** Posting early because I will be away the week of Aug 3-7 **
Registered Practical Nurses have been “fighting” to be heard at the decision-making tables for decades. Have they been successful? Do Practical Nurses have one voice? What other voices does nursing need to compete with?

RPNs are often overlooked and under valued when it comes to sharing opinions or suggestions. Historically we have been shadowed by RNs. However, I do believe RPNs voices are starting to be heard. This has a lot to do with professional organizations such as WeRPN, who advocate for the RPN profession.

While RNs and RPNs share many professional values, their roles, educational preparation, and scopes of practice differ. Which is why it is important for RPNs to have an independent voice, especially related to things like wage and scope.

RPNs can strengthen their voice by joining organizations like WeRPN, or joining committees, participating in quality improvement initiatives, engaging in research, and sharing evidence from their practice. By doing so, RPNs can be respected contributors at decision-making tables. For example, my organization has a Nursing Quality Committee where they encourage frontline staff to participate, advocate, and share real life experiences to be a part of change within the organization. The committee consists of Nurses, managers, and executive leadership to help drive quality improvement initiatives throughout the organization.

*posting early as I am away this week Aug 1-8th.

1:Registered Practical Nurses have been “fighting” to be heard at the decision making tables for decades. Have they been successful? Do Practical Nurses have one voice? What other voices does nursing need to compete with?

There has historically been a divide between RNs and RPNs that goes beyond the differences in their education and professional designation. However, I believe that this divide is becoming smaller as the roles of RNs and RPNs continue to evolve.

In my current workplace, there is little difference in the types of patients that RNs and RPNs care for, and we often perform many of the same responsibilities. Despite this, I feel that RPNs still have to work harder to have their voices heard within the organization. At times, it seems as though RPNs are competing with both RNs and PSWs to have our perspectives recognized.

The RN union is very strong within my organization, and as a result, I sometimes feel that the concerns and contributions of RPNs are overshadowed. That said, I have noticed positive changes, and I believe RPNs are becoming more involved in discussions and are gaining greater recognition for the important role they play in patient care.

2:Nurses are one voice at the policy table. Often the Registered Nurses’ voice is seen as the voice of Registered Practical Nurses as well. When and how is it important to raise the voice of RPNs separate from the RN’s? How can RPNs be heard amongst the many voices.

The voice of RPNs when decisions involve scope of practice, staffing models, workload, professional development, compensation, and opportunities for leadership is important. As the role of the RPN continues to expand, policies should be informed by those who are directly providing this care. Recognizing the contributions of RPNs also helps ensure that their knowledge and expertise are valued alongside those of RNs and other healthcare professionals.
RPNs can strengthen their voice by becoming involved in professional organizations, participating in workplace committees, engaging in quality improvement initiatives, and advocating through their unions and regulatory bodies. Sharing evidence, speaking up during organizational discussions, and collaborating with RNs and other healthcare professionals can also help ensure that RPN perspectives are included in decision-making. By advocating collectively while also highlighting the unique contributions of RPNs, they can become a stronger and more influential voice in shaping healthcare policy and practice.

While RPNs have gained greater recognition over the years, I do not think they have fully achieved equal representation at health care decision-making tables. Many policy discussions are still led by physicians, RNs, and administrators. The literature also suggests that barriers such as workload, limited political involvement, and low participation in professional organizations have weakened nursing’s collective influence.

Although RNs often represent the nursing profession, there are times when RPNs need their own voice, particularly on issues such as scope of practice, staffing, compensation, and education. Their experiences and contributions can differ from those of RNs and deserve direct representation. Rather than competing with RNs, RPNs should work alongside them while ensuring their unique perspective is heard.

RPNs can strengthen their influence by becoming involved in professional organizations, workplace committees, and policy advocacy. As the readings emphasize, nurses have a responsibility to advocate not only for individual patients but also for policies that improve the health care system.

1. Have Registered Practical Nurses (RPNs) been successful in being heard at decision-making tables?
RPNs have made progress, but they are still underrepresented in many health care decisions. Several RPNs working as ADOCs at nursing homes and are taking management roles, but there is still work to do to make sure their knowledge and experience are recognized. Thus, continued advocacy is needed for greater recognition and participation.

2. When and how is it important to raise the voice of RPNs separately from RNs?
It is important to raise the voice of RPNs when decisions affect their scope of practice, education, or daily responsibilities. RPNs can be heard by participating in committees, professional organizations, and policy discussions, and by sharing their frontline experiences.

In my LTC workplace, RPNs and RNs often perform many similar daily tasks, especially in direct resident care. However, RNs are paid more due to probably they have a broader scope of practice and length of years of education; therefore RPNs feel their contributions are not fully recognized, which is why it is important for RPNs to have a voice in discussions about roles, workload, and fair compensation.

Do RPN’s have a single voice at the decision making table?

I would answer this with a no, not yet. We are still being lumped in with RN’s who are often represented by a different union whereas RPN’s are not always part of ONA. I think that one thing that causes issues with RPN’s not being recognized is lack of role clarity, or sometimes role clarity is kept being unclear so that RN unions can bolster up their members wages. In the area that I work in there is a very high overlap with RN/RPN tasks, yet there is still a large wage gap. In addition, I have noticed that where I work, it is very difficult to move to senior clinical positions if you are not an RN and preferably with a masters degree.

