[Sharon]

How does the CNO three-factor framework support decisions in your practice area? Provide an example of how it is used for making patient care decisions.

[Nely]

This 3 factor framework can be used in many different ways. let’s consider the novice RN:
– new to the unit, may not be familiar with the care protocols for all patients
– if a patient is deteriorating, the Team Lead or Manager will need to assess and determine if a change in patient care assignment is required. considering may factors – including the nurse, the client and the environment
– it may be that it’s a good shift with extra resources, so the novice nurse can stay with the patient and receive mentorship and support by the educator or Team Lead. Give the RN an opportunity to learn.

Now let’s look at the experienced RPN – again, if a patient is rapidly deteriorating, an assessment of the entire situation will need to occur to determine the best possible care for the patient. Considering the nurse, client and environment – the RPN may be best suited. The acuity change is what requires the re-assessment

[Katie]

The knowledge, skill and judgment of all nurses is reflected in the three factor framework, definitely agree that regardless of designation we can find ourselves in over our heads and need to be able to identity that and seek the appropriate training for the given situation.

[Jeanette]

In the area I work in presently the CNO three – factor Framework works very similar to an in inpatient setting. Working in a Community Health Centre we use our RN ‘s to see patients for episodic issues, patients may follow up with the RN after seeing Doctor or NP to check on care plan that was previously set by Provider or the RN may do a well baby check. Most of these patients have many co-morbidities and are quite complex which is what requires the role of the RN.
As for the RPN’s, it is not that they would not see those patients especially if they walk in, but usually the RPN would consult with Providers for treatment and or have the patient book an appointment. The RNP’s would be involved in a patient case conference to assist with patient care.
We have many medical directives that allow the RPN’s to work at the top of their scope.
In the circle of care the Nurses work closely together consulting each other often using each others experience to benefit the patient care out comes .

[Johanna]

In my practice setting of Long Term Care, we utilize the Three Factor Framework when a resident develops physical or behavioural issues.
The RPN collaborates with the RN on these issues, with the goal of determining if the issue is episodic or chronic in nature. The RN may step in and conduct an assessment of the physical issue, or to try and resolve the behavioral issue. The next step would be to contact the practitioner for more support regarding the physical/behavioural issue, such as for orders for bloodwork, chest x-ray, or antibiotics. For acute behaviour issues, the practitioner might order a one time dose of injectable antipsychotic medication.
As the residents that I care for are diagnosed with dementia and are of advanced age, it is unusual for them to be transferred to a hospital setting, except in acute circumstances, such as for treatment of a fracture. When a resident’s status begins to decline, the focus generally becomes end-of-life care and comfort measures. At this time as well, RNs and RPNs collaborate to ensure that the resident is comfortable and that any treatable physical issues are treated.
As the resident’s condition changes, the RPN will involve the RN in the care of the resident more often. If required, the RPN and RN can request referrals from outside agencies to help provide necessary practice supports and resources.

[Katie]

In years past in community nursing there were caseloads considered RN and caseloads considered RPN, it was part of the escalation and discharge planning process based on the three factor framework.

Today, though policy continues to be based on the three factor framework it is more reflective of an individual nurses knowledge, skill and judgment level than the designation letters behind your name.

This would not be the case in all settings of practice, but nature home care clts are stable with predictable e outcomes or they return to an acute care setting. Assessment and escalation processes are in place to determine the complexity, predictability and risk of negative outcomes on a ongoing basis.

[Maame]

I work in an long term care setting, an example of the three- factor framework is used when we receive a new admission on unit. The RPN and RN collaborates together to complete admission duties. The RN would orient the POA/family to the unit and thento speak to them collect more insight on the resident. Meanwhile , the RPN will collaborate with the PSWs’ prior to the arrival of the resident to make sure the room is ready for the resident. The RN will initate the care plan and input the necessary whereas the RPN will input additional information afterwards. The RPN’s responsibility would be to collect MRSA and VRE samples and have it sent out for testing. In addition, the RN will collaborate with the doctor about medication changes when necessary.

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