Doing 'RN Work'

But Morell argues that despite their limited scope, she and other practical nurses are being asked to perform RN duties on the floor in light of the ongoing nursing shortage.

"LPNs have long been expected to do everything that an RN does by the bedside," she said. "It's just that we don't get credit for doing what we do because of our scope of practice.

"For instance, most LPNs are technically not allowed to assess patients without an RN present, but we're constantly assessing," Morell said. "How could I not be assessing as a nurse when I'm on the floor? If someone is warm to the touch, I know they could have a fever. It's all semantics. That's why I'd also like to see the LPN scope of practice change. All states' scope should include assessment, delegation and critical thinking."

Morell is also encouraging LPNs to participate in an online survey regarding scope of practice.

In Alexander's opinion, LPNs who claim to be doing the work of an RN are probably misguided.

"It may be that they lack an understanding of the role and scope of practice of an RN and, if they truly are performing activities that should be done by an RN, they are practicing outside their scope and violating the state's nurse practice act," she said.

"Studies demonstrate that many individuals 'don't know what they don't know,' and RNs do more than perform tasks. Their scope of practice entails critical thinking and high-level decision-making that has to be supported by physical assessment skills and knowledge of physiology, as well as nursing science.

"This is not to underestimate what LPNs do," Alexander continued. "They play an important role in healthcare, but it is distinct from the RN, and their education prepares them for practice at a different level."

But not all RNs agree with Alexander's premise. Count Robin Arnicar, RN, director of nursing (DON) at Frederick Villa Nursing Center, Catonsville, MD, in that number.

A former LPN who earned her ADN in 1997, Arnicar said she's gained most of her nursing knowledge working on the floor, rather than what she learned in nursing school.

"I fully support Lisa," said Arnicar, a member of the National Association Directors of Nursing Administration/Long Term Care. "I would say that 90 percent of what I've learned to do as an RN I learned while working as an LPN. I don't know that 10 years is a magic number for having enough experience [to challenge the RN exam], but then again, not everyone who goes to RN school passes the test, either."

Other Options

Academicians in practical and registered nursing speaking with ADVANCE, however, challenge the idea that experience is enough.

"Becoming a professional in anything is more than just passing a test, and it's more than just working in a particular area for 10 years," said Rocky Hanock, MBA, BSN, RN, a PN instructor with the State of Connecticut Vocational-Technical Education Department in Middletown and Eli Whitney State Technical School in Hamden.

"I don't know how LPNs can think they can get the theoretical and professional development an RN receives without getting a professional degree. LPNs may get plenty of life and clinical experience, as everyone does if they spend a significant amount of time in a profession or occupation, but a degree is required for professional development and for broader and diverse perspectives on the healthcare industry."

Patty Knecht, MSN, RN, president of the Pennsylvania Association of Practical Nursing Administrators, agrees. However, she does believe in the value of practical nurse education.

"I don't believe this initiative is educationally sound, nor is it positive for the profession as a whole," said Knecht, who's also director of the PN program at the Center for Arts and Technology, Coatesville, PA. "Seamless, cost-conscious, educational career ladders should be the goal. The depth and breadth of educational differences is an issue here, as are different job roles."

The difficulty LPNs face in earning credit and being accepted into RN schools is one of the reasons Morell said she has decided to pursue this path.

"Even with articulation programs, it's very lengthy and expensive, it's still almost like starting from scratch," she said. "Schools want you to pay to take an effective-speaking class, yet facilities hire foreign nurses who can barely speak English. I'm not bashing higher education. But with the economy the way it is today, you're paying a lot of money to go back to school just to do a job you're already doing. Plus, people work full time and have kids," Morrell continued."

Morell would like to see educators who disagree with her premise help set standards and criteria for testing such skills as assessment, critical thinking and delegation to be considered in addition to hands-on experience prior to LPNs being allowed to sit for boards.