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Monday, November 29, 2021  

Boxxing with the LPN/RN IssuePublished 7/7/2003

I have been reading the ongoing LPN versus RN issues discussed in this paper over the last several weeks and I’d like to throw in an "Out of the Boxx" opinion.

The first thing I notice from many letters is a deep sense of anger, frustration, resentment, and unhappiness at how LPNs are treated in various agencies. Yet in the next breath, some writers describe how proud and happy they are to be an LPN - how a choice oftentimes made based upon financial or time constraints, had proved to be the right choice in the long run.

The fact that nurses wear many titles and letters after their names does make it complicated for the public to understand our roles. However, the plus side is that many people found a way to carve themselves a place within our nursing structure by choosing a level that worked for them. A flexibility not provide in most other fields. In contrast, becoming a physician is all or nothing. You can’t be a doctor with two years of school. It’s four years. Period. There is no other choice and the public understands one level of MD.

Another LPN writes how the first day she started as a new nurse, right alongside a new BSN grad, the BSN nurse marveled at the comfort level and competence of the LPN, and complained about how her BSN program had not prepared her for the "real world of nursing."

I can only compare her story to my days working at Children’s Hospital when we saw new interns arrive on the scene year after year. These were individuals who had spent four years studying medicine, had spent countless hours in clinical settings, and yet who came to my unit and didn’t understand what the label said on an IV bottle! Now, this may seem horrific to you but I would argue that those people had studied a wider variety of subjects within their four years than I would ever dream of. While I might have felt cocky that I knew such simple things as what ingredients were in an IV bottle, my world was significantly narrower than theirs. I was expert in my little universe and they were generalists in so much more. Given some time, their competence showed through quite clearly, and if I was fortunate, they all taught me something by the time they moved on.

Now, compare that with the new LPN and BSN graduate story. BSN programs simply cover a broader scope of information. Besides clinical training, they emphasize leadership, (as many BSN nurses may become managers, or educators,) and have basic core courses required of any college student, (English, sociology, psychology, philosophy, etc.) Among other things, these classes enable students to develop better written and verbal communication skills, broader psychological understanding of others, and encourage the development of new ideas. It doesn’t mean it’s better – it’s just different.

I worked for one large business where they didn’t care what your degree was in, they just wanted to know that you could stick out four years of education somewhere and they hoped that you learned a wide variety of life skills in the process. One of the most important things I ever learned in college was how to listen to the ideas and opinions of others – not just my own. New ideas are frequently created when people with open minds come together.

We all make choices in our lives. You can choose to be an LPN because that works for you. You can choose to be an RN, with or without a BSN. You can choose to get your master’s or doctoral degrees. It is all about choice. The bigger issue is what you do with your choice after you’ve made it.

For a while, I chose to be a head nurse. I loved the responsibility, the ability to fascilitate change, and the feeling that I might make a difference. However, it also meant I took on the negative things that went with the job as well – complaining employees, complaining patients, ongoing staffing headaches. Yet, it was my choice. I knew these issues existed when I took on the job. Eventually, I chose to leave for those very reasons.

If you are an LPN and are proud of it, then rejoice! Be the best LPN you can be and don’t depend on the opinions of others to decide how you feel about yourself. Don’t be angry at the rest of the world for their abilities, salaries, and public recognition. Believe in yourself for who you are, and for the choices you made that worked for you. However, if you are someone who wants further education, then good for you too! You are always seeking growth and challenge, and that’s equally great!

If you are an LPN who went on to school and found new horizons, responsibilities, and challenges and you can look back at your career and understand the varying degrees of patient care that you gave throughout the different levels, then you have an appreciation that few of us have. We need to hear from more of you, as you’ve truly seen both sides.

Whatever your role or title, either be happy with it and yourself, or change it. Just don’t be angry about it or let other’s opinions dictate how you feel.

Mary Jo Fay has a motivational company called Out of the Boxx, Inc. She can be reached at

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