Role of Vocational Nurses in Modern Healthcare Settings

In today's rapidly evolving healthcare environment, the roles and responsibilities of vocational nurses (VNs) have undergone significant changes. An overview of the responsibilities, scope of practice, and career paths of VNs is essential to understand their pivotal role in providing patient care.

Historical Context

The journey of VNs and licensed practical nurses (LPNs) has transformed over the years, influenced by changes in healthcare policies and the evolving needs of the healthcare industry. For instance, my own 35 years as an LPN before becoming an RN provides a unique perspective on the evolution of LPN roles. Initially, LPNs in hospital settings were responsible for patient care, administration of oral medications, and under limited circumstances, starting IVs. However, the regulatory landscape has shifted, with an increasing emphasis on educational qualifications and scope of practice.

Current Roles and Responsibilities

Today, the duties of VNs encompass a wide range of patient care activities. They are typically required to:

Administer oral and intravenous medications Chart in the medical record Take vital signs Change wound dressings Collect biological specimens Insert and care for urinary catheters Assist with tracheostomy tube and ventilator care Care for patients with nasogastric tubes Provide feedings through nasogastric or gastrostomy tubes Monitor patients for changes in clinical condition Perform CPR in emergencies Provide care for ostomies

Notably, VNs must operate within the bounds of their scope of practice, which is defined by state nursing boards. These guidelines ensure that VNs are performing tasks that align with their training and certification while working under the supervision of registered nurses (RNs).

Scope of Practice by State

The scope of practice for VNs can vary by state. In California, for instance, LVNs/LPNs are allowed to perform a range of duties under the supervision of an RN or physician. According to the California Board of Vocational Nurses and Psychiatric Technicians, LVNs are legally permitted to:

Administer medications via hypodermic injections and oral administration Draw blood from patients, provided prior training and supervision by a RN or physician Start and continue intravenous fluids and medications, after completing a credit in such IV activity Perform skin tests under supervision, like TB, histoplasm, and coccidioidin tests Administer immunizations, if they can demonstrate knowledge of emergency reactions and remediation Practice in emergency situations outside their usual work setting, without liability for civil damages Pursue licensure as an LVN after military service in the medical corps with honorable conditions

Challenges and Future Outlook

Despite their important roles, VNs face various challenges. The increasing emphasis on educational qualifications, like the Bachelor of Science in Nursing (BSN), has made it more difficult for VNs to advance without further education. Additionally, as hospital settings change, some VNs are transitioning to clinics, nursing homes, or home health agencies. However, the field of nursing presents numerous opportunities for specialization and advancement.

To future-proof their careers, VNs are encouraged to:

Obtain a BSN degree to enhance their qualifications Seek specialized training or certification in specific areas Stay informed about changes in healthcare policies and regulations Explore diverse career paths within the healthcare industry

In conclusion, vocational nurses play a crucial role in modern healthcare systems, providing essential patient care and support. Understanding their scope of practice, historical context, and future outlook is essential for both VNs and healthcare professionals.