Becoming an LPN in Wisconsin

What is a Licensed Practical Nurse? A nurse who has technical nursing proficiencies near the entry-level but has a lot of heart. One Wisconsin staffing agency, in fact, recently sought a Superhero in Scrubs with experience putting patients first and wearing bodily fluids that were not his or her own.

86% of Wisconsin LPNs provide direct patient care in their primary work setting. LPNs have technical duties beyond those that are allowed nursing assistants. When determining the level of independence allowable at the LPN level, the Board takes into account the complexity of care and the situation.

The vast majority of Wisconsin LPNs entered the field with a certificate or diploma* (while RN programs are longer and typically confer an academic degree). There are separate licensing examinations for these two levels of nursing.

*LPN Programs in Wisconsin

A Snapshot of the Wisconsin LPN Workforce

The Wisconsin Center for Nursing provides periodic data about the LPN nursing workforce, including LPN primary work settings. The following is from a 2015 survey (http://www.wisconsincenterfornursing.org/wisconsin-nursing-supply-demand.html):

Extended care settings, including nursing homes and assisted living, employ more than 42% of Wisconsin’s LPNs. Ambulatory care settings, including clinics, surgical centers, and outpatient centers, employ nearly 30%. Hospitals are the primary work setting for 9.5%. (The Wisconsin Center for Nursing groups acute care and alcohol and drug abuse settings together.) Home health/ private settings employed about 7%; school, community, and public health settings about 4%. The remainder of the state’s LPNs work in a variety of settings.

Extended Care Settings

Extended care facilities serve primarily an elderly population but also serve younger individuals who are disabled or have serious conditions that require a level of care below that of an acute care hospital. There are a lot of exciting things going on in Wisconsin’s long-term care communities, but quality is uneven.

Wisconsin, more so than many states, allows elders to age in place in assisted living. A 2016 report notes that Wisconsin is one of ten states where the number of assisted living facilities outnumbers the number of nursing facilities.

Residents sometimes have serious issues like uncontrolled diabetes, dementia, and other chronic disease. Wisconsin assisted living includes two types of residential facility that can potentially house many residents: community-based residential facilities and residential care apartment complexes. Adult family homes (serving only a few residents) and adult day care are also considered assisted living.

Different types of facility are subject to different requirements in terms of who they admit. They also have different limitations on the care that can be provided. CBRC facilities, for example, are designed for people who need up to an intermediate nursing home level of care and up to three hours of skilled nursing a week.

There are waivers and variances in the world of assisted living. In many cases, a person may be retained as tenant who would initially not have qualified.

There have been challenges in regulating an industry that has grown so quickly (http://www.lafollette.wisc.edu/research/publications/evaluation-of-the-wisconsin-assisted-living-regulatory-system). The state has often focused on a small number of facilities while other organizations have helped to foster quality in facilities that are already, to the most part, successful. Among the major players is Leading Age Wisconsin, with its Echelon program (http://www.leadingagewi.org/members-services-education/echelon-quality-improvement-in-assisted-living).

Some Wisconsin senior living organizations boast high acuity units.

Some assisted living jobs require RN licensing. LPNs, though, may have a variety of duties, including medication management, reporting of patient condition, and assisting with assessment and oversight. The Wisconsin Coalition for Collaborative Excellence in Assisted Living (WCCEAL) is a professional resource.

There are still many thousands of residents in nursing facilities – and there will likely continue to be. One function, besides long term care for those with high needs, is post-acute rehabilitative care.

Nursing homes employ innovative strategies to reach patients with dementia. The TimeSlips program, which uses storytelling to engage people with dementia, had its start in Wisconsin (http://www.timeslips.org). Five Star Senior Living facilities utilize Montessori-based programming.

The Wisconsin Department of Health Services and other stakeholders have been able to implement music and memory in 85% of the state’s nursing homes (https://www.nhqualitycampaign.org/files/State_Dementia_Care_Coalition_Best-Practice_Strategies.pdf). The program uses personalized music to improve function and reduce agitation; the latter is a serious issue among people with dementia and one that medical professionals have sought to manage through medication. Wisconsin is doing better than the average state at maintaining long-stay nursing home residents without relying on anti-psychotic medications; here, it’s #3 in the nation, according to the AARP 2017 scorecard.

The online Clinical Resource Center is open to all Wisconsin nursing homes; dementia is one of multiple topics. Well over 300 nursing homes have one or more registered users.

Wisconsin has a number of stakeholders working to implement person-centered care. The documentary “Almost Home” follows the transformation of one Wisconsin senior living community (http://www.almosthomeoutreach.org/about_the_film). The Wisconsin Coalition for Person Directed Care can link workers to trainings and other resources (http://www.wisconsinpdc.org/resources/).

LPNs in Clinic/ Practice Settings

Clinics that seek LPNs may be general or quite specialized. The following are among the positions posted in in March 2018:

  • Pediatrics
  • Physical Medicine & Rehabilitation
  • Outpatient veteran’s clinics (floating)
  • Pain management
  • Otolaryngology
  • Occupational health clinic
  • Primary care

The following are among the duties a clinic LPN may have:

  • Rooming patients and taking health histories
  • Providing discharge instructions
  • Performing basic tests (glucose testing, strep)
  • Administering medications and vaccines
  • Assisting with medical procedures
  • Performing procedures such as catheterization or suture removal

Duties will of course vary by setting. In some hiring situations, an LPN may be competing with medical assistants. Other positions require an LPN’s level of training, and may indeed have the LPN practicing at the upper limits of his or scope – under close supervision.

Gundersen Health System notes that LPNs may work under direct or general supervision, depending on circumstances.

Career Outlook and Average LPN Salary in Wisconsin

Wisconsin practical nursing has been projected to see 4.6% occupational growth between 2014 and 2024.

Wisconsin LPNs earned an average of $21.07 per hour in 2016. Those at the 10th percentile made $16.28; those at the 90th percentile, $26.59.

States that conduct surveys about career satisfaction tend to find a high level of satisfaction with the human element, particularly with the patients themselves. Salary satisfaction tends to be more mixed. The well-rated staffing agency that advertised for superheroes listed their pay rate (which started at $20) as being (obviously) not enough. This is partly humor, but there is some truth to it. LPN may be the ultimate goal or a step along the path to RN: greater wages and higher wages to match.

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