Licensed practical nurses (LPNs) want to take on more leadership responsibilities – and operators want them to be in such positions – as the pandemic, coupled with the Patient-Driven Payment Model (PDPM) and staffing crisis, force employers to rethink paths to promotion .
The LPN wasn’t always the first choice for leadership positions, according to Cathy Mendez, an LPN at Trilogy Health Services. The pandemic has given these nurses a unique opportunity to prove what they can do while there is a spotlight on the sector, she said.
What’s more is that Trilogy is listening. The operator is considering opening the assistant director of nursing role to LPNs, a leadership role usually reserved for RNs.
“I feel like the LPN has the ability to shine through the pandemic, to show what abilities we have and where we can help,” Mendez said. “LPNs are going to be able to help within a leadership role … let them see how our schooling has helped us get where we are, and change our roles as we’ve progressed in the last couple of years.”
For those looking to step into a more management-type position at Evangelical Lutheran Good Samaritan Society, the nonprofit organization opened up charge nurse and nurse manager roles, or created new positions where the LPN can lead teams of CNAs and other LPN colleagues, according to Rochelle Rindels, vice president of nursing and clinical services.
Employers seek to fulfill that growth LPNs are asking for, Rindels said, through such newly created roles.
“If they’re in school, or if they get a certain certification, I feel like that’s something that eventually could be opened for the LPN role,” said Mendez. “There’s definitely been some openings [for leadership positions and specializations] as we go further out of the pandemic years.”
Leadership duties in a time of crisis
Mendez has felt added responsibility placed on the role since the pandemic began. Some of the added duties already fell within the LPN scope of practice, but executives are increasingly looking to the LPN to work at the top of their license.
This sometimes means stepping into management roles, or sidestepping to pick up certifications in specialized areas of care.
“LPNs are able to be in leadership positions a little bit easier than pre-pandemic, to be able to help with the burden of nursing … in the midst of the pandemic,” she said.
Compared to the RN, an LPN has to “get their feet wet a little quicker,” Mendez said, as the position can start on the front lines sometimes within a year depending on the state.
The typical day for an LPN prior to the pandemic included caring for 25-plus patients, including medication passes – each resident would have on average eight medications, according to former long-term care LPN Stephanie Tutt.
Resident assessments, with doctor and family notifications for anything outside of a normal range, charting and blood sugar checks, skin assessments and in most cases helping CNAs with daily living activities continue to be part of the LPN’s day, Tutt said.
Even pre-pandemic, Mendez saw executives start to place more weight behind what the LPN had to say, perhaps an after effect of PDPM.
“We see the big picture, based on our assessments that we’ve learned to do. There’s a lot of weight put on what we have to say as a whole to help our residents and their daily care and daily lives, to make improvements and make their days great, which is the ultimate goal,” she said.
LPNs have always been good candidates for administrators down the line, among other leadership roles, Rindels said. In fact, she started out as an LPN in the nursing home sector before becoming a registered nurse (RN) and most recently a director of nursing services (DNS).
“[The role] is definitely a stepping stone into the vast opportunities that are available in nursing,” she added. “Our LPNs love the work that they do. They love building relationships with the residents and being a part of birthday parties and anniversaries … really becoming like family.”
A fluid role
The LPN role is very “fluid,” Rindels said – someone in this role wants to be next to the resident and identify any needs they have, but also look at the bigger picture for a particular resident’s overall care plan.
“LPNs are an extremely valuable and essential part of our care team. They are on the front lines with the residents. They’re the eyes and the ears,” Rindels said. “They help contribute to the overall comprehensive plan of care.”
LPNs continue to work side-by-side with CNAs and registered nurses to provide 24-hour nursing care while also being essential to data collection and documentation, Rindels added.
In terms of education and training roles, Good Samaritan has worked with five to six different state boards of nursing to identify where an LPN can act as a skill validator, or as an educator to test core competencies for direct care staff at each facility.
Rindels said performing MDS duties has been another expansion of the LPN role and duties, specifically contributing to the MDS assessment through data collection.
“We really wanted to allow our LPNs to work to that full scope of practice and type of license,” Rindels said. “And so that was one thing that we had changed to allow more LPNs to step into those MDS positions.”
The rural nonprofit opened up the LPN position to cover infection prevention roles and quality coordinator positions too. SLPN experience is a “great complement” to these particular specialties, she said.
As a former LPN, Rindels would like to see the skill set grow to include nursing interventions, along with other leadership opportunities and general exposure to specialist programs like IP.
“It really just creates a more well-rounded caregiver when they’re part of those programs,” she noted.