The Use of Licensed Practice/Vocational Nurses in Clinical Settings
Position
The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) recognizes that licensed practical nurses (LPNs), also known as licensed vocational nurses (LVNs), can function as supportive members of the health care team. In a nursing care team that represents the collaboration of varied skill sets, the well-trained LPN/LVN can be a successful additional team member providing safe and efficient patient care. The LPN/LVN should function at their highest level of education, competency, and scope of practice as defined by state regulations and organizational policies. The professional registered nurse (RN) is responsible for a comprehensive assessment, planning, coordinating, and delivering care and can delegate appropriate nursing care to LPNs/LVNs caring for pregnant people and their newborns.
Background
Over the centuries, nurses have been at the core of health care services. However, demographics, disease, health care structures, technological advances, and conflict have shifted the focus of the attention of nursing teams to meet the challenges of nursing shortages, patient safety, and quality of care. To mitigate these challenges, the health care team may include advanced practice RNs (APRNs), RNs, LPNs/LVNs, and assistive personnel Association of Women’s HealthObstetric & Neonatal Nurses, 2022a. There are more than 900,000 LPNs/LVNs in the United States (National Council of State Boards of Nursing National Council of State Boards of Nursing, 2021 who represent a slightly more diverse workforce than their RN colleagues, with LPNs/LVNs reporting demographics of 17.2% Black, 10% Hispanic/Latinx, and 69.5% White nurses Committee for, 2016; Smiley et al., 2021 Between 2015 and 2020, the percentage of LPNs/LVNs employed in a nursing home/extended care setting decreased as the percentage employed in an acute care/hospital setting increased. The number of LPNs/LVNs employed in women’s health, obstetrics, and/or neonatology has remained steady between 2015 and 2020, accounting for less than 3% of the LPN/LVN workforce Smiley et al., 2021. The LPN/LVN scope of practice requires appropriate supervision by an RN, APRN, physician associate/assistant, or physician to facilitate, coordinate, and maintain compassionate, efficient, quality care and the achievement of desired treatment outcomes National Council of State Boards of Nursing, 2005b. Although the scope of practice for the LPN/LVN has been lessened in acute care in recent years, their role is integral to support the health care team through task-driven responsibilities MacLeod et al., 2021.
The LPN/LVN is responsible for the knowledge and skills necessary to provide nursing care appropriate to the patient population served. As United States nursing traditions and titles developed throughout history, each state developed separate training standards and regulations for LPNs/LVNs, introducing challenges in creating a summative position statement for all LPNs/LVNs throughout the United States. This position statement attempts to provide some common themes.