I met Jimmy Thompson on my first day of work on the medical and coronary care unit at Walson Army Hospital in Fort Dix, New Jersey, in 1970. He had been an army medic, then worked as an LPN after retiring from the military. A civilian, he sometimes reported to me (I was the unit's new Army Nurse Corps second lieutenant), but we both recognized that I'd arrived with fewer critical care skills than he had. Highly respected for his technical expertise, Mr. Thompson was the man to call when nurses or physicians couldn't start an IV.
He was not one to flash his skills. He waited for you to come to him, which I did. I worked with him for three years. During my last week on the job, he had trouble starting an IV and asked me to try it. When I started it on my first try, I thanked him for being such a good teacher.
Many nurses confuse educational level with clinical excellence. I had more education than Mr. Thompson, but he was certainly a better clinician than I was when I met him, even if in the end my educational preparation enabled me to become the more knowledgeable, skilled clinician.
This month AJN publishes what may be a controversial article by Jean Seago and colleagues that advocates expanding the LPN workforce as a way of ameliorating the nursing shortage. The question of the appropriate educational level for entry into the nursing workforce-whether at the technical or professional level-has evolved into a polarized debate that has left nurses with little common ground to stand on. The escalating cost of a baccalaureate education (now an average of $5,491 for public colleges and $21,235 for private ones) and the urgent need for more nurses means we need to have many routes to entry into nursing. As Seago and colleagues demonstrate, some people enter LPN programs because they can't afford even an associate's degree.
Here are some ways to enhance the education of all nurses, whether LPNs or RNs.
Smooth the LPN-to-RN path.
We have one of the best educational ladders of any profession. The weakest link is from LPN to RN. As Seago and colleagues note, we need to expand the articulation programs for these clinicians and provide more scheduling options for working students.
Encourage all states to emulate New York State's approach.
The state is considering a proposal that would require RNs to have a baccalaureate within 10 years of licensure. This requirement would apply only to new graduates, not to those already practicing-an exception that makes the proposal palatable to nurses with associate's degrees or diplomas who have been practicing for decades and see no need to return to school. (For an excellent analysis of the proposal, see David Keepnews's editorial "A Fresh Approach to an Old Issue" in the February issue of Policy, Politics, and Nursing Practice.)
The weakest link in education is the route from LPN to RN.
Urge facilities to expand tuition reimbursement for LPNs and RNs to pursue baccalaureate education, for nurses with bachelor's degrees to pursue master's degrees, and for nurses with master's degrees to pursue doctorates. As Seago and colleagues note, nurses will choose to further their education when it means a substantial increase in wages. Unions should be including such approaches in their bargaining agreements; some already provide financial support for LPNs to become RNs.
Demand more local, state, and federal funding for loans and scholarships that can support a student's life, as well as tuition and fees. The Johnson and Johnson campaign (http://www.discovernursing.com) has expanded nursing scholarships, and the Nurse Reinvestment Act (NRA) has provided additional loans and scholarships, but it's not enough. Under the NRA, only $31 million was allocated for loans and scholarships, instead of the $283.5 million needed to support all applicants. According to Robert Rosseter, associate executive director of the American Association of Colleges of Nursing, of 3,379 applicants for NRA scholarships this year, only 212 (6%) were funded.
Let's move forward on this common ground: to provide enough well-trained nurses to meet our nation's growing need.