practical nurse

This American link ( gives an excellent insight into the cost-driven type of nursing which is to be introduced into the UK, as a result of government deliberation on calls by Hospital Trust managers to ‘adjust’ the nursing mix by enabling nurse assistants to ‘train up’ and take over more tasks that were once confined to registered nurses.

The UK version of American Licensed Practical Nurse (LPN) training will be known as Associate Nurse Training. (ANT).

This will be based on the American system of the trainee (or their sponsor, the Trust Hospital), paying, or co-paying, for the cost of the course.

The section of the above given website entitled ‘Cost of LPN Programs & Schools’ gives what I consider will be an accurate reflection of the costs to trainees and/or their sponsors, it can be noticed that payment can be based on an assessment of needs approach:

‘Grants can come from the federal or state governments. They can also come from companies, organizations, colleges, or individuals. Grants are usually need-based. This is money that does not need to be repaid. It is given on a basis of financial need’. To put this into context: ‘Average cost of tuition for LPN programs is about $10,000 to $15,000 nationally’, for a typical 18 months course.

The section entitled ‘Working As A Licensed Practical Nurse (LPN), What Do LPN’s DO?, gives an expansive list of nursing tasks that LPN’s carry out, in the context of which the registered nurse is the organiser of ‘broad plans of care’; ‘At work, the RN usually organizes the patient’s broad plan of care, which is something the LPN then helps to carry out’. This system allows for less ‘generals’ and more (cheaper) ‘captains’.

The LPN may:

•Administer oral and intravenous medications
•Chart in the medical record
•Take the patient’s vital signs
•Change wound dressings
•Collect specimens such as blood, urine, sputum, etc
•Insert and care for urinary catheters
•Care for patients with tracheostomy tube and ventilators
•Insert and care for patients that need nasogastric tubes
•Give feedings through a nasogastric or gastrostomy tube
•Care for ostomies
•Monitor patients for a change in clinical condition
•Call the physician if needed
•Perform CPR in emergencies
•Are supervised by an RN
Although each state sets the scope of practice for the LPN, each organization can narrow the scope. It is important, therefore, to know what the specific organization does not allow the LPN to do. In some organizations, but not all, the RN is expected to carry out the following tasks:

•Start, monitor, and/or discontinue intravenous catheters or the intravenous fluids
•Start, monitor, or change critical intravenous medications that stabilize the heart or blood pressure
•Take phone or verbal orders from the MD
•Administer intravenous medication that are given “push” or very quickly
•Care of central intravenous lines (that go to or near the patient’s heart)

My main concern with this system is the lack of legal accountability of LPN’s; the onus for mistakes will be placed on fewer registered nurses.

Be that as it may, the LPN/Associate Nurse, will not be ‘registerable’ by the NMC (as yet?), and the way would seem open for unions such as UNISON and UNITE, who already represent many nursing assistants in the NHS, to (1) sponsor/co-sponsor members’ training (with members paying a set amount out of their monthly salary); (2) set up their own registration body, which will adjudicate over complaints about members’ actions and attitudes concerning nursing duties. The RCN, of course, will also be free to battle for the subscription fees of Nurse Associates.

This model, of people already involved in nursing tasks being the main body of recruits to Nurse Associate training, will be the norm in the UK.

The training of the new (old SEN, in reality) breed of practical nurses will be college based, probably on a day/s release basis.

There will be the prospect of graduates of this programme becoming a degree level registered nurse, although there will be substantially fewer of these required.

The only entry into nursing will be via this new (old, in reality) type of training.

The only way for university nurse education departments to (substantially) survive will be to amalgamate with their equivalents in local colleges, to offer ‘a seamless career in nursing’, with universities/lecturers ‘overseeing’ college based courses/validating training materials, of which there is a large amountin America, which could be ‘fine tuned’ for UK needs.

The Nurse Associate, I predict, will be the only ‘nurse’ in nursing homes.

Any debate on defending the status quo is rather like Canute and his courtiers chatting with the tide up to their belly buttons.

All the best, dearhearts,

lenin nightingale 2016



  1. The point is that what is best for patients should be the only thing driving nurse training, and all nurses should support this. Many believe that having more degree trained nurses leads to better patient outcomes (but only by selected clinical measures, and compassion in care is not measured); others believe in having ‘more hands on deck’ , so as to ensure that basic needs are met, but, again, these needs are not met if the nursing crew are lazy and uncaring. The public would rather have a fair level of efficiency with a caring attitude, than a better level delivered by those not fit to nurse, however trained. Lenin

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