# LPN's Being Left Go



## 18G (Feb 5, 2010)

Not so much EMS news, but I think this article and decision by Summit health shows where the requirements for more education are headed.

WAYNESBORO, PA
Thirty-three licensed practical nurses will lose their jobs by the end of the month due to a change in the nursing care model at Waynesboro and Chambersburg hospitals.

Both hospitals will switch Feb. 27 to using only registered nurses for patient care, according to a Summit Health press release. The switch means there is less need for licensed practical nurses, or LPNs, who do not have as extensive skills or educational background as registered nurses, or RNs.

FULL STORY


----------



## TransportJockey (Feb 5, 2010)

I've seen this first hand at my hospital. We only had about 15 LPNs and they were all let go at the beginning of the year.


----------



## EMTinNEPA (Feb 5, 2010)

It's not only EMS-related, but I'm seeing something very similar happen in my area.  A hospital-based service recently terminated 9 of their EMTs and replaced them with paramedics, going from two dual-medic chase trucks and six BLS units to a dual-medic chase truck, three MICUs, and three BLS trucks.  Talk is within two years every MICU will be dual-medic and EMTs will be done away with entirely.


----------



## 46Young (Feb 5, 2010)

EMTinNEPA said:


> It's not only EMS-related, but I'm seeing something very similar happen in my area.  A hospital-based service recently terminated 9 of their EMTs and replaced them with paramedics, going from two dual-medic chase trucks and six BLS units to a dual-medic chase truck, three MICUs, and three BLS trucks.  Talk is within two years every MICU will be dual-medic and EMTs will be done away with entirely.



If that type of process becomes more of a trend, then it'll be all the more easier to make the paramedic level an entry requirement for employment. If and when that happens, new medics will be more serious about the profession, since it'll take much more than 120 hours of training to get in. If you have a more serious, less transient workforce, organization will be easier to achieve, and with it an increased education requirement, like other healthcare professions. 

As I see it, that's the only realistic way to effect any real change, by the employer's actions. Medics will be plentiful at some point. Employers will be able to pick from the cream of the crop, and not just anyone with a pulse and a patch. If the number of qualified applicants remains high afterward, then the employers can start requiring degrees for entry level positions. Steps in this direction can begin now with degreed medics going to 4 year degrees, earning admin positions, and changing things from up top.

I wouldn't mind doing that myself. I'm making a career out of the fire service, but I'd like to have a lofty position in a third service or hospital based EMS system post retirement. I got my start with hospital based 911/IFT, and I still enjoy my shifts on the medic txp unit, which is about 50% of the time. My IFT side job isn't half bad, either.

As it stands now, there aren't too many in EMS admin with related degrees. This was the case at my hospital based system. A bunch of guys who were doing 911 EMS at other hospitals were courted to start up a service for the NSLIJ CEMS. I don't think any of them were degreed, just street medics. The lack of formal education in admin wasn't evident at first, but became more apparent as the agency grew, and also when they experienced attrition and later tough economic times. Those with the BA in EMS should be able to backfill admin positions as people leave and such.


----------



## TransportJockey (Feb 5, 2010)

EMTinNEPA said:


> It's not only EMS-related, but I'm seeing something very similar happen in my area.  A hospital-based service recently terminated 9 of their EMTs and replaced them with paramedics, going from two dual-medic chase trucks and six BLS units to a dual-medic chase truck, three MICUs, and three BLS trucks.  Talk is within two years every MICU will be dual-medic and EMTs will be done away with entirely.



I'm a big fan of this change. I hope more services follow.


----------



## Bloom-IUEMT (Feb 16, 2010)

EMTinNEPA said:


> It's not only EMS-related, but I'm seeing something very similar happen in my area.  A hospital-based service recently terminated 9 of their EMTs and replaced them with paramedics, going from two dual-medic chase trucks and six BLS units to a dual-medic chase truck, three MICUs, and three BLS trucks.  Talk is within two years every MICU will be dual-medic and EMTs will be done away with entirely.



