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Practical Nurses
Significant Points
  • Most training programs last about 1 year and are offered by vocational or technical schools or community or junior colleges.
  • Overall job prospects are expected to be very good, but job outlook varies by industry.
  • Replacement needs will be a major source of job openings, as many workers leave the occupation permanently.
Nature of the Work

Licensed practical nurses (LPNs), or licensed vocational nurses (LVNs), care for people who are sick, injured, convalescent, or disabled under the direction of physicians and registered nurses. The nature of the direction and supervision required varies by State and job setting.

LPNs care for patients in many ways. Often, they provide basic bedside care. Many LPNs measure and record patients' vital signs such as height, weight, temperature, blood pressure, pulse, and respiration. They also prepare and give injections and enemas, monitor catheters, dress wounds, and give alcohol rubs and massages. To help keep patients comfortable, they assist with bathing, dressing, and personal hygiene, moving in bed, standing, and walking. They might also feed patients who need help eating. Experienced LPNs may supervise nursing assistants and aides.

As part of their work, LPNs collect samples for testing, perform routine laboratory tests, and record food and fluid intake and output. They clean and monitor medical equipment. Sometimes, they help physicians and registered nurses perform tests and procedures. Some LPNs help to deliver, care for, and feed infants.

LPNs also monitor their patients and report adverse reactions to medications or treatments. LPNs gather information from patients, including their health history and how they are currently feeling. They may use this information to complete insurance forms, pre-authorizations, and referrals, and they share information with registered nurses and doctors to help determine the best course of care for a patient. LPNs often teach family members how to care for a relative or teach patients about good health habits.

Most LPNs are generalists and will work in any area of healthcare. However, some work in a specialized setting, such as a nursing home, a doctor's office, or in home healthcare. LPNs in nursing care facilities help to evaluate residents' needs, develop care plans, and supervise the care provided by nursing aides. In doctors' offices and clinics, they may be responsible for making appointments, keeping records, and performing other clerical duties. LPNs who work in home healthcare may prepare meals and teach family members simple nursing tasks.

In some States, LPNs are permitted to administer prescribed medicines, start intravenous fluids, and provide care to ventilator-dependent patients.

Work environment. Most licensed practical nurses work a 40-hour week. In some work settings where patients need round-the-clock care, LPNs may have to work nights, weekends, and holidays. About 18 percent of LPNs and LVN’s worked part-time in 2008. They often stand for long periods and help patients move in bed, stand, or walk.

LPNs may face hazards from caustic chemicals, radiation, and infectious diseases. They are subject to back injuries when moving patients. They often must deal with the stress of heavy workloads. In addition, the patients they care for may be confused, agitated, or uncooperative.

Practical Nurse, GS-0620-03

Nature, range, and complexity of work

Performs nursing care in a medical ward for the purpose of receiving orientation to the hospital facility, the ward, and its operating procedures while performing the following representative tasks:

  • Obtain orientation to the hospital, the ward, its staff members, medical patients and operating procedures.
  • Provide nursing care for and assistance to patients in meeting their personal hygiene needs such as bathing, feeding, lifting and turning.
  • Obtain and label routine urine, stool and sputum specimens.
  • Measure and record body temperature, pulse, respiration and blood pressure for the patient's records.
  • Perform such treatments and procedures as hot and cold compresses, enemas, sterile dressings and sitz bath.
  • Provide environmental safety, security and patient privacy.
  • Assist the doctor or nurse in patient examinations.
  • Prepare and administer prescribed medications.
  • Teach family and patient how to perform certain tests, e. g., the common urine test.
  • Practical Nurse, GS-0620-04

    Nature, range, and complexity of work

    Performs a range of standard patient care in a surgical ward.

  • Tube feeds and bathes patients, providing lifting, turning and oral, nail, hair and related hygiene care.
  • Observes the patient and reports gross changes in the patient's vital signs, symptoms and general physical and emotional condition for inclusion in the patient's care plan.
  • Performs treatments such as wound care, sterile dressing changes, irrigations and whirlpool baths.
  • Responds to emergency situations such as cardiopulmonary arrest.
  • Sets up and gives treatments that require the assembly and operation of special equipment such as oxygen and respirators.
  • Performs laboratory tests such as checking urine for sugar and stool for blood.
  • Prepares and administers prescribed medications (oral, topical and intramuscular) and observes for physical and emotional contraindications from the medications.
  • Teaches patient and family members how to perform certain tests and self-care such as the common urine test and diabetic self-care.
  • Practical Nurse, GS-0620-04

    Nature, range, and complexity of work

    Carries out difficult nursing care for patients with severe respiratory conditions in a pulmonary ward of a large medical center.

