Licensed Practical Nurses
Nature of the Work
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.
Working Conditions
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.
Employment
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.
Job Outlook
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.
Earnings
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.
Related Occupations
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.
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