Are you kidding? Who would do away with EMTs entirely when all we are talking about these days is waste in medical spending.  Emts help control that cost...and not every call requires two paramedics. In fact I could argue the majority don't. But as I am reading between the lines it sounds as though a move from LPNs to RNs is a prelude to transitioning more care from physicians to nurses.  Maybe I'm wrong IDK but the name of the game in American health care is the "bottom line" not patient care. But maybe I'm being cynical


----------



## VentMedic (Feb 16, 2010)

Bloom-IUEMT said:


> But as I am reading between the lines it sounds as though a move from LPNs to RNs is a prelude to transitioning more care from physicians to nurses. Maybe I'm wrong IDK but the name of the game in American health care is the "bottom line" not patient care. But maybe I'm being cynical


 
As medicine evolves a more highly educated professional is required at bedside rather than just a tech with 1 year of training/educaiton to do the patient care.  Using LPNs was the cheap way to go and patient care is demanding more.   Nurses should have no less than a BSN and right now that is the trend which started in the late 80s.

 The change from LPN to RN started over 20 years ago and the LPNs should have gotten the message and made the transition.  The doctors are NOT being replaced.


----------



## Bloom-IUEMT (Feb 16, 2010)

VentMedic said:


> As medicine evolves a more highly educated professional is required at bedside rather than just a tech with 1 year of training/educaiton to do the patient care.  Using LPNs was the cheap way to go and patient care is demanding more.   Nurses should have no less than a BSN and right now that is the trend which started in the late 80s.
> 
> The change from LPN to RN started over 20 years ago and the LPNs should have gotten the message and made the transition.  The doctors are NOT being replaced.



I actually couldn't agree more. I'd like to see all health care professionals with a bachelors degree; in fact, I'd like to see every citizen of the country have at least a bachelor's education. The problem is it raises the cost of health care! You understand that the need for higher education standards and wanting to control medical costs are at odds.  People can't laud the idea of higher educational standards but turn around and vote down the public option! And statistically 2 out of 5 people reading this would do just that.


----------



## 8jimi8 (Feb 16, 2010)

aCcording to the article, those LVNs had a free lvn to RN upgrade, but didn't take the time.   Nursing is YEARS away from requiring a BSN. If not decades.


----------



## skivail (Feb 16, 2010)

That is interesting as it seems Canada, or at least Ontario is moving in the opposite direction.


----------



## VentMedic (Feb 17, 2010)

8jimi8 said:


> aCcording to the article, those LVNs had a free lvn to RN upgrade, but didn't take the time. Nursing is YEARS away from requiring a BSN. If not decades.


 
That doesn't mean the employers can not require it.  Many health professions expected a higher level of education long before it became official.    Flight, Critical Care and Specialty units and transport teams do have higher education expectations from the RNs they hire.  Our ICUs have been expecting  RN applicants to show up with a BSN for many years.  The BSN programs in the area also out number the two year programs.


----------



## VentMedic (Feb 17, 2010)

Bloom-IUEMT said:


> I actually couldn't agree more. I'd like to see all health care professionals with a bachelors degree; in fact, I'd like to see every citizen of the country have at least a bachelor's education. *The problem is it raises the cost of health care!* You understand that the need for higher education standards and wanting to control medical costs are at odds. People can't laud the idea of higher educational standards but turn around and vote down the public option! And statistically 2 out of 5 people reading this would do just that.


 
 Most health professions have data that shows higher education can shorten a patient's stay in the hospital by improved procedures, better awareness or method to decrease infection and practitioner driven protocols.   The shift from a task driven mentality to one that involves critical thinking and a therapy driven method can  improve patient outcomes.