  • Observes, reports and records in the patient's care plan significant conditions, both physical and emotional, obvious and subtle, which have relevance to the health status of the patient. Gives special attention to details of care, since patients often are too ill to speak.
  • Performs such nursing procedures as lifting, turning, tube feedings, dressings and treatments of wounds, cleaning and retention enemas, inserting catheters, caring for patients' in isolation, giving treatments that require auxiliary equipment such as oxygen, suction and respirator, changing intravenous tubing, and monitoring and maintaining intravenous fluids including site care, and discontinuing intravenous fluids if difficulties develop, after conferring with the nurse.
  • Prepares patients for tests, examinations, treatments, and/ or surgery. Collects specimens such as urine, sputum and stool. Label specimens for laboratory examination and follows up by calling the laboratory for lab reports.
  • Reiterates and reinforces instructions for the patient and/ or family members that were previously presented by the doctor or nurse. Instructions may cover self-care, selected treatment measures and preparation for and after surgery.
  • Prepares and administers prescribed medications both orally and by intramuscular injection.
  • Recognized the need for and institutes emergency measures when indicated, calls the nurse and assists in resuscitation procedures in cardiac or respiratory arrest.
  • Practical Nurse, GS-0620-04

    Nature, range, and complexity of work

    Provides nursing care and other personal services to an average of two patients in a fourteen bed Medical/Surgical Intensive Care Unit. Duties require some specialized skill in, and knowledge of, patient care work. Patients are acutely ill medical patients, trauma cases and new postoperative patients. Some patients are on frames, use orthopedic devices, have multiple illnesses or are comatose.

  • Applies electrodes to patients placed on cardiac monitors. Continuously observes patients and keeps the nurse informed of changes in the patient's vital signs.
  • Recognizes and reports any deviations on the cardiac monitor oscilloscope.
  • Collects urine, stool and sputum specimens for laboratory tests. Maintains accurate fluid intake and output records. Lifts and turns patients. Checks neurological signs by pin prick.
  • Passes medications both orally and by intramuscular injection. Performs catheterizations, changes surgical dressings, sets up and gives patients respiratory therapy treatment, performs suctioning, and irrigates body orifices.
  • Monitors and maintains intravenous fluids, changes intravenous tubing, and discontinues intravenous fluids if difficulties develop.
  • Is familiar with the patient's infirmities from verbal information from nurses and doctors and from the patient's chart and nursing care plan. Is especially alert to changes in the patient's condition (heart beat, respiration rate) which must be called to the attention of the nurse.
  • Recognizes emergency situations and functions calmly and efficiently in supplying nurses and doctors with the crash cart and requested supplies and materials.
  • Records pertinent information in the patient's chart and supplies information for the patient's nursing care plan.
  • Performs colostomy care and instructs the patient/family members on appropriate care based on instructions previously presented by the doctor or nurse.
  • Assists in maintaining supplies and equipment by sorting and arranging supplies in prescribed ward manner. Checks dates of sterilization. Assures that equipment is in functional order by cleaning, assembling and testing diagnostic equipment, orthopedic devices, suction and drainage equipment and returning it to appropriate storage area. Observes and reports breakage and loss of equipment, safety hazards, and supply deficiencies.
  • Psychiatric Practical Nurse, GS-0620-05

    Nature, range, and complexity of work

    Provides nursing care to psychiatric patients with a variety of severe mental health problems that usually change within a predictable range:

  • Participates in patient care planning by serving as a member of the treatment team and suggesting nursing care actions.
  • Establishes, maintains and reports on therapeutic relationships with patients such as one-to-one therapy, reality orientation, and small group therapy referencing the patient's treatment care plan.
  • Reports and records gross and subtle observations and facts regarding patient treatment and progress.
  • Reinforces and reiterates instructions, previously presented by the nurse and/or doctor, that provide the patient/ family with information for self-care and follow up outpatient care.
  • Encourages patients to maintain self-care. Takes vital signs and specimens; supports the doctor in various diagnostic tests such as biopsies and lumbar punctures.
  • Performs nursing care treatments such as foot soaks or changes in sterile dressings.
  • Strives to maintain a ward environment which is oriented toward independent living.
  • Prepares and administers prescribed medications both orally and by intramuscular injection.
  • Recognizes the need for and institutes emergency measures when indicated by calling the nurse.
  • Identifies and meets needs of patients for information and guidance in daily living.
  • Promotes a sense of worth and dignity to the patient. Promotes patient participation in the therapeutic community by fostering increased self-reliance and independence and by involving patients not only in their own treatment plan but also that of other patients.
  • Psychiatric Practical Nurse, GS-0620-06

    Nature, range, and complexity of work

    Functions as a member of a psychiatric treatment team with a patient load of critically ill patients whose nursing care needs are not predictable. The employee is instrumental in changing the treatment plans established by the treatment team for assigned patients.

