“What MRP requires is that there is a role definition for all nursing staff members the hospital utilizes,” says Barbara J. Hannon, MSN, RN, CPHQ, MRP director in the department of nursing at the University of Iowa Hospitals & Clinics. “If you utilize LPNs in a caregiving role in your institution, you must define how this level of provider fits into your care delivery system. MRP hospitals use all kinds of health delivery models, but each one must be laid out in your documentation, along with how each role is filled and how you utilize the State Board of Nursing to define the health delivery roles.”
“As our patients get sicker and medical care, nursing care, and treatment get more complex, this mid-level provider (LPN) role is not cost effective because there are so many things the state boards of nursing restrict them from doing,” Hannon says. “Because there are so many things they cannot do, our LPNs are included in the unlicensed personnel count. We have to have a full complement of RNs anyway, so it becomes difficult to find a role for them in a hospital with such complex patients as ours to find them something they can do independently.”
This restriction of practice is the biggest reason LPNs are being cut at acute care hospitals. State boards of nursing decide the scope of practice for RNs and LPNs, restricting who may provide nursing assessment and nursing diagnostic decisions. Many states restrict LPNs from dispending medication.
One organization that has successfully moved away from LPNs is North Shore-LIJ, a 15-hospital health system in New York, which dispensed with them in the late 1990s.
“We realized that the acuity of patients in the acute care setting was increasing and that those patients required much more assessment,” says Maureen White, RN, senior vice president/CNO. “We would not be able to rely on LPNs for delivery of those care needs. We assessed it and felt that hiring LPNs in acute care settings would not be advantageous to the delivery of care that we need to deliver.”