Bridging from LPN to RN: How to Approach the NCLEX Differences

The traditional route to becoming a Registered Nurse is through an Associate's or Bachelor's degree nursing program that allows you to take the NCLEX-RN. But maybe you're like me and took a slightly different path to becoming an RN. I was a Licensed Practical Nurse and went through a career mobility program (also known as LPN to RN or LPN Bridge). Career mobility programs recognize that LPNs have the core nursing education and often a wealth of experience and knowledge in certain areas. But LPNs do not have the same depth of education that is required for RNs since there is a different scope of practice for LPNs and RNs.

Most LPN programs offer a certificate in Practical Nursing and take approximately 1 year to complete, although there are some programs that offer as Associates in Applied Science degree and take closer to 2 years to complete. The education focus in a Practical Nursing program focuses on basic patient care and comfort. Students learn to assist clients with activities of daily living, carry out treatments such as wound care and respiratory, and to obtain data through vital signs, lab draws, point of care testing, and observation. Students learn to administer medications (oral, topical, ophthalmic, and injection.) Some states include administration of low-risk intravenous medication administration in the LPN Scope of Practice, while others only allow this if the LPN receives an additional IV certification. Proper documentation and delegation to an Unlicensed Assistive Personnel are also covered. It is important to recognize that an LPN should be working under the supervision of an RN in most circumstances.

RN programs can take 2-4 years to complete, depending on whether you are obtaining as Associates degree or a Bachelor's degree. The RN coursework will include all of the same things covered in the LPN program, but students also learn assessment skills, advanced leadership and delegation, central line care and administration of medications through central lines, and spend a significantly greater amount of time learning about Mother-Baby skills, psychiatric nursing, and more in-depth knowledge of the pathophysiology of diseases and medications.

For most students pursuing a career in nursing, it seems obvious that going directly into an RN program would be the best option. The job opportunities are greater, and the pay rate is significantly higher than LPNs. But the wait to get into RN programs can sometimes be a challenge, and then the program is 2-4 years before you graduate and get to work. There are many reasons for choosing to become an LPN first. For some, it's a way of testing the waters with a shorter education time and lower tuition cost than the longer RN program. Other reasons for choosing the LPN path might be the desired work location, lower entry requirements such as pre-requisites. In my case, I chose to pay the lower cost of an LPN program and then got a job in a hospital that gave me valuable experience, paid me a good hourly wage, paid my tuition for the LPN to RN bridge, and gave me hospital insurance and benefits. There's no right or wrong way to enter the nursing profession!

All nurses are required to pass the appropriate NCLEX exam, whether the NCLEX-PN or NCLEX-RN. If you're a career mobility student, you've already experienced taking the NCLEX-PN, so you know what to expect with the testing setup and environment. Both the NCLEX-PN and RN are administered through Computer Adaptive Testing and have the same number of questions and the same passing requirements. But each exam has its own test plan. The test plans for both the NCLEX-RN and NCLEX-PN are very, very similar. (The NCLEX-PN test plan can be viewed here https://www.ncsbn.org/2020_NCLEXPN_TestPlan-English.pdf and the NCLEX-RN test plan can be viewed here https://www.ncsbn.org/2019_RN_TestPlan-English.pdf.) But differences include delegation (LPNs delegate tasks to an Unlicensed Assistive Personnel or UAP, RNs delegate to the UAP and to the LPN), assessment (RNs assess clients and situations where the LPN collects data which may be used in the RNs assessment), and teaching (RNs teach or provide education, LPNs should reinforce education provided by the RN). Additionally, the NCLEX-RN test plan includes questions regarding blood administration, IV therapy, and TPN.

When taking the NCLEX-RN as an LPN you need to change the way you think and how you approach the questions. So as an LPN taking the NCLEX-RN, you need to remember to think as the nurse in charge, not as the LPN you have been practicing as. The PN exam might address prioritization by asking "After collecting data on these 4 clients, which client should you report to the RN?" The RN exam might present a very similar scenario but would ask "After reviewing client data, which client will you assess first?" The PN exam might address delegation by listing 4 client care needs and asking which tasks you will delegate to the UAP, where the RN exam will ask which tasks you might delegate to the UAP or LPN and which tasks you need to do yourself.

As a nurse who probably has some work experience, it can also be difficult to think in terms of the "ideal" or "textbook" situation rather than what your life experiences have been. You may read a scenario and naturally want to eliminate an answer that says to notify the provider because in the back of your mind you're thinking "that provider never wants to be disturbed with information like that! This is definitely not the right answer!" But it is important to take those biases from your experience out of the equation and answer based on the ideal situation.

You will also want to focus extra study time to the large areas of difference in the test plans, such as blood administration, IV therapy, and TPN since those are areas you probably have less experience with. In many hospital settings, the LPN can verify blood products with an RN but is not the nurse responsible for initiating the transfusion and monitoring for reactions. This was my experience as an LPN - I often verified blood products but the RN started the transfusion and monitored the patient for the first 15 minutes. So when I encountered a question on my NCLEX exam regarding transfusion reactions I had to be sure I was thinking with the right hat on! As an LPN monitoring a patient receiving a transfusion, I was to collect patient data - vital signs and observations - and report them to the RN or notify the RN of changes. As the RN monitoring a patient, if I am given patient data or directly observe a patient experiencing shortness of breath or a rash while receiving a transfusion I need to immediately take action.

The NCSBN doesn't offer statistics for LPNs who are taking the NCLEX-RN so it's difficult to give an overall percentage of LPN career mobility students who pass on the first try. But many colleges who offer career mobility programs do give these statistics on their own programs. I did a quick review of a handful of colleges and it appears there is anecdotally a higher pass rate for LPN career mobility students than traditional students. If you are considering a career mobility program or are already in a program, your advisor or program director will be able to provide you with statistics specific to your program.

To help you get in the right frame of thinking before taking your NCLEX exam, it might be helpful to review with a professional who can ensure you're taking the right approach to exam questions and can identify the areas you may have a weakness. You may find you can do this on your own with practice questions and reviews, or maybe you have a trusted nurse who has mentored you and would be willing to talk through scenarios with you. But the best way to ensure your success is taking a review course with a professional!

And remember, once you have bridged from the LPN to RN, you don't have to stop there! Continue on to your BSN, MSN and/or PhD! I utilized an LPN to RN bridge, but then went on and did an RN to BSN program and then MSN as well! Where you start your nursing journey doesn't dictate how it ends!

If you are ready to begin preparing to take the NCLEX-RN, EduMind can help you review everything you have learned in your nursing program! Contact us today to find out how!