In Response to: LPNs in modified care delivery models

Dear Editor,

The September issue of American Nurse published a paper entitled LPNs in modified care delivery models reporting on a pilot initiative to implement “team nursing.” I applaud the authors for taking an evidence-based approach to pilot their model.

However, there are significant errors, the worse one being defining LPNs as “licensed professional nurses” instead of “licensed practical nurses.” Authors imply the model they are testing is an “interprofessional team” model of care delivery, which is a misuse of the term as the only professionals on the team are RNs; the rest are not professionals but LPNs and aides. This is a common error in recent papers about “team nursing” that should be challenged.

The authors go on to say that literature identified introducing LPNs into delivery models as a “best practice.” That is not accurate as there is robust research showing that the greater the number of LPNs in hospitals, the worse the outcomes for patients. Needleman published an influential paper in Health Affairs, Nurse staffing in hospitals: Is there a business case for quality?, documenting that replacing LPNs with RNs in hospitals would save lives and money. The authors’ concluding remarks, that less than competitive acute care LPN compensation may create barriers to the recruitment and retention of LPNs, describes one of the reasons why LPNs were dropped from the hospital nursing workforce in large numbers decades ago — when used in the acute hospital nursing workforce their unions negotiated higher LPN wages narrowing the wage differences with RNs and reducing potential cost savings.

The shortage of nursing care in hospitals is real and we should continue to search for rigorous evidence-based solutions.

Sincerely,
Linda H. Aiken, PhD, RN, FAAN
Philadelphia, PA

References

Jack Needleman 1, Peter I Buerhaus, Maureen Stewart, Katya Zelevinsky, Soeren Mattke, Nurse staffing in hospitals: is there a business case for quality?  

Authors’ Response

Licensed professional nurses should be licensed practical nurses. That was an error our team should have caught. (Editor’s note: This has been corrected in the article online.)

Regarding the EBP approach, we’d like to clarify that it’s not that we are intending to imply that LPNs are an improvement over RNs; there is simply a shortage of RNs available for hire to sustain current staffing/care delivery models.

The reintegration of LPNs into the acute care setting allows another way of caring for our patients, providing exceptional care and fostering teamwork within the unit.

Another Reader Response

Dear Editor,

I am writing in response to the article LPNs in Modified Care Delivery Models published in Volume 18, Issue 9 of the American Nurse Journal. This article discusses the introduction of LPNs into the healthcare delivery team in the inpatient hospital setting as a solution to the critical nursing shortage. Including LPNs into staffing decisions can increase a unit’s overall job satisfaction, communication, and workflow (Bilyeu et al., 2023).

Team nursing is a logical approach for clinical areas with severe staffing shortages. As a profession, we must utilize our resources to provide patients the care they deserve. Introducing team nursing models with LPNs into acute care settings is a cost-effective method to combat staffing issues. Team nursing allows members to work at their maximum scope of practice, which drastically improves patient outcomes, allows care to be more efficient, and alleviates some of the burden of staff (Robinson et al., 2023). This staffing model allows LPNs to do tasks for the RN so they can concentrate on complex patient care or critically ill patients. LPNs employed in hospital settings often show excitement about working in a fast-paced environment and bring a positive morale to the department they work in while RNs report more manageable patient loads and improved teamwork (Robinson et al., 2023). Since COVID-19, the nursing profession has reached a critical shortage in staffing, and team nursing has been proven as an effective method for resource allocation (Jones et al., 2022).

Sincerely,
Morgan Studdard, RN, BSN, CMSRN
Jacksonville, Fla.

References

Cathlyn Robinson 1, Mary Beth Russell, Michelle Eaton, Nancy Holecek, Maureen Harding, Nicole Martinez, Renewing the care team model: Leveraging the LPN role in the acute care setting

Kelly L Jones 1, Maren R Johnson 2, Andrea Y Lehnertz 3, Robert R Kramer 4, Kelly E Drilling 5, Lisa D Bungum 6, Sarah J Bell, Rapid Deployment of Team Nursing During a Pandemic: Implementation Strategies and Lessons Learned