ROLE TRANSITION: A PERSONAL PERSPECTIVE

Role Transition: A Personal Perspective
Amber M. Sisi
Firelands Regional Medical Center

Role Transition: A Personal Perspective

	I am short of breath, tachycardic, sweating profusely, and am starting to feel fatigued and light-headed - what is the diagnosis? No, I am not having a heart arrythmia, but this is what it feels like while I am working out on the stairclimber at the Rec Center. I overhear a man talking about his great recovery from a recent knee surgery. He chats with all nearby, and I am up next. We discuss the stairclimber and his surgery - who did it, where did he go to have it done, etc. And since we were talking medical, I decide to tell him that I am a nurse over at Firelands Regional Medical Center in Sandusky. He seems interested "Really - are you an RN?" I reply that "No, I am an LPN" and go into details about how I am currently taking classes to become an RN. He just says "Oh" in an unimpressed tone after I tell him I'm an LPN as if he's disappointed or something, as if I'm not a real nurse. He looks disinterested, the conversation ends, and he moves on to talk with treadmill guy. I was left there on the stairclimber feeling somewhat offended - perhaps I had read too much into his response. Maybe it was my own insecurities acting up again, but then again maybe not. It has been my experience that the lay person does not really fully understand the individualized and significant ways RNs and LPNs both contribute to the nursing process. Both are necessary members in an everchanging world of health and sickness. No, Mr. Knee Surgery Guy, I am not an RN, but I am still a nurse.
	If my LPN best friend Brandi and I are having a bad day, we might occasionally joke about how the title Licensed Practical Nurse does not guarentee respect in the way the Registered Nurse credentials usually do. It's like you are practically a nurse or you are an L-peon. Ha Ha. In the long-term care setting you are managed and supervised to death and in the hospital you are made to feel like an RN's burden. It is no secret that there is some tension between the two types of nurses, and LPNs are often left to defend and prove themselves. I speak from some of my own personal observations and experiences. I know I certainly did not feel like a superstar nurse on May 4, 2010 at a work meeting where I was informed that my current LPN job would be eliminated less than one year later on the date of April 1, 2011. All of the LPNs working on the FRMC Med/Surg, Progressive, Pediatric, and Critical Care Units were given three options at this time: apply for a position on a unit that continues to use LPNs, be accepted in an accredited RN school of nursing, or retire. Well, retirement is usually not an option for a twenty-seven year old and I couldn't see myself working in Psych, Rehab, or Dialysis for the rest of my life; so I decided to apply to the LPN to RN Fastlane program at the Firelands School of Nursing instead. 
	Honestly though, FRMC's decision to convert my job into an RN position was no shock to me. Even when I graduated from the Owens Community College LPN Program in 2006, I knew it was going to be tough to get into a hospital setting. Out of about ten applications sent to area hospitals, I received three phone calls, two interviews, and one job. Some days, I would be driving into work, just shocked that I actually worked in a hospital. Hello, I take care of some really ill people here. Yes, that's me taking care of your ninety-eight year old grandpa who fell, broke his hip, and is now blowing up the telemetry monitor with some crazy heart arrythmias. Yes, that's me taking care of your mom who had a stroke and is currently unable to eat, speak, or walk. There is no debate: nursing is tough, but knowing you have made a difference in a life makes it all worthwhile. And so, transitioning into the new RN role will not be easy, but hopefully the reward will be much greater than the sacrifices it demands. 
	Economics and opportunity as also wise factors to be considered in the quest for educational advancement. In fact, according to the U.S. Bureau of Labor Statistics website, Registered nurses constitute the largest health-care occupation, with 2.6 million jobs, and employment of RNs is expected to grow by twenty-two percent from 2008 to 2018, which is much faster than the average for all occupations (Bureau of Labor Statistics [BLS], 2011). It seems the health-care sector of society is constantly booming, lets face it: people will continue to get old, get sick, and die. It is not a morbid or fatalistic mentality, this is a fact of life. And it is great job security if you are a health-care worker. 
	On another note, opportunities are varied and plentiful for the RN who has a wide range of specialties to choose from. And as LPNs are phased out of the hospital setting, this will only increase the demand for RNs in the future. Under the job outlook section, the BLS estimates job growth will occur in three major areas for the LPN: nursing care facilities and community and home heath care services (BLS, 2011). Sure, these are great areas to work in, but it only makes sense for an LPN to further their education if possible in order to take advantage of the limitless opportunities that are available to RNs. 
	But how do LPNs and RNs differ in regards to their everyday practices? I have been an LPN going on five years now, and it has been my observation that an RNs skillset includes administering intavenous medications and blood products, inserting naso-gastric tubes, handling central lines, PCAs, and epidurals, giving and receiving report on patients being transferred to or off of the unit, and interpreting telemetry monitors. Also, I see RNs as having a bigger role in collaborating with hospital administration, nursing supervisors, physicians, and case management. They are more autonomous in their everyday practice which I believe leads them into having improved critical thinking and decision making skills. In contrast, as an LPN I have to have an RN "team leader" do all of my intravenous push meds (except saline). If one of my patients needs a physician's order, the RN charge nurse will usually make the call and take the order. It feels burdonsome at times having to ask an RN to administer pain or nausea medications for my patients when often times they have their own full patient load to carry as well being my team leader. I have heard from other LPN to RN students that it is really a relief to be able to just give an intravenous push pain medication right away if needed and be done with it - instead of constantly having to hunt down and remind an RN to give it. 