I do feel that WeRPN has been going a great job advocating for RPN’s and there are many more opportunities for RPN’s than there were years ago. I think that as RPN’s we need to become more involved in our professional associations and unions at any level in order to bolster numbers in order to be taken more seriously.

Q. Registered Practical Nurses have been “fighting” to be heard at the decision-making tables for decades. Have they been successful? Do Practical Nurses have one voice? What other voices does nursing need to compete with?
Q. Nurses are one voice at the policy table. Often the Registered Nurses’ voice is seen as the voice of Registered Practical Nurses as well. When and how is it important to raise the voice of RPNs separate from the RN’s? How can RPNs be heard amongst the many voices?

Although the RPN voice is gaining impact within the profession and within political circles, it is the RN who is given the authority to lead and implement change. This has been explained by a facility executive director that she relies on an RN over an RPN to ensure safe nursing practices. This is due to the reality of the extended education and training. As a business administrator, and not based in nursing or health care, the executive director has met the due diligence required to ensure the wellbeing of residents and nursing standards.
It is challenging to argue with the reality of education and training when striving to have the voice of the RPN heard. Working to overcome the bias of might (years of RN training) and right (years of RPN experience) in the current health care regime would streamline the bottlenecks relating to healthcare reforms. This theory is based on the number of experienced RN’s retiring or leaving the field and the number of inexperienced new RN’s coming onboard. The gap in the brain drain is filled by the RPN. This puts the RPN category of nursing in a heightened level of responsibility that is expected to be maintained not only by the facilities, the CNO, but also by the governing legislators and general public.
It is not certain that RPN’s have one voice because participation in associations such as WeRPN are not compulsory. Therefore, for the most part, only those nurses who wish to explore the outer limits of their classification participate in this association. It is through WeRPN for example that the voice of the RPN is solidified and presented as a cohesive reality that must push its way into the political forum. In the writer’s experience, many retired RN’s have demonstrated their resentment to the presence of the RPN. The evolution of prejudice and professional bias is ongoing. Consequently, the RPN voice must not only compete with that of the RN but must also work toward eliminating the historical bias that still lingers withing the health care system right down to the individual facility and the unit.
The individual RPN could support the collective voice at the policy tables by evidence-based practices. This translates into yearly execution of learning plans with evaluations on results that must be submitted to a governing authority. It is unknown whether the CNO has or is willing to open a category whereby evidence is provided to its governing board and legislative advocates with the professional development of the RPN classification; or, whether RPN associations, like WeRPN can obligate RPN’s to participate in on-going learning so that documented evidence can be provided, disseminated, and reported to policy advocates and makers.

Registered Practical Nurses have been “fighting” to be heard at the decision-making tables for decades. Have they been successful?What other voices does nursing need to compete with?

Success?
I am extremely happy and proud of the progress RPNs have made. Although there is still work to be done I can appriciate the level of professionalsm within the RPN title. We are nurses, educators and leaders. I think there needs to be more education because that is where the lack of understanding and ignorance is primarily found. People dont know what they dont know.

Other voices?
I think that the main voice RPNs need to compete with is unfortunately RNs. Where we should be one team there is obviously still a huge divide. The RPN scope is expanding while the wage stays the same, RNs complain of their “jobs being stolen” and it causes tension between both groups, when there should be one united voiced for all nurses.

Registered Practical Nurses have been “fighting” to be heard at the decision making tables for decades. Have they been successful? Do Practical Nurses have one voice? What other voices does nursing need to compete with?

Yes and No. I feel that RPN voices are heard at the union or operational level, but not as much at the government level. RPNs have seats on regulatory bodies (like the CNO) and professional associations (like WeRPN), and often have union seats that represent RPNs.

I believe that alot of the time, it depends on where you work. Personally, in the past, I’ve been part of a union that represented both PSWs and RPNs. Because I worked in LTC, RPNs were greatly outnumbered by PSWs. This meant a lot of the committee seats and issues fought for were geared towards the PSWs, which ultimately did not give the small group of RPNs much of a voice. RNs have a larger advocacy and union voice as they have dedicated organizations across different sectors (like ONA and RNAO).

Despite clinical advancements, high-level healthcare decision-making (hospital boards, ministry policy roundtables) is still heavily dominated by Registered Nurses , Nurse Practitioners , physician leaders, and non-clinical health administrators. RPNs are frequently consulted on implementation, but less so on policy creation.

Decades of advocacy have broadened RPN scope, which has allowed RPNs to take on more lead roles. I feel more time, advocacy, and representation for RPNs will allow us to continue to have our voices heard.

Nurses are one voice at the policy table. Often the Registered Nurses’ voice is seen as the voice of Registered Practical Nurses as well. When and how is it important to raise the voice of RPNs separate from the RN’s? How can RPNs be heard amongst the many voices.

RNs often advocate regarding high-acuity care,however, RPNs bear a massive amount of direct, hands-on, stable-to-predictable patient care, especially in main sectors like LTC, rehab, and home care. When policies are made about nurse-to-patient ratios or workload only through the lens of an RN perspective, this overlooks how task redistribution directly impacts RPNs and patient safety.

How can RPN raise their voices?

RPNS need to advocate to stop competing with RN’s on who has more education. We should focus on the value RPNS bring to our systems longterm stability. RPNS are often the backbone of care continuity in LTC and in the community. Policy briefs should frame RPNS as essential managers of chronic diseases and long term patient stability and safety.