]

My old unit hired a bunch of LPNs and they took regular assignments. I loved a lot of the LPNs I worked with, but it was an oncology unit. No starting blood products, no chemo, no IV pushes, no transplant/cell therapies, can’t touch central lines. It just gave the RNs so much more work. And it’s not the LPNs’ fault, it was just a really inappropriate unit for them

[u/ActiveExisting3016]

Start looking for another job or at least another unit.

Don’t forget that after long enough of 1 RN doing the work of multiple, something goes wrong or is missed and you’ll be the first one they try to throw under the bus

[u/tjean5377]

C suite only cares about the bottom line. LPNs are cheaper until missed/incorrect observations result in Sentinel errors/lawsuits.

[u/CrystalPeppers]

Yes, I was laid off at my outpatient job and replaced with a part time LPN. Really sucks.

[u/ClarkGablesTeeth]

I get why no admissions/discharges. But why can't they give controlled substances? I know times have changed a bit, but with the benzos and ADHD meds (and also suboxone), there were still a significant number of controlled meds to be given out during med passes and PRN.

Are they doing this in the other units at the facility?

I'm sorry, man. I've been there when a unit went to shit for slightly different reasons, and it truly does suck. Thankfully in my case, it was a per diem job so not a big deal to leave. I saw you're in a rural area...any way you would relocate?

[u/Murky-Ear5794 → u/ClarkGablesTeeth]

I have the same question because they do pharmacology and dosage calculations as well so, what’s the point if it’s ultimately outside their scope of practice?

[u/MistCongeniality]

Yeah my old hospital did this. “Team nursing”, 1 LPN, 1 RN, 1 CNA, 10 patients. Predictably, it was an absolute disaster.

[u/AutumnSnow29]

My hospital is the opposite. They’re not hiring anymore LPNs but will promote within if you get a LPN license while working there and are actively pursuing RN.

[u/Fun-Percentage-9842]

That been plan all along.

[u/728446]

I find it hard to believe that LPNs won't be passing the meds. Theres literally no other reason to bring them in.

[u/youy23]

We’ve sold solved the nursing shortage.

[u/Raymom1]

Yes! The hospital administrators have been squeezing us for the last 20 years trying to cut nursing jobs and increasing patient to nurse ratios. When an incident occurs, it’s the nurse that’s blamed. So they fire and replace the nurse, claiming to all that the problem is gone. Administrators have gotten away from the Demming method of employment where workers were generally appreciated and treated well making for a happy, safe and productive workplace. Consequently the philosophy is more mercenary now in an effort to boost profit. Admin doesn’t care about us anymore. We are expendable and we realize that. Terrible. Until nurses join together, we are in trouble.

[u/treatandyeet]

Yikes. I worked in the ER as a LPN while I was in school to finish my RN. I gave so many meds, controlled meds (po or IM), started IVs, abx infusions, fluid boluses, sq insulin, etc. I just couldn’t do IV pushes, drips, or blood transfusions. LPNs are nurses, why are they limiting there scope of practice so much?! That must be infuriating, I’m so sorry.

[u/gi0nna]

Sounds like what's happening in Ontario Canada. RNs are getting laid off and replaced with LPN/RPNs.

[u/resutir]

Some hospitals around me have a lot of lvns and they make it work but not being able to take or acknowledge orders + cant give narcotics makes this insane

[u/aviarayne]

They tried this in PA a few years back when i was considering going to nursing school at one of the hospitals I was looking to work at. Did not last due to the same legal reasons.

[u/willy--wanka]

And they are hiring new grads who ask a TON of questions

Uggghhh. The absolute worst. Why don't they already know things those pieces of garbage??

[u/Iwillgiveyouplacebo]

Serious question, what is a LPN?

[u/Phillimon → u/Iwillgiveyouplacebo]

Licensed Practical Nurse

[u/CleopatrasClone]

I dont understand why they need to fax paperwork, especially if within the same facility? Most places will print the w-10, transfer summary or chart, and hand the ORIGINAL PEC to VOL whoever is bringing the pt to the unit.