Practical Nursing in North Carolina

Licensed Practical Nurses occupy a place on the career ladder between nursing assistant and registered nurse. LPN programs can be completed in about a year (LPN programs in North Carolina). LPNs are indeed nurses. North Carolina’s LPNs carry out a wide range of nursing duties, from collecting blood samples to performing wound debridement. They apply critical thinking and have a role in the various stages of the nursing process, including patient assessment.

LPNs collect a good deal of information about their patients and may also make suggestions to the RN about care planning. They provide patient education and show patients how to carry out tasks to maintain personal health. Sometimes LPNs assign or delegate to others. However, their role in supervision is more limited, and ultimately, an RN bears a good deal of the responsibility.

There are limitations on technical duties as well as assessment and planning. LPNs carry out a number of IV-related duties but not all that an RN can. The Board hasn’t made a comprehensive list of everything that an LPN can or cannot do, but nurses are expected to do what’s customary according to nursing literature and what their own training prepares them for.

The duties an LPN carries out will vary by setting. In some settings, the required supervision is more readily available. While it’s not written into code what settings will employ LPNs, there are trends. The Sheps Center for Health Services Research notes an increase in LPN employment in the following settings: long term care, assisted living, and doctor’s offices (http://www.shepscenter.unc.edu/wp-content/uploads/2016/09/Fraher_NCGenAssembly_Mar2016.pdf). Nationwide, hospital employment is on the decline.

Early 2018 finds many of North Carolina’s long term care and assisted living facilities hiring LPNs. Among the other healthcare organizations advertising for practical nurses: a veteran’s outpatient center, an allergy practice, a family practice, a family planning clinic, a multi-specialty practice, and a correctional institution. Hospice and home health have some need at the practical nursing level.

In short, there is opportunity. Of course, some practical nurses ultimately decide they want more choices, more responsibility, and more income. They can continue their education beyond the LPN level and become registered nurses.

Nursing Facilities and Assisted Living Facilities

Nursing facilities have made great strides in improving resident condition. Some have units specifically for short-term rehabilitation. Residents may be there for any of many reasons: to improve function after a stroke, to receive continued care after a cardiac event, to improve balance and coordination so they are no longer at risk of falls.

Many facilities are also making strides in changing what it’s like to live (and work) in a nursing home. They are implementing consistent resident caregiver assignments, meeting needs in a more human-centered and holistic way, and allowing residents to plan their days in ways that feel more comfortable to them. The term culture change is often used to describe the collective set of changes. In2016, the North Carolina governor declared a Culture Change Month: October.

The state’s dementia care coalition has reported culture change initiatives specifically focused on dementia: Music and Memory and It’s Never 2 Late (iN2L). The iN2L Memory Care program uses technology to provide meaningful content that engages memories, sparks conversation, and sometimes simply soothes. Among the things people can do: call up content related to their homelands and youth or slide their fingers across a computer screen to color and paint (http://in2l.com/benefits/memory-care/).

North Carolina assisted living facilities are designed primarily to provide personal care, not nursing services. However, some nursing services may be provided; nursing care is considered incidental to personal care. Giving medication, moreover, can be considered personal care. Residents do tend to be elderly: often over 85.

What can an LPN do in such settings? It depends on many factors. Sometimes services such as IV care are needed. Some duties are more cognitive. There are roles that are reserved for RNs; they may, for example, require an RN’s ability to assess health. Sometimes LPNs are hired by assisted living facilities for roles where an LPN license is not actually mandatory. In these cases, the person may have greater latitude in carrying out supervisory duties. He or she may even have an administrative role. However, there are Board standards that he or she will need to be aware of and adhere to.

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The American Health Care Association and National Center for Assisted Living have a program to foster quality in skilled nursing and assisted living facilities. The following North Carolina facilities reached silver level in 2017:

  • Brian Center Southpoint in Durham
  • Liberty Commons/Columbus County in Whiteville
  • Liberty Commons/Rowan in Salisbury
  • Mapleleaf Health Care in Statesville
  • Westfield Rehab and Health Center in Sanford

LPN Career Advancement

The Sheps Center notes the importance of the LPN credential in the nursing career ladder: for those who want to move up from CNA or CMA and for those who have their sights set on RN. A minority of LPNs become RNs, but it’s still an important path. It is possible to advance even further, despite obstacles like time and money. In early 2018, the Sampson Independent profiled a psychiatric nurse practitioner who had recently earned her doctorate from the UNC-Chapel Hill (https://www.clintonnc.com/news/27389/bronson-earns-doctorate-helps-mental-health-patients). At the start of her career, she had been an LPN. She has worn many hats while advancing her nursing career — including that of single mother. One thing she has long had: a passion for working with a particular patient population.

LPN Salary in North Carolina and Career Outlook

Geographically, the distribution of LPN jobs in North Carolina is more balanced than that of other nurses. (Positions are not as highly concentrated in urban counties.)

18% LPN occupational growth has been projected for North Carolina across the 2014 to 2024 decade.

North Carolina’s Licensed Practical Nurses averaged $20.44 per hour in 2016.

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