Becoming an LPN in New Hampshire

Licensed Practical Nurses are crucial to New Hampshire health. The job often involves providing care for the state’s most vulnerable, including the elderly and disabled and medically fragile children. Many LPNs, though, serve healthier populations in clinic settings. LPNs carry out a wide range of nursing duties under the supervision of registered nurses or doctors; state code also allows them to work under dentists.

LPN competencies include providing technical nursing care appropriate to their credentialing, collecting information, carrying out focused assessments, and participating in evaluation of patient response to treatment. They may, as appropriate, assign or delegate to health workers with lower credentialing.

In some settings, LPNs typically have a greater degree of autonomy and authority than others. In part, this is dictated by the nurse practice act. LPNs can plan care for patients who are stable: those with long-term health conditions who have predictable responses. Patients with stable conditions are more often found in settings such as nursing homes.

Practical Nursing Education

Prospective LPNs must graduate from a Board-approved LPN program in New Hampshire and pass a licensing examination. Some positions require training beyond the minimum. A frequently cited example: IV duties.

LPNs in Long Term and Rehabilitative Care

Many LPNs serve populations who are elderly or have long-term health needs. Nursing facilities are in need of competent workers – and indeed leaders. One area where New Hampshire nursing homes are doing very well: preventing pressure ulcers in those at high risk. The AARP scorecard shows the state at #2 in the nation on this important quality of life measure. One area where they – and much of the nation – are working toward improvement: reducing the use of antipsychotic medications. Some nursing homes have taken strides toward changing the emotional climate of the nursing home and taking into account the need for choice, dignity, and human relationship.

Assisted living and senior living facilities represent an alternative to skilled nursing homes for resident and worker alike. Among the employer-cited duties: observing residents abilities to perform activities of daily living and providing services that are beyond the capabilities of resident assistants or that are dictated by law as requiring a nurse. Some people do remain in assisted living even after diagnosis with life-limiting illness; the LPN may have a role in coordinating hospice services.

Some units in senior living communities are designed specifically for people with Alzheimer’s and other dementias.

Benchmark Senior Living, an organization with a presence in New Hampshire and elsewhere in New England, notes that it has made the Boston Globe’s list of Top 100 Places to Work nine years in a row.

A closely related position is providing services in adult day care settings.

Providing Nursing Services in Private Homes

Home-based nursing positions are highly varied. LPNs may provide relatively specialized skilled nursing services. They may have a role in ensuring that Licensed Nursing Assistants provide appropriate care. Positions may note that duties will include performing a check of the safety of the home. There may be some client education involved. Some organizations seek nurses specifically for hospice (end-of-life care).

The nurse may travel from home to home providing brief skilled nursing services or may spend entire shifts with one high needs patient; New Hampshire permits LPNs to work as private duty nurses.

Patients can be juvenile – even infant. Parents’ struggles to find reliable in-home nursing services for their children have made the news in the recent past. A scan of job postings in June 2018 finds multiple pediatric positions. One employer notes that basic care can include oxygen as well as medication and feeding while advanced care may include vent or trach care. BAYADA is an industry leader; the organization notes in the job ad that a hire will have excellent training.

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LPNs in Clinic and Office Settings

Clinic and positions will call for a slightly different skill set. LPNs who work in doctor’s offices and similar settings often count among their duties rooming patients, taking basic information such as principle complaint, and managing patient flow. An office or clinic LPN will likely take vital signs. The LPN may perform a variety of procedures. Phlebotomy is within their scope. In some cases, procedures will be determined by clinic or practice specialty. The Board stated in an advisory opinion, that LPNs may administer vaccines at flu clinics. LPNs can do allergy testing. They can assist in preparing patients for Hyperbaric oxygen therapy, though their role will be limited.

School Employment

School positions can take multiple forms. An LPN may provide general services under an RN or may be hired to provide one-on-one care for a medically fragile child. June 2018 finds employers seeking LPNs for both types of employment.

LPN Salary in New Hampshire and Career Outlook

New Hampshire LPNs averaged $24.11 in 2017. The range of earnings is wide, with those at the 10th percentile averaging $19.33 and those at the 90th percentile averaging $30.22.

The Governor’s Commission on Health Care and Community Support Workforce addressed the issue of shortages of healthcare workers in the long-term industry in a December 2016 document of recommendations to the governor (https://www.dhhs.nh.gov/ombp/caremgt/health-care/documents/hc-20161216-recommendations.pdf). The Education Subcommittee urged support for practical nursing programs. They noted that the long-term care industry valued LPNs and that the industry benefited from having a balance of LPNs and RNs, given the realities of third party payment. The Education Sub-Committee also noted the importance of the LPN credential as part of the potential career pathway from nursing assistant all the way up to RN – with RN being a level stakeholders are deeply invested in creating pathways for.

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