Licensed practical nurse
A licensed practical nurse, in much of the United States and Canada, is a nurse who provides direct nursing care for people who are sick, injured, convalescent, or disabled. In the United States, LPNs work under the direction of physicians, mid-level practitioners, and may work under the direction of registered nurses depending on their jurisdiction.
In Canada, LPNs' scope of practice is autonomously similar to the registered nurse in providing direct nursing care. They are also responsible for their individual actions and practice.
Another title provided in the Canadian province of Ontario is "registered practical nurse". In California and Texas, such a nurse is referred to as a licensed vocational nurse.
In the United States, LPN training programs are one to two years in duration. All U.S. state and territorial boards also require passage of the NCLEX-PN exam. In Canada, the education program is two years of full-time post-secondary and students must pass the Canadian Practical Nurse Registration Exam, administered by the for-profit Yardstick Assessment Strategies. In 2022, Ontario and British Columbia plan to discontinue CPNRE in favour of the REx-PN, administered by the National Council of State Boards of Nursing.
United States
According to the 2010–2011 Occupational Outlook Handbook published by the Department of Labor's Bureau of Labor Statistics, licensed practical nurses care for patients in many ways:According to the Occupational Outlook Handbook, while most LPNs are generalists and will work in any area of health care, some LPNs work in specialized settings, such as nursing homes, doctor's offices, or in home care. In some American states, LPNs are permitted to administer prescribed medicines, start intravenous fluids, and provide care to ventilator-dependent patients. While about 18 percent of LPNs/LVNs in the United States worked part-time in 2008, most work a 40-hour week. The Occupational Outlook Handbook states that LPNs may have to work nights, weekends, and holidays; often stand for long periods and help patients move in bed, stand, or walk; and may face occupational hazards which include exposure to caustic chemicals, radiation, and infectious diseases; back injuries from moving patients; workplace stress; and sometimes confused, agitated, or uncooperative patients."
In California, licensed vocational nurses empty bedpans, commodes and clean and change incontinent adults. Licensed vocational nurses read vital signs such as pulse, temperature, blood pressure and respiration. They administer injections and enemas, monitor catheters and give massages or alcohol rubs. They may apply dressings, hot water bottles and ice packs. They help patients bathe and dress, treat bedsores and change soiled bed sheets. LVNs feed patients and record their food consumption, while monitoring the fluids they take in and excrete.
In May 2023, the median annual wages of LPNs/LVNs in the United States was $59,730, with the lowest 10 percent earning less than $45,670, and the highest 10 percent earning more than $77,870. Median annual wages differed by setting:
| Setting | Median annual wages |
| Employment services | $63,340 |
| Nursing care facilities | $61,690 |
| Home health care services | $58,620 |
| General medical and surgical hospitals | $54,490 |
| Offices of physicians | $51,820 |
According to the Occupational Outlook Handbook, in 2008 there were some 753,600 jobs held by LPNs/LVNs in the United States, with about 25 percent working in hospitals, 28 percent in nursing care facilities, and 12 percent in physicians' offices. Other LPNs/LVN worked for home health care services; employment services; residential care facilities; community care facilities; outpatient care centers; and federal, state, and local government agencies. In the United States, employment of LPNs is projected to grow by 21 percent between 2008 and 2018, much faster than average. The growth is expected to be driven by the "long-term care needs of an increasing elderly population and the general increase in demand for healthcare services". By contrast hospitals are phasing out licensed practical nurses. While LPN jobs were expected to decline, in 2010 the Bureau of Labor Statistics reported the job growth rate of Licensed Practical Nurses as 22%, far above the national average of 14%. Median annual salary was reported as $44,090 per year, and hourly salary was reported as $19.42.
