Texas and California have two things in common. Both had their own state specific nursing exams for a number of years. And both call entry-level nurses Licensed Vocational Nurses (or LVNs) while other states call them Licensed Practical Nurses (LPNs or PNs). Is this a rejection of the other states’ professional nomenclature? Probably not.
To understand how the LVN title came about, you have to go back in history to the time after World War II. When the war started, no state licensed practical nurses or vocational nurses. As the war drew to a close, New York became the first state to do so. A decade later, all states would. There was a lot happening in a short span of time.
Formal education preceded the practice of licensing practical or vocational nurses. It’s likely that it’s the nursing educational programs that first put the term vocational nurse into the vernacular. In Texas, the use of the term crystalized with the passing of a particular piece of legislation.
Step back to the beginning of the 1950’s. In Texas, the Vocational Nurse Act (52nd Legislature, House Bill 47) was working its way through congress. It passed, and the Texas State Board of Vocational Nurse Examiners was established in 1951. (It would later be subsumed by the Texas Board of Nurse Examiners.)
The state’s professional organization had come into being a year earlier, in 1950, and was then known as the Practical Nurse Association of Texas – using the title that is more commonly used around the country. After the establishment of the Texas State Board of Vocational Nurse Examiners, the Practical Nurse Association changed its name, becoming the Licensed Vocational Nurses Association of Texas, or LVNAT, the name it is still known by today.
The Vocational Nurse Act called for LVNs to be licensed by examination. At the time, some states were not yet licensing LPNs.
The California Board of Vocational Nursing was also established in 1951. Although there have been many amendments, some language in the state’s Vocational Nurse Practice Act remains unchanged since 1951. The legislators who originally crafted the act defined vocational nursing as performing the technical skills that one acquires “by means of a course in an accredited school of vocational nursing” (http://www.bvnpt.ca.gov/pdf/vnregs.pdf).
That’s a clue that the language wasn’t a rejection of the term practical nursing. In California, the license title drew from the educational setting. Vocational nurses were being trained in vocational programs.
So what of California’s other claim to fame? Here there may be a bit more of a renegade streak. California used a state constructed exam between 1974 and 1986. They continued to license LVNs with a state constructed exam when other states were using the SBTPE.
So what about the title Licensed Practical Nurse? There were practical nursing programs long before there were LPNs. The term was used before the turn of the 20th century – the Ballard School of Practical Nursing – though the movement grew slowly. Ohio’s Central School of Practical Nursing, established in 1937, notes that it was one of the first of its kind in the nation. The school further notes, in the history section, that it was established to fill a need: The community needed home care nurses. Those nurses didn’t necessarily need all the skills that professional nurses (who were at the time frequently educated in hospital-based diploma programs) did.
Internationally, the lower level of nursing is called second-level nurse. While there’s been a movement toward homogenization, it’s important to realize that nursing traditions and titles grew up relatively independently in places around the United States and the world.
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