Licensed practical nurse

Assistant Editor-In-Chief: Michelle Lew

Overview
Licensed practical nurses (LPNs) are also known as licensed vocational nurses (LVNs) in California and Texas and as registered practical nurses (RPNs) in Ontario. They are called enrolled nurses (ENs) inAustralia and state enrolled nurses (SENs) in the United Kingdom.

United States
These individuals usually have twelve months to two years of training in anatomy and physiology, pathophysiology, pharmacology, and practical patient care. They must pass state or national boards (such as NCLEX-PN in the U.S.) and renew their license periodically.

LPNs can perform simple as well as complex medical procedures, but must operate under the supervision of either a registered nurse (RN) or a physician. They can administer most medications, excluding IV push medications, monitor patient response to medications, implement wound care, perform vital sign measurements (blood pressure, heart rate, temperature, oxygen saturation, etc), maintain patient records, help with patient-care planning, surgery, Basic Life Support, sterile and isolation procedure, collect samples for lab testing and provide a standard and consistent level of care.

LPNs work in a variety of health care settings. They are often found working under the supervision of physicians in clinics and hospitals, or in private home health care. In long term care facilities, they sometimes supervise nursing assistants and orderlies.

The United States Department of Labor's Bureau of Labor Statistics estimates that there are about 700,000 persons employed as licensed practical and licensed vocational nurses in the U.S.

LPNs must at least be high school graduates. They follow the rules of State Boards of Nursing. Requirements for taking boards usually include a clean criminal record and graduation from an approved practical nursing program.

The first practical/vocational nurse training occurred at the Young Women's Christian Association in New York City in 1892. The first official training was three months long, offered at the Ballard School in New York in 1893. Students studied homemaking as well as learning how to care for patients. All states did not have licensure for LPN/LVNs until 1955. Current training is usually college-based.

United Kingdom
The state enrolled nursing qualification can no longer be gained in Britain. Prior to the implementation of Project 2000 which radically altered the face of nurse education in the mid-nineties SEN students used to follow the first twelve months training of the state registered nurses (SRNs, now known as level one nurses), and then had another twelve months of training before sitting SEN exams and becoming registered. Some auxiliary nurses with many years of experience used to be allowed to sit the SEN exams and enter the register without requiring further training. People training to be SRNs who failed their exams at the third attempt were also able to enter the nursing register as a SEN. Although no new SENs are trained in the UK, the Nursing and Midwifery Council (the regulatory body for nurses in the UK) does allow people to be added to the register as level two nurses if they are moving from a similar position abroad.

Formerly, there was a large segregation between the "green" SENs and "blue" SRNs, which were the colour of uniform typically worn. SENs were very much complementary to the nursing team, however did not have the status of SRNs and were ineligible to be promoted, e.g to ward sister. Many SENs sat or re-sat the SRN exams, however a large number did not and were quite content being a SEN. Nowadays, the divide between level one and two nurses is diminishing due to the small number of SENs still in practice. However, many SENs had the same responsibility as level one nurses, especially in a ward environment and were expecting to perform largely the same duties such as taking charge of wards unsupervized at night as well as taking charge of wards on nights and weekends. The demise of the SEN is lamented by many who saw it as a balanced way to staff a ward however the divide also meant that potentially, the gap in clinical excellence could be to wide.

Auxiliary nurses (also known as nursing assistants, healthcare assistants, or clinical support workers) are taking on a lot of tasks which have until now been done by the registered nurses - things like taking blood samples, changing dressings, and recording ECGs. Recent announcements consider these staff having their own part on the nursing register. At present they work under the supervision of a registered nurse who is accountable for their actions. Auxiliary nurses on their own part of the register would have huge implications regarding professional responsibility, pay and conditions along with logistical problems.

Australia
Enrolled Nurses in Australia usually spend twelve months training, consisting of fourteen (14) weeks theoretical component at TAFE colleges, followed by practical experience in hospital wards for the remainder of the time. The majority of EN's eventually move on to attend university and become Registered Nurses, although a substantial number remain as EN's in public and private hospitals, and nursing homes.

The role of Enrolled Nurses in Australia has greatly increased in recent years, in response to the continuing shortage of Registered Nurses in the public health care system. In 2004, a Medication Endorsement certificate was introduced, allowing EN's to administer most oral medications (excluding drugs of addiction) upon completion. Endorsement also permits the administration of some intravenous (IV) medications and fluids (IVT), as well as intramuscular and subcutaneous injections. Endorsed Enrolled Nurses (EEN)'s are also permitted to check S4D and S8 medications with a Registered Nurse, although they remain unable to participate in the drug count, that is usually done at least once a day. Most Enrolled Nurses working in public hospitals are permitted to conduct ECG's, collect pathology specimens, and routinely take a patient load under the supervision of a Registered Nurse.