  • Conducts patient groups using a variety of treatment procedures (reality orientation, small group therapy, large group therapy) for the purpose of helping patients to interact and function in accordance with patients' treatment plans.
  • Establishes constructive relationships with individual patients (one-to-one therapy) for the purpose of exploring behavior, feelings and attitudes and promoting interpersonal relationships, communication, and socialization skills.
  • Identifies and meets needs of patients for information and guidance in daily living.
  • Promotes a sense of worth and dignity in the patient by such techniques as addressing the patient as "Mr. Jones".
  • Takes vital signs, takes specimens, and supports the doctor in diagnostic test such as biopsies and lumbar punctures. Assesses subtle changes in the patient's condition, such as slight changes in the patient's ability to speak or remember.
  • Leads large group meetings (e.g., 10 to 12 patients) with patients sharing thoughts and feelings with reference to the subject of the meeting and the behavior of the participants.
  • Prepares and administers prescribed medications orally and intramuscularly; monitors and maintains intravenous therapy.
  • Participates with the interdisciplinary team in the development, implementation and evaluation of the patient's treatment plan and the ward treatment program.
  • Participates in the admission of patients by collecting patient information, orienting patients to the ward, and checking them for contraband.

  • Recognizes emergency situations, responds promptly, and institutes appropriate action (initiates resuscitation measures in the event of cardio-pulmonary arrest).
  • promotes patient participation in the therapeutic community by fostering increased self-reliance and independence and by involving patients not only in their own treatment plan but also that of other patients. Before discharge, instructs patient and family on use of prescribed medications, contraindications of medications and the value of proper follow up care.
  • Practical Nurse, GS-0620-06

    Nature, range, and complexity of work

    Serves as a member of a nursing team with an assigned patient load of selected critically ill patients. Employee is responsible for patients from admission to discharge and has considerable knowledge, experience and skill for concentrated effort and self-motivation to carry out patient care assignments.

  • Observes patients' changing conditions and participates in updating patient care plans throughout the tour consistent with recognized nursing standards and in accordance with appropriate nursing care and prescribed medical treatment. Enters information about the patient's condition, an assessment of the patient's condition and a plan of action to carry out nursing care.
  • Supports the patient and/or family members in the integration of the patient care plan toward the achievement of discharge objectives. Provides instructions to patient on preoperative and postoperative procedures which were previously provided to the patient by the nurse or the doctor. After surgery, assists and instructs patients on how to keep lungs clear. Instructs patient on how equipment is used (oxygen, suction or respirator). Before discharge, instructs patient and family on use of prescribed medications, contraindications of medications and the value of proper followup self-care.
  • Performs a range of treatment procedures that includes using hot and cold packs; extensive sterile dressing changes; giving enemas; monitoring intravenous fluids; inserting catheter; inserting nasal gastric tubes, passing medications; caring for patients in isolation; and setting up and giving treatments that require auxiliary equipment such as oxygen, suction and respirator.
  • Performs a range of diagnostic support duties which includes taking vital signs, taking specimens, calling the laboratory for lab reports, recording lab reports given over the telephone, and assisting the doctor in a variety of diagnostic examinations such as lumbar punctures, liver biopsies, and bone marrow examinations by positioning patients and setting out and passing instruments.
  • Observes and documents all pertinent data regarding the physical and emotional status of patients. Promptly assesses and takes actions to alleviate problems reflected in subtle changes in the patient's condition such as dizziness or slight rise in temperature. Makes careful observations to assure that nursing procedures and treatments are not causing additional distress.
  • Training, Other Qualifications, and Advancement

    Most practical nursing training programs last about 1 year, and are offered by vocational and technical schools or community or junior colleges. LPNs must be licensed to practice.

    Education and training.

    LPNs must complete a State-approved training program in practical nursing to be eligible for licensure. Contact your State’s board of nursing for a list of approved programs. Most training programs are available from technical and vocational schools or community and junior colleges. Other programs are available through high schools, hospitals, and colleges and universities. A high school diploma or its equivalent usually is required for entry, although some programs accept candidates without a diploma, and some programs are part of a high school curriculum.

    Most year-long practical nursing programs include both classroom study and supervised clinical practice (patient care). Classroom study covers basic nursing concepts and subjects related to patient care, including anatomy, physiology, medical-surgical nursing, pediatrics, obstetrics nursing, pharmacology, nutrition, and first aid. Clinical practice usually is in a hospital but sometimes includes other settings.