	The Ohio Board of Nursing mentions the words execute, assess, modify, supervise, delegate, and evaluate under the scope of practice for an RN while the LPN is more of an observer who makes contributions to the plan of care (Ohio Board of Nursing, 2011). I have noticed that RNs hold many of the leadership and management positions at the hospital; in fact, FRMC's Senior Vice President of Operations is even an RN. When I think of a true leader, I envision someone who is hard-working and strives for integrity in all situations; they set their expectations high and demand excellence in return. A book entitled Conceptual Bases of Professional Nursing addresses several key leadership and management skills nurses should strive for; they include such skills as challenging others to expand thinking and actions, set personal goals, maintain composure and  a high energy level when encountering stressful situations, establish trust with all persons, and demonstrate sincere empathy towards others (Leddy and Pepper, 2010, p. 468). The list goes on and on. No one is perfect, but we could all stand to improve upon many of these areas. Becoming a better leader would not only have an impact on improving work relationships, but would, no doubt, positively affect all areas of a person's life. I would like to be known as a likeable person of character and integrity on my deathbed, how about you?
	Transitioning from the familiar into a brand new role is definite reason for a person to feel uncomfortable and insecure in the beginning stages. A person in role transition is holding onto the known and comfortable while attempting to hope and look forward to something better. The obvious transition that I am faced with today is going from LPN to RN at both of my jobs. Once an RN, I know I might become overwhelmed with adding new responsibilities onto what I already do as an LPN. I am one of those perfectionist types, so I know I will try to "do it all" in the beginning and probably end up wearing myself out. I am not foolish in thinking this change is going to be easy. I know some of my peers will try to take advantage of me or still think of me as the LPN, but I am taking mental notes. Previous LPN to RN students have told me not to precept on too familiar of a unit as some nurses will just put me to work and not show me the RN skills that I should be learning instead. Hopefully, I receive adequate orientation time as well and am not forced into taking patient assignments early due to low staffing. I assume, a lot of people will just figure, "Oh she can do it, she's been a nurse for five years already."
	Another role transition will be going from being a quieter type person to becoming more confident and assertive especially with physicians. Right now, I am still somewhat intimidated by them. Once, I was yelled at by a doctor over the phone because I told him I couldn't take an order. He must have been in shock because he went totally silent for a minute, then said rudely "What do you mean you can't take an order?" I tried to explain that I was an LPN, but he still didn't get it so I handed the phone over to the charge nurse to let her explain. Sometimes I wonder if doctors even know there are two kinds of nurses. So, I felt like crud because I couldn't even take a dumb order, what kind of nurse am I? I thought. Well, the physician called back later that night to apologize and he has been nice to me ever since. Miracles do still happen. 
	How can I work on becoming more assertive? For one, I am allowed to call doctors and take orders over the phone at my side job at Hospice, so this might help to prepare me somewhat. Hospice is a very autonomous job as well; there is always someone just a phone call away, but I have to make any immediate decisions that need to be made. Also, I need to make sure I know what I am talking about; knowledge is power. Being a nurse for almost five years, I do have some idea of what areas I need to focus on in regards to education including interpreting telemetry and making sure I know my intravenous drugs. Several good tips for the LPN to RN transition process include find positive role models or a mentor, keep employment options open, take risks, work hard and be a team player, and take care of yourself (Leddy and Pepper, 2010, p. 469). 
	Writing this paper has helped me to become more aware of what is going to take to survive the LPN to RN transition. A few years ago when I first started thinking about going back to school, I was doubting myself, but then one day I had a thought that helped. If God took care of me when I was an STNA, and he is taking care of me now as an LPN - then surely He will take care of me as an RN too. I know the journey through the Firelands School of Nursing will not be an easy road, but I am currently working on becomimg more disciplined and mentally prepared for the next year and a half. To make it through, I know it is going to require a fair amount of hard work, sacrifice, and steadfast determination, but it will be worth it in the year 2013 when I am asked the question "Are you an RN?" and I will be able to smile and give a proud, confident reply "Yes, I am."

	References
Hood, L. J., & Leddy, S. (2010). Leadership and Management in Professional Nursing. Leddy & 	Pepper's conceptual bases of professional nursing (7th ed., pp. 468-469). Philadelphia: 	Wolters Kluwer Health /Lippincott Williams & Wilkins. 

Licensed Practical and Licensed Vocational Nurses . (n.d.). U.S. Bureau of Labor Statistics. 	Retrieved November 3, 2011, from http://stats.bls.gov/OCO/OCOS102.HTM

Registered Nurses . (n.d.). U.S. Bureau of Labor Statistics. Retrieved November 3, 2011, from 	http://stats.bls.gov/oco/ocos083.htm

Scopes of Practice: Registered Nurse and Licensed Practical Nurse. (n.d.). 	www.nursing.ohio.gov. Retrieved November 3, 2011, from 	www.nursing.ohio.gov/PDFS/Practice/RN_and_LPN_Scope_of_Practice.pdf