Newly minted LPN-to-RNs expect to experience a fresh sense of empowerment after earning their degrees.

However, for those who take an RN position at the facility where they previously practiced as an LPN, the transition may feel like they're starting their nursing career all over again.

"My thought process as a nurse is really different now," said Michelle Gibbs, RN, a staff nurse at Coler-Goldwater Specialty Hospital and Nursing Facility, New York, who previously worked four years as an LPN before earning her RN in 2008. "I'm making more decisions based on my nursing judgment and assessment. As an LPN, I always felt like I could go to an RN with questions, but as an RN I feel more responsibility to understand what the patient needs. It's just a different mindset."

But Gibbs adds that her previous LPN experience helped build her confidence as an RN student. Some LPNs who have gone through the process say this is especially true in long-term care (LTC) clinicals where they often have worked in leadership positions.

"In long-term care [clinicals], your daily focus is on every aspect of care, nothing's minute," said former LPN Janin Boone, RN, now an assistant nurse manager at Tucker House in Philadelphia. "In acute care, you're focused on what you need to do to get the patient out of the facility, but the residents in long-term care are there to stay. There is also more paperwork and more to document. You really learn a lot." 

Trumping the Transition
Boone, 40, had accrued 14 years of nursing experience at Tucker House before receiving her ADN at Philadelphia Community College in May 2007. She told ADVANCE the transition she experienced in going from practical to registered nurse has been career altering. Today, her outlook on patient care and nursing practice is completely different from her days as an LPN.

Additionally, as a student who entered clinical rotations for the RN program a seasoned nurse, Boone had the opportunity to mentor and delegate to other students as well as fellow LPN-to-RNs with less nursing experience.

As a result, she walked onto the nursing floor as an RN who could more confidently and effectively assess, care plan and delegate, she said.

This evolvement is hardly uncommon, said Kathie Brogan, EdD, MSN, RN, director of education and CNO at NewCourtland, a network of community services, housing and nursing homes of which Tucker House is a member of. Brogan said the seven skilled-nursing facilities in the network often serve as clinical sites for students in the Philadelphia area.

"Part of the transition from LPN to RN is learning how things connect - that's the heart of it," Brogan continued. "For instance, LPNs know that diuretics, diet and blood levels are significant in the care of someone with congestive heart failure; but as an RN you're going to have put all of the pieces together and coordinate that care."

Boone credits the LTC portion of her rotations as an eye-opening experience because of the challenges posed during this instruction. By the time she exited LTC clinicals, Boone said she had developed a different perspective on nursing in general.

"Critical thinking was a big part of what I learned - looking at the patient in a more critical aspect," she said. "As an LPN, you're focused on each task you're doing instead of looking at the whole picture. You may put in a Foley [catheter] because a doctor told you, but you may not understand all the things behind it. As an RN, you understand more about why things are needed. You're less task-oriented. You anticipate things more often."

It's no coincidence that LPNs are more comfortable with the transition and the enhanced responsibility that comes with the rotations, Brogan added.

"LPNs certainly do come with a different clinical foundation than someone who's having their first clinical experience," she said. "They've passed meds before, bathed residents, fed them and assisted in other ADLs. As an LPN, you already know a lot."