    Licensure. The National Council Licensure Examination, or NCLEX-PN, is required in order to obtain licensure as an LPN. The exam is developed and administered by the National Council of State Boards of Nursing. The NCLEX-PN is a computer-based exam and varies in length. The exam covers four major Client Needs categories: safe and effective care environment, health promotion and maintenance, psychosocial integrity, and physiological integrity. Eligibility for licensure may vary by State; for details, contact your State’s board of nursing.

    Other qualifications. LPNs should have a caring, sympathetic nature. They should be emotionally stable because working with the sick and injured can be stressful. They also need to be observant, and to have good decision-making and communication skills. As part of a healthcare team, they must be able to follow orders and work under close supervision.

    LPNs should enjoy learning because continuing education credits are required by some States and/or employers at regular intervals. Career-long learning is a distinct reality for LPNs.

    Advancement. In some employment settings, such as nursing homes, LPNs can advance to become charge nurses who oversee the work of other LPNs and nursing aides.

    LPNs may become credentialed in specialties like IV therapy, gerontology, long-term care, and pharmacology.

    Some LPNs also choose to become registered nurses through LPN-to-RN training programs.

    Job Outlook

    Employment of LPNs is projected to grow much faster than average. Overall job prospects are expected to be very good, but job outlook varies by industry. The best job opportunities will occur in nursing care facilities and home healthcare services.

    Employment change. Employment of LPNs is expected to grow by 21 percent between 2008 and 2018, much faster than the average for all occupations, in response to the long-term care needs of an increasing elderly population and the general increase in demand for healthcare services.

    Demand for LPNs will be driven by the increase in the share of the older population. Older persons have an increased incidence of injury and illness, which will increase their demand for healthcare services. In addition, with better medical technology, people are living longer, increasing the demand for long-term healthcare. Job growth will occur over all healthcare settings but especially those that service the geriatric population like nursing care facilities, community care facilities, and home healthcare services.

    In order to contain healthcare costs, many procedures once performed only in hospitals are being performed in physicians' offices and in outpatient care centers, largely because of advances in technology. As a result, the number of LPNs should increase faster in these facilities than in hospitals. Nevertheless, hospitals will continue to demand the services of LPNs and will remain one of the largest employers of these workers.

    Job prospects. In addition to projected job growth, job openings will result from replacement needs, as many workers leave the occupation permanently. Very good job opportunities are expected. Rapid employment growth is projected in most healthcare industries, with the best job opportunities occurring in nursing care facilities and in home healthcare services. There is a perceived inadequacy of available healthcare in many rural areas, so LPNs willing to locate in rural areas should have good job prospects.

    Earnings

    Median annual wages of licensed practical and licensed vocational nurses were $39,030 in May 2008. The middle 50 percent earned between $33,360 and $46,710. The lowest 10 percent earned less than $28,260, and the highest 10 percent earned more than $53,580. Median annual wages in the industries employing the largest numbers of licensed practical and licensed vocational nurses in May 2008 were:

    Employment services $44,690
    Nursing care facilities 40,580
    Home health care services 39,510
    General medical and surgical hospitals 38,080
    Offices of physicians 35,020

    Sources of Additional Information

    For information about practical nursing and specialty credentialing, contact the following organizations:

    • National Association for Practical Nurse Education and Service, Inc., 1940 Duke St., Suite 200, Alexandria, VA 22314. Internet: http://www.napnes.org
    • National Federation of Licensed Practical Nurses, Inc., 605 Poole Dr., Garner, NC 27529. Internet: http://www.nflpn.org
    • National League for Nursing, 61 Broadway, 33rd floor, New York, NY 10006. Internet: http://www.nln.org

    Information on the NCLEX-PN licensing exam is available from:

    • National Council of State Boards of Nursing, 111 East Wacker Dr., Suite 2900, Chicago, IL 60601. Internet: http://www.ncsbn.org

    Lists of State-approved LPN programs are available from individual State boards of nursing.

    Information on obtaining Practical Nursing positions with the Federal Government is available from the Office of Personnel Management through USAJOBS, the Federal Government's official employment information system. This resource for locating and applying for job opportunities can be accessed through the Internet at http://www.usajobs.gov or through an interactive voice response telephone system at (703) 724–1850 or  (703) 724–1850  or TDD (978) 461–8404 and   (978) 461–8404. These numbers are not toll free, and charges may result. For advice on how to find and apply for Federal jobs, download the Insider's Guide to the Federal Hiring Process” online here.

    Sources:

    • Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2010-11 Edition; and
    • Office of Personnel Management, Position Classification Standards.

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