Interchangeability of Licensed Nurses in Nursing Homes: Perspectives of Directors of Nursing

Background: Licensed nurse (registered nurse [RN] and licensed practical nurse [LPN]) roles in nursing homes are often viewed as interchangeable. Interchangeability occurs when the differences in RN and LPN education and scopes of practice are not recognized or acknowledged, leading to staffing patterns where the roles and clinical contributions of RNs and LPNs are perceived as equivalent. Purpose: This study describes the perspectives of directors of nursing about interchangeability between RNs and LPNs and factors that contribute to interchangeability. Method: This is a secondary analysis of data from a larger study in which 44 Directors of Nursing from Nurisng Homes in two different states were interviewed about their perceptions of the roles of RNs and LPNs. Findings: Interchangeability of RNs and LPNs was influenced by directors of nursing's knowledge and awareness of the scopes of practice for the two types of licensed nurses, corporate policies, and educational background of RNs. The findings suggest opportunities for better differentiating roles through the use of job descriptions that more clearly delineate the distinctive contributions of both RNs and LPNs in nursing home settings. Discussion: While increasing the number of RNs in nursing homes is desirable, there is immediate opportunity to ensure that the few RNs in nursing homes are used effectively to ensure that the professional nursing care needs of residents are met.