----------



## VFFforpeople (Feb 17, 2010)

In a world where education is affordable and the aide is there I can see where a BA would be easier to obtain. I see this in the ems world as well EMT-I is gone in CA (yes there is one place that teaches it in all of CA) EMT is getting a tiny upgrade and medic is getting a huge overhaul. The cost of going to school and expecting a BA in this case it is a B.S. degree (no pun intended). I love education and enjoy learning but the jobs need to be there for the money to be put out, and it just isnt there. Which is why the vocational programs came out for smaller areas along with LPNs ect, to help smaller based hospitals off set cost.

I guess the whole point of this rant is I see the cost of hospital stays going way up along with EMS.


----------



## VentMedic (Feb 17, 2010)

VFFforpeople said:


> Which is why the vocational programs came out for smaller areas along with LPNs ect, to help smaller based hospitals off set cost.
> 
> I guess the whole point of this rant is I see the cost of hospital stays going way up along with EMS.


 
LPNs did not come along to offset hospital costs. At one time what they did in healthcare was okay. Almost every profession started with a "tech" level which is what the LPN is. However, as technology and medicine evolved, their knowledge and skills were no long adequate. Insurances started to demand more for their dollar when paying for patient care. Right now if you want to use EMS as an example, CMS would probably be appalled that they are paying only for a speedy taxi ride to the hospital in some cases. There may come a time when the insurances start to demand more qualifications than a 110 hour course or a 6 month tech school rather than those providers trying to demand reimbursement at a professional level. This is seen in some areas for a CCT or SCT reimbursement with CMS.

RN should be the entry level for nurses and the nursing profession has seen that for many years. The LPN is too much like the EMS Intermediate with some of the skills but very little of the knowledge. Their profession has advanced out of the skills only mentality to where it values education for assessment and protocols. Accrediting agencies want better qualified people doing the assessments and triaging. EMS can still get away with using the lowest level provider because they are taking the patient to a higher level of care. The hospitals are expected to provide a level of care to the patient that satisfies accrediting agencies and insurances. 




> The cost of going to school and expecting a BA in this case it is a B.S. degree (no pun intended).


 
Getting an education is nothing new in the U.S. Accountants have degrees. Teachers have degrees. Both have been required to have degrees for many, many years. Why shouldn't health care professionals be expected to have an education as well? Look at how many people attend universities. It is not just a few people but hundreds of thousands.

For nurses there is also no excuse not to go for the higher degree with grant programs and Federal assistance as well as the hospitals being willing to pay for it and work with ones hours. The LPNs who have had every opportunity to take advantage of the hospitals' offers to upgrade have no one to blame but themselves. But then we have now seen this in almost every health care profession in the hospitals. Those where chose to remain as "techs" and ignor the future have often found themselves left out.


----------



## MrBrown (Feb 17, 2010)

In New Zealand you can't become an RN or a Paramedic without a Bachelors Degree.  We have all but done away with the lower level nurses although some do exist out there but I think they're pretty few and far between.

I envisage in a year or two it will be pretty much impossible to be hired as an Ambulance Technician here and I expect that majority of our new paid Officers will be Degree graduates at Paramedic (ILS) level.

My understanding was California wanted to do away with EMT One (Basic) and use only EMT Two (Intermediate) and Paramedic.

Given thier past position on the National EMS Education Standards and a bunch of other issues, I am waiting for the outcry from the Fire unions about how the US cannot have Degree Paramedics.

The local experience seems to be that Degrees do increase instutional and clinical knowledge which is ultimately a good thing but that you must be careful in how they are delivered to avoid a whole bunch of graduates who are a culture-clash and not work ready.


----------



## JPINFV (Feb 17, 2010)

MrBrown said:


> My understanding was California wanted to do away with EMT One (Basic) and use only EMT Two (Intermediate) and Paramedic.



Just curious, but where did you hear that? Right now, California is moving towards adopting the new standards and titles (EMT 2010 project). Similarly, to adopt AEMT as the entry level would require a huge paradigm shift from EMT-II as being "limited advanced life support" (current paradigm) to "EMT-1 plus."


