Passing The Exam

Hale said she isn't sure LPNs should be made to believe they could pass the RN exam.

"Knowing what I know as a nurse, I know you have to have the appropriate knowledge to pass that test," she said. "I don't think I'd pass the test, I don't think Morell would pass the test, I don't think any LPN would."

Newman said this logic would also likely impact her state's board.

"You wouldn't want to set people up for disappointment," she said. "To grant an opportunity you'd want to promote success, not failure."

Morell and Darling prefer to think differently than Newman.

"This is all still a work in progress," Morell said. "We should be able to take the test as many times as an RN student would be permitted. I don't think that's something people think about anyway. And I may ultimately lose this battle, but at least I can go to bed at night knowing I tried to do something about it. If people already agree with me, nobody can tell me I'm wrong."

"I'd be interested to see if I could pass the test," Darling added. "I think at some point some of us get too old to go back to school, or at least too set in our ways as nurses. I think there'd have to be strict criteria for taking the test though, not just 10 years of experience."

Reeling In More Believers

Morell has heard the arguments against her "testing-out" initiative, but she still hasn't been persuaded to abandon the cause.

"Everyone has the right to disagree or add their perspectives, and I'm expecting more opposition as I move forward because people who set the agendas have already set the agendas," Morell explained. "But I also expect support to grow as well because those RNs who work with LPNs and respect us know we're competent and know that they need us."

One such individual is Maureen McCarthy, BS, RN, who signed the petition the weekend it went online.

"I don't agree with many of the restrictions that are placed on LPNs," said McCarthy, owner and operator of Celtic Consulting LLC, Goshen, CT. "For instance, in some states LPNs can't work as MDS coordinators. That's ridiculous, and facilities shouldn't have to use all their existing RN resources when they could turn to their LPNs."

Though she signed the petition, McCarthy believes there should be limitations to it.

"I do agree that LPNs should be able to challenge the boards, but I think they should be limited to attaining the ADN and should be forced to practice in the setting they're experienced in," she said. "So, I don't think you should be able to work 10 years as an LPN in long-term care and then challenge the boards to work as an RN in the OR. And the BSN degree is more geared toward management and scientific research, which isn't the same as experience working at the bedside."

Similarly, Darling proposes that those LPNs who would test out receive a level of pay commensurate with ADN nurses.

"That way, this initiative would clearly be about the nursing, not about the money," she said.

But Arnicar isn't sold on these theories. Passing the test is passing the test, she says.

"Many LPNs have the skills and abilities to do what RNs do," she said. "In fact, 90 percent of my administrators are LPNs. I honestly consider my two best clinical nurses to be LPNs. I only staff RN in administration where required by law."

What Would Happen To The LPN?

This "challenge" discussion begs the question, Alexander says, of what would become of the LPN role if states followed this trend. Would LPNs simply disappear or would they lose their duties to experienced unlicensed staff?

"I wonder if these same LPNs who want to challenge the RN licensure exam would be comfortable with nursing assistants with 10 years' experience being allowed to challenge the LPN exam, and taking their jobs," she mused. "But boards of nursing would not support that because it'd be as equally an unsafe a situation as LPNs challenging RN boards, and I'm sure LPNs wouldn't support this either."

As far as Morell is concerned, this is already an issue, sort of.

"There are many facilities who promote the use of unlicensed personnel instead of the LPN," she said. "In Connecticut, we now have paid feeding assistants - people who feed residents who have no swallowing difficulties. By using these unlicensed personnel, facilities can get things done cheaper. It's just not fair. The RNs could argue the same thing against LPNs, but if our scope of practice was more involved, we wouldn't have to be looked at in that light."

Joe Darrah is associate editor at ADVANCE.