Dr. Glazer's Reply:

I understand your frustration related to the blurring of the roles between RNs and LPNs. It is critical that administrators know which tasks or activities can appropriately and safely be performed by only registered nurses and which activities or tasks can be delegated to others. Since each state has its own Nurse Practice Act, and a Board of Nursing that may view its rule making authority either quite rigidly or flexibly, tremendous variation exists between states.

There are several possible problems with imposing more rules related to what a LPN can and can't do. First, we do not have sufficient research to link outcomes to practice differences. We do not have enough data to support that there are negative outcomes when LPNs perform specific tasks and activities that historically have been done by registered nurses.

Second, what criteria are we using to say that certain activities and tasks should be restricted to registered nurses, or that others could be delegated to LPNs? Most of the arguments that I have heard for expanding the practice of LPNs center around the idea that through revised LPN curricula and additional educational offerings in the workplace, LPNs have gained additional knowledge and skills to perform tasks or activities previously performed by RNs. This argument has enabled LPNs to assume many new tasks and activities, as you have noted. However, there is no standardization of content, nor uniform testing of skill performance after educational offerings, to assure the public that the LPN can safely take on the new tasks and activities. In fact, many of the offerings are institutionally based where the cost savings of hiring an LPN instead of an RN may be a very real incentive for expansion of the LPN role.

Third, who is going to make the rules? RNs, LPNs, administrators, legislators, professional associations, and consumers all have a stake in this rule making. As I wrote in my original article, registered nurses need to gain consensus now about what tasks and activities should be performed only by a registered nurse. Once we have come to some agreement, we can develop strategies to influence the other stakeholders.

I hope that you will engage in research in this area during your PhD program. It is urgently needed. Best of luck.

Greer Glazer

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Letter by Kathy Smith

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