Too Many Nurses in the Kitchen: CNA, LPN, RN, APRN, PHD, DNP

Back in 1990 when I was fresh out of my initial nurse training program, for a LPN, the word in the hospital corridors was that LPN jobs would soon be obsolete. Go back to school and “get your RN” was the buzz. Since rising through the nurse ranks I’ve paid attention to the demise of the LPN and it’s not just alive and well, it’s thriving, in 2014.

I’ve got some analogies: movie ratings — G, PG, R, and X. And places to receive healthcare.

When I was a child my parents only let me see G rated movies. When I turned 13 or so, reluctantly they let me see PG. That was in the 1970’s. When my own children started seeing movies, society was becoming more desensitized to sex and violence and the movie industry changed the ratings. G was now PG; PG was now R; and R was now X. I’m astonished at what passes for PG today and it’s no wonder jails are the new long-term mental health providers.

Not many decades back, a medical-surgical hospital unit had patients that were high acuity. Now it’s all changed. Our current players: ALF, SNF, Med/Surg, ICU. Private duty falls somewhere in there. ALF (Assisted Living Facility) is now SNF; SNF is Med/Surg; Med/Surg is ICU.

Because healthcare in the US is all about capitalism, hospital CEOs prefer to hire LPNs than RNs because they can pay them a fraction of what they’d have to pay a RN. CNAs are now doing LPN tasks; LPNs are probably hanging blood and TPN; RNs are prescribing medications; APRNs are diagnosing and performing surgery (gosh, do we even need MDs anymore?). And PhD? They’re busy researching how to fix this problem.

Maybe we should have left well enough alone and just kept RN as RN. Nothing above or below. But alas…

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