Despite the fact that nursing is a demanding profession, it is a very popular one. There are almost three million registered nurses, or RNs, and almost seven hundred thousand licensed practical nurses, or LPNs, in the U.S.
The call to help the sick and injured is as old as time. Long considered women’s work, it was a vocation held in respectful condescension for decades. Due to the essential work done by Clara Barton and Dorethea Dix during the Civil War, the professional has gradually gained in respect and pay, attracting men to it along the way.
People entering the field today are presented with a decision. Should they aim for LPN certification or RN status? Here is a look at the similarities, differences, and the education and licensing required for each.
Similarities and Differences
The essentials of nursing are the same for both LPNs and RNs. They both care for people who are suffering from illness and injury, providing medical and functional assistance to help them live as pain-free and as comfortable as possible, and hopefully move forward in their journey toward health. The medical system requires the talents and skills of both LPNs and RNs.
For both, helping patients is physically hard. They must also handle the mentally and emotionally draining distress of interacting daily with people in pain and people who are dying.
The differences are found in workplace settings, types of duties and level of responsibility at work, years of education, licensing requirements, rate of pay and status.
Status, Duties and Responsibilities
RNs are considered next in the healthcare hierachy after physicians. The range of work they do is large. They can diagnose and treat a patient. This gives them considerable status in the medical field and among lay people.
LPNs work under the supervision of an RN or a physician and can’t legally diagnose or treat patients. However, many long-term LPNs have the experience and training to unofficially assess a patient’s condition with expertise. Within the professional these workers are highly appreciated for the practical knowledge they bring to patient care.
But there is no question that overall, the role of the LPN has a lower overall status than that of an RN, both in and out of the profession.
The most common place to find LPNs is in a long-term care facility. Almost 30% of them choose to work in a long-term facility. The demand is high and the setting gives them a chance to move up the ladder into supervisory work. In fact, working in long-term care facility makes it six times more likely they will be given administration responsibilities than if they worked in a hospital.
LPNs in a hospital routinely carry out the jobs like emptying bed pans, bathing patients, taking vital signs, and at times giving medication. Their chances of specializing, for example working in the neonatal ward, are very limited.
RNs work hands-on with patients, in supervisory roles, and in patient education. The duties can vary considerably according to the specialty they choose. Highly trained RNs with advanced training work in emergency rooms, assist doctors in surgery, work with cancer patients, and with people fighting diabetes, heart disease and stroke, eye problems and many more.
Here is the breakdown of work settings for LPNs and RNs according to the Bureau of Labor Statistics (BLS):
- 29% of LPNs in nursing care facilities
- 15% of LPNs in hospitals
- 12% of LPNs in doctor’s offices
- 9% of LPNs in home health
- 48% of RNs in private general hospitals
- 6% of RNs in local hospitals
- 5% of RNs in long term care facilities
Rate of Pay
According to BLS records kept in 2010, RNs averaged $64,690 a year. An LPN averaged $40,380. With specialization, the annual pay for an RN goes much higher. LPNs have very limited chance of specialization, and therefore it is much less likely they can break through to higher annual incomes.
Education and Licensing
It takes one to three years less time to get the education needed for LPN licensing than it does to become and RN. The cost of the program is almost always less for an LPN than for an RN.
For an LPN, the training is both book-based in the classroom and hands-on in a clinical setting. This prepared students to work in hospitals, long-term care facilities and other medical settings.
Training is available at a large number of community colleges and technical colleges. A number of them allow the student to apply the college credits earned getting an LPN certificate to a nursing degree at a later time. Each school has its own requirements for getting into the LPN program.
The licensing process involves a background check based on fingerprints and a screening process. LPN candidates must pass a national exam called the NCLEX-PN. Every LPN must acquire the required number of continuing education credits each year in order to stay licensed. In addition there are regional requirements that vary state by state.
RNs can get either a two-year associate’s degree or a four-year bachelor of science in nursing, or BSN. Career choices are wider with the BSN, which is a necessity if a nurse wants to advance through the ranks into management. Many career RNs later get a masters, essential for certain specialties like clinical nurse, anesthetist, midwife or nurse practitioner.
