The effect of LPN reductions on RN patient load

Abstract

Objective: This study explores the effect of licensed practical nurse (LPN) reductions on registered nurse (RN) staffing.

Background: RN staffing is usually evaluated by assessing RN/patient and RN/nursing staff ratios. Using these measures, researchers generally have not found deterioration in RN staffing. Despite differences in roles, RNs and LPNs frequently share a substantial amount of patient load. Given reductions in LPNs, adequate RN staffing can be assessed more completely by looking at the changes in the staffing of licensed nurses (RNs and LPNs combined).

Methods: This study measures the percent change in RN, LPN, and licensed nurse staffing from 1991 to 2000 in 185 to 215 Pennsylvania hospitals. Paired sample t tests measure the significance of change from year to year and for the period overall.

Results: A 29% reduction in LPNs during the years 1991 to 2000 affected RN staffing through an increase in licensed nurses' patient load and a slight decrease in skill mix. When adjusted for acuity, both RN and licensed nurse patient load increased significantly.

Conclusions/implications: These results help explain the perception that hospitals are understaffed. Future research and managerial decision-making should consider the adequacy of licensed nurse staffing, and its impact on cost, performance, and quality.