TRANSISTION RESEARCH PAPER FALL 2016
Research Paper
September 17, 2016
Mercy Williams
Dallas Nursing Institute
Mrs. Whitehead
Transition RNSG 2307 2/17T
Introduction
Nurses are described as individuals who are naturally equip to affectionately delivers care to people who are ill, experiencing infirmities and emotionally disturbed(Catherine Janzen 2013). The job of nurses are very unique, it cuts across different professions due to the demand of their services that deals with human life in various perspective of needs. Over decades, nurses has been struggling with societal recognition of the great services they offer among other health care professionals. Both registered nurse and License Vocational nurse faces all kind of challenges, demeaning and referring with certain derogating names. Catherine Janzen in her article of 2013 cited “ …….Faced with an almost impossible image to live up to, in some specialties, nurses themselves struggles at times to claim for themselves the identity of a real nurse.” The issue of marginalization of nurses affect the License vocational nurses more compare to the Registered nurses. The License Vocational nurses faces all-round marginalization and humiliation among other nursing professionals, patients and the general public (Catherine Janzen 2013). This issues of margination among nurses, arises the quest for the answers to the question, “Is there a Difference between a RN and a LVN in the Delivery of Patient Care” This research paper will concentrate in exploring and presenting answers to the question. Also providing answer to the question “Why would an Employer utilize a LVN before utilizing a RN” The answers to this questions will be based on comparing assessment skill of RN and LVN pain management in nursing homes, comparing of Role conceptions and role management of LVN transition to RN and Traditional AND, and RN and LVN medication reconciliation in Nursing homes.
Is there a Difference between a RN and a LVN in the Delivery of Patient Care?
The limitation in paindetection, assessment and medicationadministrationby RNs and LVNs in nursing homes remain a societal health challenges (Corazzini Kirsten 2013). Nurses achieves effective pain management through assessment, resident’s response to pharmacological and nonpharmacological involves regimen and communication among nurses, prescribers and pharmacists (Corazzini Kirsten 2013. Corazzini Kirsten (2013 her article explored three grouped areas in which RNs and LVNs differs in pain management. These are; 1.The extent to which RNs and LVNs connected formally and informally to provide pain care.2. The degree to which RNs and LPNs were considered interchangeable with one another, and 3. The RN–to-LPN ration.
- The extent to which RNs and LVNs connected formally and informally to provide pain care.
Registered nurses are academically trained and licensed to performed
comprehensive assessment, care and management of pain. Although RNs may delegate specific pain management tasks to LVNs but remain responsible for its result and comprehensive assessment. In most nursing home LVNs are delegated to perform pain assessment and management due to low number of RNs. However, LVNs lack the concepts of assessment and prompt action to control pain. They regard the delegation to manage resident with pain as observation. Mostly an LVNS relied on nursing assistant personnel to observe and report resident with pain. This is difference with RNs, who delegate to LVNs and NAS with specific instructions and frequently return to evaluate the result. In addition, RNs are formally trained to manage resident with pain however, he/she informally uses LVNs to achieve this goal. Also, LVNs can be used informally to perform this duty in the absence or low number of RNs. (Corazzini Kirsten 2013).
- The degree to which RNs and LPNs were considered interchangeable with one another.
The reality of scope of practice, LVNs and RNs cannot be interchange however,
this happens in nursing homes. Staffing in nursing homes contributes to the limitation of insufficiency of proper pain management. Most of the nursing home employs low number of Registered nurses and engaged in using LVNs and NAS to supplement in management of patient‘s pain. The major different is the LVNs and NAS were not trained to provide comprehensive assessment, care planning and evaluation of patient in pain. Corazzini Kirsten and others (2013) in her article concluded that “higher RN- TO-LVN in nursing home result in lowers interchangeability and higher capacity to detect, assess the need for pain medication and more likely provide timely and appropriate pain medications”
- The RN–to-LPN ration.
The ration of RN to LVN staff is vital, however not sufficient to deliver adequate
care to residents. The need for team work is crucial in proper management of care patient pain in nursing home. RN will delegate and direct those staff that work at the patient bedside on the specific care he/she expect them to do. Also being specific and setting limits on the difference on the role of the RNs and LVNs, making sure that all instruction and cares are carried out appropriately. The success of pain management in nursing home lies on collaborative study of license and unlicensed nursing staff (Corazzini Kirsten, 2013)
2. Comparing of Role conceptions and role management of LVN transition TO RN AND Traditional and.
The increasing changes in health care requirement of registered nurse has spurred the quest of License Vocational nurse to reenter school for transition to RN. This moves of LVNs transitions indicate the distinct difference between and RNs and LVNs. This prove of difference is seen on the role concept and role deficit noted while the LVNs and entering school and when they exit school. In comparison with traditional ADN student. Lengacher (1992) in his article cited some studies which indicates that LVNs service role concept are limited. He continue to stress that professional role conception and service role conception seem to be the reason nurses partake in continue education activities. Due to LVNs health experiences before going back to school for transition to RN, they show significant higher on role deprivation than traditional ADN both in entry and exit from the program (Lengacher (1992). In contracts, the ADN student show higher differences in professional and role services conceptions upon entrance and exit. This studies according to Lengacher (1992) shows a clear distinction in professional responsibilities of RN over LVNs.