Each school has its own requirements for admittance. The background check is the same as for an LPN.
RNs need to fulfill the national licensing requirements before they can work in the profession. This means graduating from an approved program and passing the National Council Licensure Examination, both the written and practical sections. There are also state-by-state licensing requirements, especially if the RN works in a specialty. All RNs need to keep up with continuing education credits annually to stay licensed.
LPNs vs RNs
RN and LPN: two different sets of initials on different name badges – and often two very different roles. Registered nurses (RN) have, at the minimum, a two-year degree or three-year diploma. Many have baccalaureate degrees. RNs have an expanded set of duties and are more frequently employed in hospital settings. They, RNs, are generally expected to do more critical thinking on the job. Find a Registered Nursing program in your state.
Licensed practical nurses (LPN) have about a year of nursing education, often culminating in a certificate. A minority complete longer programs and walk away with a degree – often an Associate of Applied Science (AAS). Find an LPN or LVN program in your state.
The role of an LPN is, as the name suggests, practical. LPNs are expected to report even minor changes in patient care to a registered nurse or other medical professional. As for what they actually do on the job, often it’s a lot!
More licensed practical nurses work in long term care than in any other setting. In these settings, they have opportunities to move up in the ranks, often supervising nursing assistants who perform the most basic duties (for example, bathing or changing bed pans). The NLN reported in 2011 that newly licensed LPNs in long term care were almost six times as likely to have administrative responsibilities as their counterparts in hospitals were.
Every state has a Nurse Practice Act that defines the scope of practice for Registered Nurses and for Licensed Practical Nurses.
In hospitals, LPN duties, as well as advancement opportunities, are more limited. You’ll find LPNs taking vitals and sometimes administering medications. You won’t find them caring for premature infants in the neonatal ward. They won’t have as many options for specialization.
Work settings are varied. The BLS reports that 29% of LPNs work in nursing care facilities, 15% in hospitals, 12% in doctor’s offices, and 9% in home health. For RNs, hospitals are the most common setting, with 48% in private general hospitals and 6% in local hospitals. Only 5% work in long term care.
Demand for LPNs and RNs
Nursing is one of the few fields where there is more demand at the higher levels of practice than the lower ones. Nationwide, there are far more RNs with active licenses than LPNs -- 3,236,288 to 816,687. Why? Their skills – and legally allowable duties -- are needed.
Both fields are growing, but the registered nursing field is growing a little faster. The BLS has predicted 22% job growth for LPNs between 2010 and 2020. For RNs, the projection is 26%.
It is important to be aware that there are different scopes of practice in different states. States have varying policies regarding IV therapy, for example. Some states allow LPNs a range of IV duties, but require additional coursework or certification.
There are also geographic differences in work setting. Many states have workforce centers, and in some states, the board releases detailed information about licensees. Both sources can give a state-specific portrait of the profession. A 2005 Georgia survey found 29.4% of practical nurses employed in nursing homes/ long term care, 28.8% in hospitals, and 14.1% in medical practices (like doctor’s offices). A 2011 South Dakota report found 31% of practical nurses employed in long term care.
The Path to a Nursing License
Is it easier to become a practical nurse? Yes – in terms of the length of the program, difficulty of subject matter, and (in many cases) the cost of the program. Read the article "Becoming an LPN" to gain a greater understanding of the process.
Licensed practical nurses go through a licensing process that is very similar to registered nurses. There is a screening process and often a finger-print based background check. LPNs are accountable to their licensing agency when it comes to demonstrating ethical practice and following the scope of practice.
They also must pass a national exam. The NCLEX is offered at both the RN and PN levels. The NCLEX-PN is considered the easier exam, but differences go beyond difficulty level. Both tests assess knowledge and decision making appropriate to a particular job role. The NCLEX-RN requires more critical thinking; the RN is expected to carry out more assessments and make more decisions on his or her own before seeking the support of a supervisor. Read "Becoming an RN" to better understand the path.
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