When I began working in this field, I was astonished to realize that very few nursing homes and no assisted living facilities have a full-time doctor working there. I found that facilities at times may be staffed almost entirely with nurse aides and Licensed Practical Nurses (LPN) as opposed to Registered Nurses (RN). RNs received far more training and education than LPNs and are able to do far more. LPNs are supposed to do most activities under the direction of a RN and their duties are limited to collecting data. For example, LPNs cannot assess residents for injury after a fall.
This problem was recently highlighted in an article in the New York Times. It reports a study that shows that 11.4 percent of nursing homes did not have an around the clock RN. This is significant because, as the article states, “With higher registered-nurse staffing, patients have fewer pressure ulcers (aka bedsores) and urinary tract infections and catheterizations. They stay out of hospitals longer. Their homes get fewer serious deficiencies from state inspectors. Their care improves, but it costs less.”
As a result, legislation entitled Put A Registered Nurse in the Nursing Home Act, or House Vote 5373, was proposed by Jan Schakowsky (D-Illinois) and six other democrats. You can read the full article here.
I’ve personally encountered facilities that staff with LPNs and then have them conduct activities they should not do, such as assessing injuries and pain. In some cases they are not competent to do these activities and serious and sometimes mortal injuries go undiagnosed leading to amputation and death.
Why aren’t there more RNs? In short, cost. RNs cost more than LPNs, and if the nursing home company does not offer good enough pay, RNs choose higher paying jobs in hospitals.
Hopefully, the legislation will pass and resident will all see the benefits of properly staffed facilities.