- RN and LVN medication reconciliation in Nursing home.
In nursing home, nurse both RNs and LVNs involves in medication reconciliation.
However the scope of practice, academic and professional training differentiate the different perspective of performing this duty. Amy .A. Vogelsmeier (2011) in his journal indicated that “RNs performed the observe medication reconciliations more often I lager nursing home whereas, LVNS performed it more often in smaller nursing homes” RNs and LVNs has different perception on why medication reconciliation are being done and their action for any identify discrepancy. An RN discuss that the need for medication reconciliation is to provide the required resident’s medications. The RNs also emphasis on their responsibility to ensure resident safety and ability to reconcile between the physician orders and pharmacy delivery together. Whereas a LVNs staff viewed medication reconciliation as a task and part of assigned duties. Amy .A. Vogelsmeier (2011) The LVNs concentrate on the accomplishment of the facility policy. RNs during medication reconciliation, identify discrepancy and follows up with physician. RNs always see it as clinical responsibility to reconcile medication discrepancywhen transition of resident in care occur. The process of medication reconciliation performin nursing homes by LVNs and RNs is a huge difference in RNs and LVNs scope of practice.
Why would an Employer utilize a LVN before utilizing a RN?
The reasons why Employers utilizes LVN before utilizing RN are due to cost of paying an RN. Corazzini Kirsten (2013) in her article refer this as higher interchangeability in Nursing homes that employs only one RNs as DON then uses LVNs to perform other duties that at the scope of RN under RN’s directive. Lengacher (1992) in his article indicated that “studies suggest that LVNs due to their previous nursing background, were more readingly influenced by the professional concepts attained through the educational process, and the socialization process had a great effect on the LPN-transition student.”In other word, LVNs were believed to have more clinical experience after transition to RN compare to traditional RN .One other major reason is the increase shortage of RNs, the high demand for registered nurse in health care industries has result the utilizations of RNs to facilities that can afford the high payment and retainment of RNs. This result to most of the facilities resort in using LVNs more to achieve the same result RNs will provide.
Conclusion
In conclusion, there are distinct difference between a RNs and LVNs as discussed earlier in this research paper. In addition, the Texas Nursing Practice Act (NPA) defines the legal scope of practice for professional registered nurses (RNs). “Professional nursing” means the performance of an act that requires substantial specialized judgment and skill, the proper performance of which is based on knowledge and application of the principles of biological, physical, and social science as acquired by a completed course in an approved school of professional nursing. The term does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures. Professional nursing involves:The observation, assessment, intervention, evaluation, rehabilitation, care and counsel, or health teachings of a person who is ill, injured, infirm, or experiencing a change in normal health processes;, the maintenance of health or prevention of illness; the administration, supervision, and evaluation of nursing practices, policies, and procedures and others. Whereas a LVNs, advocate for the patient and the patient’s family and promotes safety by practicing within the NPA and the BON Rules and Regulations. LVN scope of practice does not include acts of medical diagnosis or the prescription of therapeutic or corrective measures. 4 The practice of vocational nursing must be performed under the supervision of a RN, APRN, physician, physician assistant, podiatrist or dentist. (Texas Board of Nursing Position Statements).
Reference
Vogelsmeier, Amy A, PhD,R.N., G.C.N.S.-B.C., Scott-Cawiezell, J., & Pepper, Ginette A, PhD,R.N., F.A.A.N. (2011). Medication reconciliation in nursing homes: Thematic differences between RN and LPN staff. Journal of Gerontological Nursing, 37(12), 56-63. doi:
Janzen, K. J., Melrose, S., Gordon, K., & Miller, J. (2013). ' RN Means Real Nurse': Perceptions of Being a 'Real' Nurse in a Post- LPN- BN Bridging Program. Nursing Forum, 48(3), 165-173. doi:10.1111/nuf.12026
Lengacher, Cecile A,PhD., R.N., & Keller, Rosemary,M.S., R.N. (1992). Comparison of role conception and role deprivation in LPN-transition students and traditional ADN students in a specially designed associate program. Journal of Nursing Education, 31(2), 79-84. Retrieved from
Corazzini, K. N., PhD., Mueller, Christine, PhD,R.N., F.A.A.N., Anderson, Ruth A, PhD,R.N., F.A.A.N., Day, Lisa, PhD,R.N., C.N.R.N., Hunt-McKinney, S., & Porter, K., M.P.H. (2013). Pain medication management in nursing homes and nursing scope of practice. Journal of Gerontological Nursing, 39(4), 40-46. doi:
By definition, both vocational and professional nursing excludes “acts of medical diagnosis or the prescription of therapeutic or corrective measures” [Tex. Occ. Code Ann. §301.002(2) and Texas Board of Nursing Position Statements. Retrieved September 16, 2016,