The Health Resources and Services Administration projects the U.S. supply of licensed practical nurses to be short by 30% by 2038.
While hospitals are not the primary employer of LPNs, many have reintroduced this workforce into their ranks in recent years amid the rise of team-based nursing care. Federal projections of a growing shortage could hinder those new care models.
About 4 in 10 LPNs and licensed vocational nurses — the same role with different titles depending on the state — work in skilled nursing facilities and residential care facilities, according to the U.S. Bureau of Labor Statistics. Hospitals are the second-largest employer in the U.S., employing 16% of the nation’s workforce. LPNs and LVNs provide basic care at a more limited scope than registered nurses.
HRSA workforce projection data from Dec. 18 shows the U.S. will have 565,690 LPNs by 2038 but will need 811,640, equaling a shortage of 245,950. Becker’s set out to determine whether health systems are redesigning care models in anticipation of this shortage, or assuming RNs will fill the gap.
About a dozen health systems declined or did not reply to Becker’s interview requests. Among those that responded, leaders in nursing and human resources said they are taking a measured approach — selectively integrating LPNs into care teams without significantly altering RN-dependent acute care models.
Where systems see the highest demand
Rachel Kemp, DNP, RN, chief nursing officer of Singing River Health System in Ocean Springs, Miss., said demand for LPNs is strongest in nonacute and transitional care settings, where their scope aligns closely with patient needs.
Singing River operates primary care clinics, specialty centers and three hospitals on the Mississippi Gulf Coast. The system runs apprenticeship programs for professions experiencing acute, local shortages, including LPNs. Many apprentices are single mothers, unit clerks and cooks who work at Singing River, Dr. Kemp said.
“They are people who otherwise would not have had the opportunity to go back [to school] and further their career,” she said. “That was the driving force behind the academy — to help our community grow their career [and] have an opportunity to better support their family while being able to actually get paid while they work. But in the end, it also does benefit our workforce.”
Because LPNs and LVNs have a narrower scope of practice than RNs, Dr. Kemp said acute care facilities historically looked down on these workers. After the COVID-19 pandemic, however, she said the perspective shifted to a more positive view as experienced RNs left the bedside.
At Singing River, LPNs work in the system’s skilled nursing facility, comprehensive rehabilitation center, clinics, medical-surgical floors and emergency departments, including ED fast-track units.
“We have LPNs in direct patient care with their own patient load, things like that, where other organizations may not use LPNs in that way,” Dr. Kemp said.
Other health systems have pursued initiatives to grow their LPN workforce, such as team-based nursing models in which LPNs and RNs trade off tasks depending on scope of practice.
At Louisville, Ky.-based Baptist Health, LPNs play an important role in surgical orthopedic and observation units, where they support patient-centered care through education, pain management, intake and documentation and timely responsiveness at the bedside. They practice to the full extent of training in a team-based approach, partnering closely with RNs and clinical colleagues to support safe, positive outcomes, Baptist Health Louisville chief nursing officer Meg Scheaffel, BSN, RN, told Becker’s.
The system invests in LPN growth through tuition reimbursement and flexible pathways that support advancement into RN roles or other areas of medicine based on individual goals, she said.
“We are expanding partnerships with community colleges to offer clinical rotations and ‘day in the life’ experiences to help grow and retain local talent, build early connections and expand career pathways so caregivers can see a future within the organization,” Ms. Scheaffel said.
Miami-based Jackson Health System has a highly concentrated LPN workforce embedded in correctional health services. The system employs about 200 LPNs — roughly 1% of its total workforce — with more than half working in correctional facilities as part of its role providing care for Miami-Dade County, Anna Fababeir, associate vice president of human resources, told Becker’s.
During and after the COVID-19 pandemic, the system began expanding where LPNs could practice. Leaders piloted the role in the emergency department, where about 25 LPNs now work full time. The caregivers also work in Jackson’s two nursing homes and, to a lesser extent, in ambulatory settings, though they remain absent from most inpatient units.
Key recruitment, investment challenges
At Jackson, LPN recruitment challenges are concentrated in corrections — largely because of the setting itself.
“It’s not a typical setting,” Ms. Fababeir said. “If you go to LPN school or nursing school, you don’t think of correctional facilities — you think of a hospital or clinic. That’s the challenge: how do we sell the setting?”
To address this, the system has invested in earlier pipeline development, partnering with local high schools and community organizations to raise awareness of correctional healthcare careers. Leaders have also shifted their hiring strategy, bringing in newly graduated LPNs and providing onsite, setting-specific training.
Jackson is also using the role as a pipeline into registered nursing, with college partnerships and tuition support for LPN-to-RN transitions, while tracking participants to retain them post-graduation. While some LPNs remain in the role long term, many newer hires aim to advance, making them a key feeder into RN positions.
Dr. Kemp also pointed to another phenomenon weighing on broader acute care investment in LPNs.
She said the “Magnet movement,” or an industrywide push across hospital systems to achieve a Magnet designation, is deterring organizations from expanding their LPN workforces. The American Nurses Credentialing Center’s Magnet designation recognizes an organization’s ability to attract and retain nurses.
Although the ANCC does not require a specific ratio of RNs to LPNs, it does require each nurse leader to have at least a Bachelor of Science in Nursing for a healthcare organization to be eligible for the designation.
This can lead hospitals to reject LPNs altogether.
“Those that are pursuing a Magnet journey may not even entertain LPNs in an acute care hospital at all,” Dr. Kemp said. “Some hospitals I worked for in the past, that’s been the case. That’s not the case here. We’re not on a Magnet journey here” at Singing River Health System.
In 2022, Wolters Kluwer said not every Magnet hospital has a BSN benchmark for nurse hires, but many have programs for nurses to obtain BSNs.
“While it is a myth that Magnet hospitals only hire nurses with baccalaureate degrees or BSNs, part of a Magnet organization’s ‘action plan’ calls for RNs to progress toward obtaining a BSN or higher degree,” according to business consultant Wolters Kluwer.
Despite these barriers, some systems see clear opportunities to expand the LPN role.
Looking ahead, Jackson sees its greatest opportunity for LPN growth in ambulatory and primary care, where the system is expanding its footprint. Leaders are evaluating how LPNs could complement medical assistants and other roles to create a more efficient care team model, while maintaining a steady recruitment strategy for correctional facilities.
“There should always still be places for strong LPN programs. There should always be places for strong [Associate Degree Nursing] programs,” Dr. Kemp said. “We can’t be so shortsighted and label it ‘the only right way to nurse is a BSN,’ because that’s not the only right way to nurse, and we need to make sure we create space and support those LPN programs the same way we support higher education programs.”
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