Top 8 Challenges for an LPN
Patients rely on licensed practical nurses (LPNs) for emotional support and to help them with everyday functions. LPNs assist patients with tasks such as bathing, changing dressings, and walking. Registered nurses (RNs) also need LPNs to carry out care plans and document patient medical histories in nursing homes, hospitals, physicians' offices, and rehabilitation centers.
However, LPNs have a limited scope of practice compared to RNs. State regulations and workplace rules often limit what an LPN can do. While it takes less time to become an LPN than an RN, a major draw for busy professionals, the entry-level educational requirements often restrict LPNs and licensed vocational nurses (LVNs).
This LPN guide outlines the challenges that these nurses face, including demanding work environments, limited job advancement opportunities, salary caps, and nursing shortages.
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1. Experience vs. Education
LPNs almost always have less education than RNs. That does not mean LPNs lack experience, as many have worked for decades in nursing. They often work in specialty areas, such as respiratory and physical therapy. State regulations and workplace restrictions, including those established by the state's Nurse Practice Act, can limit the role of LPNs.
As an LPN, you have fewer opportunities for growth within your career, unless you invest in further training. This could potentially mean that even though you have been doing a certain job for decades, you may be managed by someone who has just become an RN. This can be frustrating when you have more experience.
Hospitals and other employers may regulate LPNs in their roles, even nurses with decades of experience. Because nursing places more value on education than experience, LPNs may work under less experienced RNs.
It takes a certificate, diploma, or associate degree to become an LPN. RNs can work with an associate degree but many hold a bachelor of science in nursing (BSN). Nursing organizations, such as the American Association of Critical-Care Nurses, recommend RNs hold at least a four-year degree.
2. Limited Job Outlook
The 9% projected job growth rate for LPNs matches the average occupational growth rate for all industries, according to the U.S. Bureau of Labor Statistics (BLS). While employers could add about 60,700 jobs every year, career growth within the LPN field remains limited without additional education.
Duties performed by LPNs vs. RNs depend on the setting and location. LPNs can gain experience giving medication and starting intravenous drips, tasks reserved for RNs in some states. LPNs can prepare for the clinical requirements needed to become an RN by performing duties typically done by registered nurses.
3. Demanding Working Conditions
As an LPN, you work shifts that are often long and at undesirable hours. You might work nights, weekends, and holidays. Unfortunately, the only way around that is employment in a private practice, which can be rare for an LPN, or to earn a higher degree.
Working as an LPN is also challenging on one's body. Many nurses who have worked for several years have problems with their backs and joints. This is because they spend most of their time bending, lifting, and being on their feet.
Likewise, LPNs work with hazardous materials. They may care for patients with infectious diseases, which are sometimes unknown. Furthermore, hospitals are breeding grounds for infections and other problems, including methicillin-resistant Staphylococcus aureus (MRSA), for instance. The risk of becoming infected is increased.
Radiation from equipment like X-ray machines puts nurses at risk, as do other hazardous materials, such as sterilizing substances and chemotherapy drugs.
4. Capped Wage Outlook
State regulations often place wage and benefits caps for nurses. Unions cannot negotiate higher salaries even when nurses have gained experience. Caps often mean LPNs have not seen wage increases in years, despite gaining more skills and training.
LPNs who have certificates or diplomas make an average annual salary of $43,000 as of June 2020, according to the Journal of Nursing Regulation, while those with an associate degree earn an average of $45,000 a year. Speciality areas offer some of the best-paying LPN jobs. The Journal of Nursing Regulation cites occupational health LPNs and rehabilitation LPNs as making an average annual salary of $50,000.
Some places where LPNs might work include:
- Nursing homes
- Long-term care facilities
- At-home patient care
- Physicians' offices
5. Problems With Delegation
LPNs work under RNs who delegate tasks. This can become a problem because LPNs cannot perform routine functions and life-saving tasks without permission. Performing responsibilities and duties reserved for RNs may put LPNs at risk of violating regulations.
As an LPN, you cannot diagnose, assess, or evaluate patients. This is all done by an RN or doctor, who then delegates work to you as the LPN. You cannot pass that work to someone else, which means it can be difficult to manage your own workload.
LPNs are often the first to notice something wrong with a patient. For instance, the patient may have a soiled pad that needs to be changed. However, LPNs need the approval of an RN to change that pad, which could potentially leave the patient uncomfortable for long periods of time.
Most RNs have standard delegations to their LPNs, but it is possible that you might feel incapable of doing something you are assigned to do.
6. Challenging Patients
LPNs are at the forefront of primary care. They have a lot of personal contact with patients. Because they often work in residential settings, LPNs regularly deal with challenging patients.
For instance, patients might be frightened and lash out at the staff. Similarly, their families may not understand what is happening and behave inappropriately towards the LPN. Most times it is a result of a misunderstanding, but that doesn't make it any easier to manage.
Nurses once accepted physical abuse from patients as an occupational hazard. Healthcare facilities started implementing zero tolerance policies and flagging abusive patients with bracelets.
To further protect LPNs, professional healthcare organizations pushed the federal government to enact laws to protect healthcare workers and prosecute violators.
7. Staffing Shortages
The pandemic intensified nursing shortages. Nurses went into early retirement during the COVID-19 crisis. Employers faced difficulties keeping nurses because of nurse burnout from job stresses: longer shifts, heavier workloads, and shorter times with patients.
Nurses must juggle larger workloads after budget cuts slashed healthcare staff. The increased workloads put LPNs — and their patients — in danger. Overworked LPNs risk making medical errors, experiencing workplace injuries, and comprising health data.
Demand for LPNs could increase as baby boomers continue to age, and people seek treatment outside of hospitals for chronic disorders, such as diabetes. By 2030, the BLS projects employment for LPNs to reach 751,900 — up from 688,100 in 2020.
8. Dealing With Death
LPNs help sick and dying patients. Part of the job includes comforting family members who have lost loved ones and advising grieving families on bereavement resources. Nurses also must process grief after losing a patient.
Learning about the stages of grief remains a principal component of nursing and part of the National Council Licensure Examination.
To overcome some of these challenges, LPNs can grow their careers through higher education and specialty training. Earning a BSN degree and a master's in nursing degree puts LPNs in a more knowledgeable nursing bracket and makes them eligible to take the NCLEX-RN exam. Occupational health, rehabilitation, palliative care, and gerontology remain some of the best-paying LPN jobs with an average salary of about $47,500-$50,000.
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