Becoming an LVN in Texas
A Texas LVN license can be a short path to a rewarding career. Texas vocational nursing programs are just a year in length (LVN programs in Texas). The minimum training is 1,398 hours, though most are longer. LVNs receive training to work across age groups, from mother-baby care to geriatric care; mental health populations are also covered.
LVNs most often work with older adult populations, though some work with children. Pediatric populations are varied: Patients may be generally well and in need of only primary care. Others, on the other hand, have high needs, necessitating private duty nurses. Private duty nurses are hired to work with medically fragile children or adults, including ones who rely on medical equipment like trachs or G-tubes. In a sense, pediatrics represents multiple specialties.
The Texas Board calls the certificate programs clinically intensive. LVNs exercise more limited amounts of professional judgment than RNs (who typically hold academic degrees in nursing). Texas differentiates competencies by educational level. Descriptions of vocational nursing competencies use words like “assist” and “report”; LVNs often report changes in condition to RNs or other healthcare professionals. They function as part of healthcare teams.
LVNs, though dependent, have much more nursing training than nurse aides. They sometimes assign duties to unlicensed personnel and supervise their performance. This is something that routinely happens in settings where residents have ongoing stable needs.
The Board periodically issues position statements about scope of practice. Some technical duties, for example, particular tasks related to IV therapy, will require training beyond the basic. Others have been found to be beyond LVN scope.
Ultimately, many who start at the LVN level do choose to advance beyond this. Nursing positions have been projected to grow at the LVN level and grow at an even more accelerated rate at the RN level. Texas stakeholders emphasize the value of LVN to RN programs. Successful LVNs can receive credit for previous study.
LVN Work Settings and Roles
The Texas Board released data about the LVN workforce in 2018 (https://www.bon.texas.gov/reports_and_data_nursing_statistics.asp).
The largest single employment setting, and by no small amount, was nursing home and extended care facilities. The next most common setting was home health, followed by hospital inpatient. (Inpatient hospital positions at the LVN – or LPN – level are on the decline nationwide, however, and a job search will not necessarily turn up openings in the same settings, and the same proportions, that experienced nurses report them.)
The following settings are also fairly common, according to the most recent Board data: community and public health agencies, hospital outpatient, doctor’s (or dentist’s) offices, rural clinics, and freestanding clinics. Some LVNs are employed in private industry.
Different areas of the state have different types of facility and different needs. The Texas Board has made information about work setting available by county (https://www.bon.texas.gov/reports_and_data_nursing_statistics.asp).
The most common LVN position is staff nurse, followed by office nurse. Some LVNs work in head nurse/ assistant or supervisor/ assistant roles.
Geriatrics is the most commonly reported practice area: 21,254 LVNs. Well over 9,000 report home health; similar numbers report general practice. Other common practice areas include pediatrics, psychiatric/ substance abuse/ mental health nursing, medical/ surgical nursing, and rehabilitation.
Nursing Homes and Other Care Facilities
Nursing homes are changing. Many residents are short-stay. The nursing home can serve as a bridge between hospital and home. There is a trend toward discharging patients from the hospital at an earlier stage than was common in the past, but this doesn’t mean sending them home unsupported – and it doesn’t mean sending them straight home. The Veterans Administration, for example, has a Short Stay Community Living Center that focuses on helping people regain function after medical events such as the following: coronary artery bypass surgery, hip and joint replacement, amputation, hip fracture, acute flare-ups of MS.
Some nursing facilities are part of continuing care communities. Residents who are at the “assisted living” level may require support with personal care, medication, and mobility. Assisted living facilities may also be standalone. Many services are provided by unlicensed personnel, but nurses are integral to service provision. Silverado Vivre, for example, includes RNs and LVNs in their staff mix and touts the facility as appropriate for various populations from diabetics to people awaiting transplants.
Texas Health and Human Services has provided basic information about the many types of care facility and program operating in Texas (https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers). For assisted living, the department provides both the total number of licensed beds and the number licensed for Alzheimer’s.
Varied LVN Roles
Statistics fail to capture the variety of settings and roles possible. In 2017, KVUE News reported on a new psychiatric facility, one designed to provide short-term stabilization (typically two to three days). The facility was set to open with an equal staff mix of RNs and LVNs (four of each) and a couple relief nurses (http://www.kvue.com/article/news/local/austin-mental-health-center-offering-new-innovative-services/269-460949924). Part of the goal of the facility: to provide an alternative to incarceration. One of the major sources of referrals would be law enforcement.
The following are among the roles Texas organizations have sought LVNs for in early 2018:
- Caring for hospice patients who require continuous care shifts
- Supervising caregivers in an assisted living setting
- Carrying out utilization review
- Providing wound care
- Acting as charge nurse at a nursing facility
Texas Licensed Vocational Nurses made an average hourly wage of $22.17 in 2016.
The Texas LVN profession has been projected to see 27% occupational growth over the course of the 2014 to 2024 decade. Given its size, Texas was expected to add more practical nursing positions than any other state.
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