In the United States, training programs to become a LPN/LVN last about one year and are offered by vocational/technical schools and by community colleges. The Occupational Outlook Handbook states that in order to be eligible for licensure, LPNs must complete a state-approved training program. A high school diploma or equivalent usually is required for acceptance into a training program, but some programs accept candidates without a diploma and some programs are part of a high school curriculum. According to the Occupational Outlook Handbook states that most programs include both classroom study and supervised clinical practice.
The National Council Licensure Examination-Practical Nurse, a computer-based national licensing exam developed and administered by the National Council of State Boards of Nursing, is the exam required to obtain licensure as a LPN/LVN. In many states, LPNs/LVNs are required to obtain continuing education credits throughout their career.
Advancement
In some settings, LPNs/LVNs have opportunities for advancement, including the possibility of becoming credentialed in a certain area or of becoming a charge nurse, responsible for overseeing the work of other LPNs and various unlicensed assistive personnel, such as nursing assistants. Some LPNs/LVNs choose to undergo further education and become registered nurses. LPN-to-RN training programs exist for this purpose. These include further classroom study to obtain at least an Associate of Science in Nursing and clinical practice followed by another exam, the National Council Licensure Examination-Registered Nurse.The origins of the practical/vocational nurse can be traced back to the practice of self-taught individuals who worked in home care in the past, assisting with basic care and light housekeeping duties. Licensing standards for practical nurses came later than those for professional nurses; by 1945, 19 states and one territory had licensure laws, but only one state law covered practical nursing. By 1955, however, every state had licensing laws for practical nurses. Practical nurses who had been functioning as such at the time new standards were adopted were usually granted a license by waiver, and exempted from new training requirements.
The first formal training program for practical nurses was developed at the Young Women's Christian Association in New York City in 1892. The following year this became the Ballard School of Practical Nursing and was a three-month-long course of study concerned with the care of infants, children and the elderly and disabled. The curriculum included instruction in cooking and nutrition as well as basic science and nursing. The school closed in 1949 after the YWCA was reorganized. Other early practical nursing education program include the Thompson Practical Nursing School, established in 1907 in Brattleboro, Vermont, and the Household Nursing School, established in 1918 in Boston. In 1930, there were still just 11 schools of practical nursing, but between 1948 and 1954, 260 more opened. The Association of Practical Nurse Schools as founded in 1942, and the next year the name of the organization was changed to National Association for Practical Nurse Education and Service, and the first planned curriculum for practical nurses as developed.
Canada
In Canada, nursing, as with all other health care professions and trades, is regulated by the respective province or territory, through an enabling statute legal scheme where an act of the relevant legislature grants delegated authority to a non-sovereign entity such as a college of nurses with powers to regulate the profession within specific parameters and also grants to the respective minister of the Crown oversight and the powers to write regulations through a Ministerial Order in Council.As an example, the Canadian province of British Columbia's enabling act is the Health Professions Act, RSBC 1996, c. 183, and the resulting nursing-specific regulation is incorporated into one Regulation together with a number of other practitioners such as audiologists and naturopaths in the Health Professions Designation Regulation, BC Reg 270/2008.
While the act and the regulation outline basic organizational architecture, each professional organization creates its own bylaws and codes of conduct and practice subject to ministerial and judicial review and must be in compliance with accepted norms of administrative law such as transparency and accountability in governance, fundamental principles of natural justice, an internal appeal process and compliance with the Canadian Charter of Rights and Freedoms.
Such legal schemes enable self-governance and save costs to governments by delegating regulatory responsibilities to a self-funded and self-administered professional entity, but are also known to engage in protectionist practices since the delegation also grants a monopoly for the provision of services to only one body, as widely studied by the late economist Uwe Reinhardt.
A nurse who is entitled to practice in one jurisdiction cannot work in another without applying to and being granted a license by the local regulatory body. Educational, legal and practice requirements are similar, so mobility is possible; however, the nurse still has to fulfill requirements, such as writing exams and paying fees, in each location they wish to practice. This is akin to all other regulated professions where the provincial government holds exclusive jurisdiction.