LPNs can perform simple as well as complex medical procedures, but must operate under the supervision of either a registered nurse (RN) or a physician. They can administer some medications, in some states may start IV's and administer IV push medications, monitor patient response to medications, implement wound care, perform vital sign measurements (blood pressure, heart rate, pain management, temperature, rehabilitation, oxygen saturation, etc), maintain patient records, and collect blood and urine samples for lab testing. They may perform simple lab diagnostic procedures like urinalysis.
LPNs work in a variety of health care settings. They are often found working under the supervision of physicians in clinics and hospitals, or in private home health care. In long term care facilities, they sometimes supervise nursing assistants and orderlies.
LPNs must at least be high school graduates. They follow the rules of State Boards of Nursing. Requirements for taking boards usually include a clean criminal record and graduation from an approved practical nursing program.
The first practical/vocational nurse training occurred at the Young Women's Christian Association in New York City in 1892. The first official training was three months long, offered at the Ballard School in New York in 1893. Students studied homemaking as well as learning how to care for patients. Some states did not have licensor for LPN/LVNs until 1955. Current training is usually college-based.
The state enrolled nursing qualification can no longer be gained in Britain. Prior to the implementation of Project 2000 which radically altered the face of nurse education in the mid-nineties SEN students used to follow the first twelve months training of the state registered nurses (SRNs, now known as level one nurses), and then had another twelve months of training before sitting SEN exams and becoming registered. Some auxiliary nurses with many years of experience used to be allowed to sit the SEN exams and enter the register without requiring further training. People training to be SRNs who failed their exams at the third attempt were also able to enter the nursing register as a SEN. No new SENs are trained in the UK, the Nursing and Midwifery Council (the regulatory body for nurses in the UK) previously used to allow people to be added to the register as level two nurses if they are moving from a similar position from within the European Union, however this has now stopped. Level two nurses from the EU wishing to gain entry to the Register in the UK must be willing to train as a first level (staff) nurse. This is by two different means: starting their training from scratch as a pre-registration student nurse, or by joining an existing cohort of student nurses starting their second year of training, and completing years 2 and 3 with them
Formerly, there was a large segregation between the "green" SENs and "blue" SRNs, which were the colour of uniform typically worn. SENs were very much complementary to the nursing team, however did not have the status of SRNs and were ineligible to be promoted, e.g. to ward sister. Many SENs sat or re-sat the SRN exams, however a large number did not and were quite content being a SEN. Nowadays, the divide between level one and two nurses is diminishing due to the small number of SENs still in practice. The demise of the SEN is lamented by many who saw it as a balanced way to staff a ward. However, the divide also meant that potentially, the gap in clinical excellence could be too wide.
Enrolled nurses (EN) in Australia usually spend twelve months training, consisting of fourteen (14) weeks theoretical component at TAFE colleges, followed by practical experience in hospital wards for the remainder of the time. The majority of EN's eventually move on to attend university and become registered nurses, although a substantial number remain as EN's in public and private hospitals, and nursing homes. Trainee enrolled nurses (TEN's) become employees of the hospital for the twelve month training period, meaning that, as well as gaining practical experience on the wards, they are paid for hours worked. This attracts a substantial number of applicants, who may wish to pursue nursing as a career, but are unable to afford to become full-time university students. The enrolled nurse programme also allows people to ascertain whether or not they are suited to nursing, before they make the decision to study it at university level.
The role of enrolled nurses in Australia has greatly increased in recent years, in response to the continuing shortage of registered nurses in the Australian public health care system. In 2004, a medication endorsement certificate was introduced, allowing EN's to administer some oral medication (excluding schedule 8 drugs of addiction) upon completion. Endorsement also permits the administration of some intravenous (IV) medications and fluids (intravenous therapy or IVT), as well as intramuscular (IM) and subcutaneous (SC) injections. Endorsed enrolled nurses (EEN)'s are also permitted to check & give S4D and S8 medications with a registered nurse. Most Enrolled Nurses working in public hospitals are permitted to conduct ECG's, collect pathology specimens, and routinely take a patient load under the direct supervision of a registered nurse.
Despite the fact that the role of the EN in Australia has been greatly expanded in recent years, opportunities for career progression remain somewhat limited, and for this reason, many choose to go on and study to become registered nurses. In terms of financial remuneration, the earning capacity of an enrolled nurse is capped at five (5) years of service, whereas registered nurses continue to eight (8) years before salary capping is applied.