----------



## MrBrown (Feb 17, 2010)

JPINFV said:


> Just curious, but where did you hear that? Right now, California is moving towards adopting the new standards and titles (EMT 2010 project). Similarly, to adopt AEMT as the entry level would require a huge paradigm shift from EMT-II as being "limited advanced life support" (current paradigm) to "EMT-1 plus."



I am honestly not sure, maybe I misinterpreted something you said or saw it somewhere on the internet or in the wind.

Perhaps I am confusing that with the Los Angeles EMT One Expanded (!) SOP project


----------



## fortsmithman (Feb 17, 2010)

skivail said:


> That is interesting as it seems Canada, or at least Ontario is moving in the opposite direction.



I think that's because our RN's are being recruited by US hospitals when they graduate.


----------



## VentMedic (Feb 17, 2010)

fortsmithman said:


> I think that's because our RN's are being recruited by US hospitals when they graduate.


 
Canadian RNs are a nice recruitment because they do generally do have more than just a two year degree.   Their education level is a welcome asset here in the U.S. and they are usually able to land a nice ICU position easily. 

Interesting info from the Canadian Nurses' Association:
http://www.cna-nurses.ca/CNA/nursing/education/baccalaureate/default_e.aspx

One of the advantage of being an RN instead of just an LPN is the opportunity to travel.   An RN can go just about anywhere they can get a license for short or long assignments with just about all expenses paid.


----------



## mycrofft (Feb 17, 2010)

*Economic backlash*

RN's get laid off, then LVN's get laid off so cheaper RN's can work their jobs.
LPN and LVN were invented during wartime for the same reason all the intermediate types of EMT were invented between EMT-A and EMT-P: get more work for less money at a higher techncal, but not professional, standard.

Organizations "warehouse" RN's when their wages drop. Right now RN's are being forced to take cuts, work on call or part time, and the RN mills (many bankrolled by hospitals and some HMO's in the late Nineties to present) are still working in overdrive.


----------



## VentMedic (Feb 18, 2010)

mycrofft said:


> Organizations "warehouse" RN's when their wages drop. Right now RN's are being forced to take cuts, work on call or part time, and the RN mills (many bankrolled by hospitals and some HMO's in the late Nineties to present) are still working in overdrive.


 
The "RN mills" still must meet the minimum national standard for testing which is not with the wide range of "hours" like EMS.    The mail order programs like Excelsior are also very much under scrutiny and banished from many states since they have only 2 weeks or less of clinicals.

Fortunately, like nursing, EMS (or at least the NREMT) is getting the message and eliminating the Intermediate. 

I also saw where a couple areas in Canada are rewriting their LPN programs to increase the education content to compliment the skills.  

Right now very few professions, medical and nonmedical, are immune from pay cuts.  You can not just state it is an RN thing.  In northern CA, a dollar/hr off their hourly wage is still going to leave them making a very decent take home  check.


----------



## Outbac1 (Feb 18, 2010)

Around here LPNs seem to be moving upward. Their education and skill set is now not much different than the old 2 yr RN diploma, so some LPNs have told me. It's been the best part of 20 yrs since you could take a 2 yr RN diploma here. It is all a 4yr BSN degree. In fact many of the 2yr RNs are upgrading to a BSN degree. Most of these nurses are in their late 30's / early 40's. 

 As to EMTs, we don't have them. Its been 9yrs since we have had any sort of EMT/P1 type courses. Our short course now is 10 months of full time school.  Degrees in EMS aren't that far away here. They will be here sooner than we think.


----------



## fortsmithman (Feb 19, 2010)

Outbac1 said:


> As to EMTs, we don't have them. Its been 9yrs since we have had any sort of EMT/P1 type courses. Our short course now is 10 months of full time school.  Degrees in EMS aren't that far away here. They will be here sooner than we think.


Medicine Hat College and University of Toronto at Scarborough offer Bachelor degree programs in EMS.  Medicine Hat College offers an ACP program and U of T offers a PCP program.


----------

