Salem Hospital’s licensed practical nurse jobs get eliminated

( Salem Hospital is eliminating its last 13 licensed practical nurse (LPN) positions, a move that reflects a national trend in the profession, officials said.

The positions primarily are in Women’s and Children’s Services, chief nursing officer Marty Enriquez said.

They were given notice Jan. 9 and 60 days to either find another position in the Salem Health system or become a certified nursing assistant (CNA), which is a step down from practical nursing. The move was separate from the hospital’s recent decision to eliminate about 30 jobs and vacancies in an effort to save $30 million.

As the conditions of patients admitted in hospitals have become more complex and demand higher levels of care, registered nurses, who either have associate’s or bachelor’s degrees, are more equipped to provide the care, Enriquez said.

The shifts in the health care profession is resonating with nurses, and many are seeking to improve their job marketability.

Kay Carnegie, the dean of health sciences for Chemeketa Community College, said she’s noticed an increase in inquiries from LPNs who are considering further education.

“There are people who have been LPNs for a long time and they’re feeling pressure to get their RN,” she said.

During the past several years, Salem Hospital has eliminated about 20 inpatient LPN positions.

LPNs work under the supervision of a registered nurse (RN) or physician. They complete a 12- to 18-month program at a vocational school or community college and are required to pass a nationally standardized licensing exam in the state they’ll begin practice.

As of Jan. 31, Oregon has 3,756 LPNs working in the state, said Barbara Holtry, a spokeswoman of Oregon State Board of Nursing. That’s compared with the almost 48,000 RNs working in the state.

According to a report issued by the Office for Oregon Health Policy and Research, more than half of the state’s LPNs work in clinics, nursing homes and long-term care facilities.

Almost 15 percent work in hospitals, a number that is expected to decline.

Enriquez said Salem Hospital decided eight years ago to increase its proportion of high-level nurses, and LPNs were encouraged to go back to school through its tuition reimbursement programs.

The hospital also sought Magnet Recognition with the American Nurses Credentialing Center, which recognizes hospitals for nursing excellence.

Salem Hospital was designated in October 2010, but it must demonstrate plans and efforts to increase its proportion of nurses with bachelor’s degrees when it is up for redesignation in 2014, Enriquez said.

The benchmark for Magnet hospitals is to have 53 percent baccalaureate-prepared nurses. Enriquez said 44 percent of Salem Hospital’s nurses have bachelor’s degrees.

In the 2010 report “The Future of Nursing: Leading Change, Advancing Health,” the Institute of Medicine (IOM) recommends nationally increasing the proportion of nurses with bachelor’s degrees from 50 to 80 percent by 2020.

Legacy Health has gradually been decreasing its LPN positions in inpatient care through attrition, chief nursing officer Carol Bradley said.

Fewer than 20 of the organization’s 9,000 employees are LPNs, Bradley said.

“If they were to retire tomorrow, we would replace them with an RN,” she said.

Bradley said Legacy also is encouraging its nurses without bachelor’s degrees to go back to school, which also is a vision laid out in the IOM report. It calls for an infrastructure for nurses to seamlessly achieve higher-level education, from associate’s to doctorate degrees.

Bradley said hospitals have been decreasing their use of LPNs for years, because RNs are the most equipped to work in acute care settings. Leaders say CNAs will continue to be used in hospitals to support RNs.

Mary Rita Hurley, executive director of Oregon Center for Nursing, said economics plays a role.

“Particularly in hospitals, they want nurses who have a larger scope of practice,” she said. “You get a bigger bang for your buck.”

Among nurses who have returned to school is Beth Pelletier, a registered nurse in Silverton Hospital.

She earned her license in practical nursing in 1991. In 2008, she went back to school to earn her associate’s degree and become a registered nurse. She is in the process of earning her Bachelor of Science in Nursing.

“I just see the trend,” Pelletier said. “I want to stay marketable because I’m the sole worker in the family.”

Chemeketa’s nursing program is a two-year associate’s degree program. It allows students to exit the program after the first year and start working as an LPN.

Those who decide to return for their associate’s degree can start where they left off, Carnegie said. A partnership with Linfield College allows an easy transition for Chemeketa nursing students to earn their bachelor’s degree.

Space can limit nurses’ efforts to pursue higher degrees. For Chemeketa, Carnegie said, clinical space and faculty are the main issues.

Students must be placed in hospital or clinics as part of their education, but as the number and size of nursing programs increase, fewer have become available to Chemeketa students.

Also, Chemeketa keeps the faculty-to-student ratio at one-to-eight.

Last fall, Chemeketa admitted 56 first-year students. Two LPNs joined the second-year students, Carnegie said.

Those who began their nursing education elsewhere but hope to continue at Chemeketa would have to go through a testing process to demonstrate their knowledge and skills base, Carnegie said.

Pelletier said although she understands hospitals’ reasons to seek nurses with more advance degrees, she doesn’t think formal education is everything.

Her sister, who is one of Salem Hospital’s LPNs being eliminated, has a 38-year career and has deeper knowledge than recent graduates with bachelor’s degrees, Pelletier said.

“I still believe LPNs could be just as a vital resource for employers,” she said.

Although LPNs are dwindling in hospitals, they’ll continue to be in demand in nursing homes and long-term care facilities, Hurley said, adding that they’re the backbone of elder care.