Practical Nursing in Arizona
Many Arizonans seek LPN credentialing as an introductory nursing credential. Some have the intent of seeking higher credentialing down the line. For others, it is a step up from nursing assistant. What level of licensing does one need? This depends on one’s preferred setting and the level of care they want to provide (for example, long-term or acute).
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LPN Scope of Practice: Basic and Advanced
LPNs may carry out a number of tasks that require technical expertise. They have a role in assessment, treatment planning, and evaluation, but these sort of duties are usually carried out in concert with a registered nurse or physician. Arizona code states that LPNs may plan episodic care for people with stable or predictable conditions.
LPNs are allowed to delegate duties to unlicensed personnel in some instances. What an LPN actually does on the job tends to vary by setting.
The Arizona Board issues advisory opinions about scope. An LPN can carry out some duties related to ventilator care but also has some limitations.
Some nursing duties are noted as appropriate for LPNs who have had particular types of training. With appropriate training, an Arizona LPN could carry out advanced wound care tasks like selection of specialty products or management of devices that are used for treatments such as negative pressure therapy. Sharp wound debridement would be within the scope of an LPN who had had a qualifying national course.
Advanced training can expand an LPN’s scope of allowable duty with regard to IV therapy, but there are still some limitations.
LPN programs in Arizona can be completed in about a year. They are not as theory-oriented. There are limitations on cognitive aspects of nursing (decision making) as well as on intervention. Arizona schools may offer associate-level RN programs that also include an LPN option. To become an LPN, one must pass the NCLEX-PN.
LPN Practice Overview
A 2008 healthcare workforce report provided insight into LPN work settings and practice areas. There was a predominance of LPNs citing geriatrics as their primary clinical area. They were employed in these facilities at a far higher rate than were RNs. The next most common specialties for LPNs (discounting the “other” category) were generalized community health nursing and medical/ surgical nursing. (Medical/ surgical nursing is a common specialty cited by hospital nurses). A large proportion (9.3%) considered themselves to have an informatics specialty.
Slightly over one-third of LPNs reported long-term care as their primary work setting. Nationally, there is a continued trend of seeing increased proportions of LPNs in long-term care settings. Home health, considered a separate setting, employed more than 10% of Arizona LPNs.
At this time, more than 15% were employed in hospital settings. The University of California-San Francisco, comparing the national practical nursing workforce in 2008 and 2013, noted a downward trend in LPN hospital employment but also noted that LPNs in Western states were more likely to be employed in hospitals than were their counterparts in other parts of the nation (https://healthworkforce.ucsf.edu/publication/profile-licensed-practical-nurselicensed-vocational-nurse-workforce-2008-and-2013).
Other Arizona LPN work settings included ambulatory care, insurance, and community and public health.
Employment of LPNs in Assisted Living
Assisted living facilities are for people who do not have needs at the nursing home level but are no longer able to live independently. Memory care facilities are for individuals with Alzheimer’s or dementia. Early 2018 finds a number of assisted living facilities advertising, sometimes for relatively high positions. Positions may go by titles such as wellness director or wellness nurse. The nurse may have a role in the admissions process and in determining that the resident will be provided with the appropriate level of care. He or she may ensure that the service plan is met. The job may entail supervising resident assistants. Sometimes a facility will utilize round-the-clock LPNs for a high acuity unit. A nurse may be used specifically as dementia resource.
Lancaster Pollard describes one reason assisted living residences are hiring more healthcare professionals: acuity creep (http://www.lancasterpollard.com/NewsDetail/tci-sl-acuity-creep). Residences can find themselves with residents with significant medical needs even when it’s not their intent. They may have a difficult time knowing at the onset what level of care a person requires. So, too, needs may change quickly. Sunshine Village in Phoenix notes the importance of ongoing assessment.
The president of the Arizona Assisted Living Association an LPN (http://www.alnursing.org/about/chapters).
New Nursing Facility and Assisted Living Care Models
Some facilities are re-envisioning long-term care. Person-centered care facilities may utilize universal workers with blended duties. Cross-training allows for deeper relationships and also allows residents to make food choices more like they would in a home setting; the midnight snack or late morning breakfast becomes a more feasible option. Typically, universal workers have nursing education at the nursing assistant level. However, nurses are also utilized in these facilities, and in varying ways. One recent posting was for a manager for an Eden Alternative facility who would have responsibility for, among many other things, coordination with the director of culinary services.
The Eden Alternative is one model for person-centered care and elder self-determination. There are others.
Newer facilities may have more homelike physical structures. In Tucson, for example, one finds Hacienda at the River, a senior living community operated by Watermark Communities (http://haciendariver.watermarkcommunities.com/). Most residents live in private suites. Guests at the skilled nursing facility can participate in equine therapy and horticultural therapy as well as traditional therapy. The organization hires LPNs as well as RNs and caregivers.
LPN Salary in Arizona and Career Outlook
Arizona licensed practical nurses averaged about $24.84 an hour or $51,670 a year in 2016.
The Arizona practical nursing occupation has been projected to see 16.8% growth across the 2014 to 2024 decade.
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