High Nursing Workload Correlated with Increased Patient Mortality! Also, RNs and LPNs are not the same
You know when the nurses say they are overworked and that it is affecting patient care? They are totally right! I think we all knew this, but the health authorities seem to be in denial. Check out this fantastic InfoPOEM from the CMA on the issue.
The increasing Patient to Registered Nurse (RN) ratio is – in my view – in part due to trends toward changing the makeup of hospital staff. Health Authorities have had a tendency to decrease the number of RNs and increase the number of Licenced Practical Nurses (LPNs) working in hospital as of late. They perceive savings in staffing costs, but this study makes me wonder if there is a financial/ethical/care cost that they aren’t taking into account. As much as I think LPNs are a crucial part of the system, they are not a replacement for RNs. (Read a little bit about how RNs and LPNs differ). In our city there is a one-year accelerated training program for LPNs which is great – it gets them on the job quickly so they can start doing the tasks they are so desperately needed to do. LPNs earn a lower salary than RNs, but are expected to perform some of the same complex tasks as their RN counterparts. LPNs catch physician and medication errors, provide great direct patient care, and free up RNs who can then take on a greater leadership role. A year of training – directly after highschool for some – rarely allows the time and world experience for a person to form a ‘big picture’ view of patient care.
When I get a phone call from an RN, they’ll tell me about the patient, why the patient was admitted, what the problem is, what the vital signs are (if relevant), what they believe is going on, and what they think I should do about it. The RN may not be right, although often they are, but they have formed a logical recommendation in order to solve a problem. When I get a phone call from an LPN, sometimes it is to the same standard as an RN’s assessment would be. However, often it is lacking a few key pieces. Those in the medical community will recognize calls like this:
Brand New LPN: I have a patient and their heart rate is 120. I would like an order for Ativan for this.
Doc: Sorry, can you tell me which patient it is? How old are they? Why were they admitted?
LPN: It’s a . .. . *rustling of chart pages* 50 year old man, he was admitted with *more rustling* uhm I uhm urosepsis I think.
Doc: Okay, and what are the other vital signs?
LPN: Oh, I haven’t taken them yet. . . .
The LPN has correctly recognized there is something abnormal, and they are doing the right thing by calling to have a physician assess the situation. But one year of training simply has not provided them with the knowledge required to think about WHY something is happening and what approach we might take to figure it out. Fortunately many smart and keen LPNs develop quickly into astute caregivers after just a few months on the job. And many of these go on to become skilled RNs. Who may then become Nurse Practitioners (NPs). And so on.