We’re all nurses, dedicated to the same goal: patient care. So why does a ‘two-tiered’ system often feel like the reality for registered nurses (RNs) and registered practical nurses (RPNs)? Are we truly one profession, or are invisible lines drawn in the sand?

While both are essential to the healthcare system, an “us vs. them” mentality often permeates workplaces—fueled by subtle comments, ingrained policies, and perhaps most significantly, separate unions. Why are RPNs grouped in with teachers in a union, while RNs have their own separate nursing union? Why can RPNs read telemetry in some organizations, whereas others limit RPNs from a skillset that is within their scope under the College of Nurses?

This division seems paradoxical, considering both are governed by the same College of Nurses. Essentially, we perform the same core job, yet, the separation persists.

WHY?

It’s a question that needs to be asked, and more importantly, explored. Why does this divide exist? What purpose does it serve? Who does it truly benefit?

Many of us have witnessed this tension firsthand. Maybe you’ve experienced it yourself. Perhaps it surfaces in break-room gossip sessions, during shift handovers, or even woven into sarcastic remarks. Sometimes, it’s not even a spoken sentiment, but a palpable undercurrent that affects the entire work environment.

Here’s what one of the RNs in our team shares…

“When I was in my second year’s simulation labs, I remember we were practicing making phone calls using SBAR to a physician. Of course, our instructor played the physician. Here’s how the conversation went.

Student: ‘Hi, I’m Anna—I’m the nurse taking care of—’

Instructor: ‘Do not only say nurse! Are you a registered nurse or a registered practical nurse? Be proud of yourself. You worked hard for this. You’re different from them.’

Different from them? This interaction stuck with me… My teacher fully interrupted me to tell me that I should not label myself as a nurse—or else I’d run the risk of being identified as an RPN. It’s like my education was teaching me to have demeaning attitude towards RPNs. We were literally being taught that we were better than them.”

The Impact

This division can have significant consequences. It leads to:

• Compromised Collaboration: Creating an “us vs. them” mentality undermines teamwork and effective communication, which are crucial for optimal nursing care.
• Stunted Growth: Barriers between us can limit opportunities for knowledge sharing and professional development across the nursing spectrum.
• Diminished Job Satisfaction: Internal divisions can create a stressful and uncomfortable work environment—impacting job satisfaction and potentially leading to burnout.

Ultimately, remember that nursing is nursing – regardless of the initials after your name. Both RNs and RPNs bring unique skills and perspectives to the table, and both are vital to providing comprehensive patient care.

Instead of focusing on the differences, perhaps it’s time to examine the root causes of this divide. Could it stem from historical contexts? Are there systemic issues that perpetuate this separation? Or is it simply a matter of perception and ingrained biases?

Many Registered Practical Nurses (RPNs) find that RPN-to-RN bridging programs offer limited new information. This isn’t surprising, considering RPNs are already competent nurses who frequently manage “RN-only” assignments when hospitals are short-staffed. They handle critical cases, recognize deteriorating patient conditions, and possess a wide range of complex clinical skills – abilities often on par with their RN colleagues.

While RPN and RN scopes of practice share similarities with subtle differences, these scopes can vary significantly depending on the institution. This raises critical questions: Are RPNs viewed as a liability by some healthcare partners? If an RPN is assigned a patient requiring RN-level care (based on scope), why aren’t they compensated at the RN rate? Do hospitals prioritize hiring RPNs, while claiming an RN shortage, to provide equivalent care at a lower cost? Does the current system allow educational organizations to profit from RPNs by charging high fees for courses with significant content overlap?

The fundamental difference lies in compensation: RPNs are consistently paid less than RNs for work of comparable complexity and responsibility.

A prevalent bias, held by both some healthcare professionals and patients, mistakenly assumes RNs are inherently more intelligent than RPNs. This is blatantly false. Many RPNs serve as mentors and teachers to RNs in the workplace, demonstrating their extensive practical knowledge. In fact, due to the hands-on focus of their training, RPNs often possess stronger practical skills than RNs, whose education emphasizes theoretical learning. Nursing, as we know, is a profession that demands both theoretical understanding and hands-on expertise.

RPNs are not inferior to RNs, and vice versa. Both professions are essential and require unique skill sets.

To the RPNs who have felt undervalued and treated as “less than,” know that your contributions are seen and deeply appreciated. We stand in solidarity with you. It is disheartening to enter a profession dedicated to caring, only to face systemic inequities and biased perceptions that undermine your expertise and value.

Let’s Talk About It

This blog post isn’t meant to provide all the answers, but rather to spark a conversation. We encourage you to share your thoughts and experiences.

• Does this divide resonate with your workplace? Is this true for you?
• What are the potential benefits of bridging this gap?
• What steps can we take to foster greater unity and collaboration between RNs and RPNs?

By acknowledging the issue and engaging in open dialogue, we can hopefully move towards a more unified and supportive nursing community.

The Teach Me Nursing STAT Team