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After 15 years as an RN with an associate's degree, I received my bachelor of science in nursing (BSN) in May and am working on a master's degree. I have no doubt that I've provided good care to my patients. What I lacked was care for my own professional life, and the consequences were beginning to show.


People enter nursing with the promise of a profession, then they're taught to be technicians. Nurses practicing with less than a BSN may have excellent assessment and clinical skills, but they're not treated as full, equal members of the health care team because their professional skills are not equal to those of other team members. After many years of working with only an associate's degree in an increasingly complex health care environment, I nearly left the profession. But I stayed, and through higher education I've found the skills I need to continue. I wish it had been required of me years ago.


One year of nursing school, or even two, isn't enough to sustain a lifelong career in nursing.


Shelly Kuhns, BSN, RN, CCRN, TNS


Mason, IL


I became a practical nursing instructor in 1980 and in 1987 was promoted to program director, a position I held until 2001. During nursing shortages, my graduates were embraced by local hospitals. When nurses weren't so scarce, my graduates weren't allowed even to fill out an application. If jobs were plentiful, we struggled to fill a class. If the economy was distressed, we received three applications for each available spot.


Because LPNs have been denied hospital positions, they have become an important part of extended-care staffing. The LPN is allowed greater responsibility and given more respect in such settings. But even if hospital administrators and policymakers decide to welcome LPNs as team members, will they then turn their backs on them when the nursing shortage eases? I strongly support a ladder mechanism for moving up in nursing education. Why are we still debating this issue?


Sheila M. Warner, MSN, RN


Erie, PA


I discourage aspiring nurses from first becoming LPNs. Many college programs don't accept as prerequisites courses taken in an LPN program, requiring the LPN nearly to start over if he wants to become an RN. The associate's degree doesn't take much longer than the LPN program, and those credits usually transfer if the nurse wants to further his education.


We should strive for a culturally diverse RN workforce-even though significant cultural barriers in academia and in the workplace still exist. Anyone who can complete the LPN program can become an RN with the proper encouragement and economic support. When looking for ways to alleviate the nursing shortage, we should avoid shortcuts and Band-Aids. Recruiting minorities to become LPNs does not best serve anyone. Instead, let's help everyone reach his highest potential.


Gail Rattigan, MSN, RN, FNP-C


Henderson, NV


In 1979 I was a director of nursing in a 350-bed long-term care facility in Wisconsin. LPNs made up the core of the nursing staff; RNs supervised. A powerful legislative initiative sought to eliminate LPN and diploma nursing programs because they created technical, not professional, nurses. The bill never passed, but it did some damage. Within a few years, several LPN schools in the Milwaukee area closed.


Today, home care agencies want to increase the use of LPNs as caregivers. In most states, LPNs can provide wound care, change catheters, or give injections, freeing up RNs for more complex tasks.


LPNs aren't RN substitutes. The challenge is to recognize LPNs' abilities and develop a team that makes the best use of every member's skills.


Diane J. Omdahl, MS, RN


Mequon, WI


Articles like these are showing how the LPN can take over aspects of the RN's practice. So many RNs have left nursing; we want to touch our patients, hear their laments, and participate directly in their recovery. It seems that LPN education has improved, sometimes including microbiology and nutrition, which have been eliminated by many associate's-degree nursing programs. Hospital administrators want to employ LPNs because they are "cost effective." But RNs must take a stand: let's delegate the paperwork to LPNs and take back our hands-on practice. Let's not put ourselves out of business.


Sue Berger-deRada, RN, LMT


Pearl River, LA


In her accompanying commentary ("Concerns Remain About LPNs' Scope of Practice and Recruiting Minorities to Become LPNs"), Catherine Georges correctly points out that sometimes students are compartmentalized in primary and secondary schools and then tracked into nursing programs beneath their ability. However, I've seen many underserved students feeling incapable of handling the rigors of higher education. Community college education is designed with this type of student in mind. We're committed to step-by-step remediation and providing access for them. This, in my opinion, is what attracts students, many of whom are underprepared educationally, have financial restrictions or language barriers, and lack self-confidence.


Four-year colleges and universities falter with this type of student. They tend to be more selective in their admissions. The four-year time commitment is staggering to many.


Rather than discouraging potential nursing students from coming to community colleges or from becoming LPNs, it would better serve their needs and those of nursing practice if we worked together to move students with desire and ability from one level of education to the next. There's a place for every level of nursing; the roles simply need better definition, regulation, and salary delineation, and we, as nurses working together, are the only ones who can make that happen.


Deborah J. Orre, MSN, RN


Gardner, MA


As an RN with a baccalaureate, I was mentored twice by LPNs who were kinder and more patient than most of the RNs I worked with, and I related well to the story Diana Mason relates in her editorial. But I was uncomfortable when I read that Mason had become a "more knowledgeable, skilled clinician" than her LPN mentor. If he had helped her to become a better clinician, why was she "more" than he was? I doubt she intended to condescend, but that's how I took it.


The loss of three-year hospital training programs, with their "practical" second- and third-year students, who were often used as extra hands, has compromised patient care on medical and surgical units. Maybe it's time to reconfigure nursing positions and staffing patterns in hospitals.


Janet D. Robinson, MEd, RN, CIC


Providence, RI


We made our mistake when we called LPNs "nurses" in the first place. What will we do next? Let them join the American Nurses Association? LPNs overstep their bounds. They think they know things that they don't. I am shocked that the authors would take the position their article espoused.


Dana Mason, EdD, BSN, RN, CNS



We published a news story on Medscape Nurses in July ("Licensed Practical Nurses May Be Able to Fill Gap in the Nursing Shortage,", highlighting AJN's article on the use of LPNs in alleviating the nursing shortage. We offered an online discussion forum for readers to voice their opinions and more than 400 did so. (See


The responses ranged from those extolling the skill and work ethic of LPNs to others pointing out the differences in educational background between the two groups ("RNs should know the why, not only the how"). Many also commented on state nurse practice acts, pointing out that the roles of RNs and LPNs are not interchangeable. Some readers brought up the issue of the need for a standard bachelor of science entry into practice, believing that using more LPNs is a "short-term fix that just perpetuates this issue, and does nothing to provide a long-term solution."


Many LPNs wrote that they had considered further education but found that there were not enough LPN-to-RN programs available that were affordable and accessible. One reader pointed to using our energies to "strive for better working conditions, incentives for LPNs to earn their RN licensure, and incentives for experienced RNs to remain in practice [horizontal ellipsis] [as] obvious solutions to the nursing shortage."


At Medscape Nurses, we find that issues related to the nursing shortage, roles, compensation, and working hours elicit the most response from our readers. Thanks to Jean Ann Seago and colleagues and AJN for investigating one approach to alleviating the nursing shortage. It's obvious that we need a variety of workable solutions-soon.


Susan Yox, EdD, MSN, RN


Editorial director, Medscape Nurses