[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.

[Kirandip]

The CNO Practice Standard: Scope of Practice (2023) supports decisions in determining the scope of practice by providing expectations for all nurses of what to consider when they are deciding if an activity is safe for them to provide to their client- these are broken down into 3 key concepts that the nurse must consider prior to provision of said activity; authority, context, and competence. The Scope of Practice Standard also further reviews controlled acts authorized to RNs, RPNs, and NPs, and the 2 authorizing mechanisms of how to obtain authority to perform a controlled act (orders vs delegation). An example of how a nurse could use the standard to help make a decision with patient care could be an RPN who has been delegated by an RN to communicate a client’s diagnosis made by the RN- if the RPN would refer to this Scope of Practice Standard, they would understand that though the RN (with prescribing authority) is authorized to communicate to a client their diagnosis made by the RN where the purpose of that communication is for prescribing a medication (page 7), delegation of this specific activity is restricted for nurses as outlined on pg 11 (delegation restrictions) and so the RPN cannot accept the delegation of this specific activity.

[Samantha]

In LTC the role of the RPN and RN has many areas of overlap.
The RN is expected to be assessing any residents who would be considered high risk- for example- new admissions, complex EOL (multiple unmanaged or difficult symptoms) highly responsive behaviors residents needing to be sent to ER on a Form 1 are a few examples.
The RPNS are expected to have a excellent understanding of the residents baseline and are able to identify subtle changes in a resident, and engage with others when required.

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[Babita]

I agree with my peers. This depends on work settings and environments. With our abilities to work in a variety of settings increase, not all clinical areas will have RPN’s working with RN’s or Doctors. It is my responsibility to be aware of the CNO Standards to practice and determine if we have the knowledge, skill and judgement to carry out task at hand.

[Megan]

In past settings the caseload was determined on RN and RPN, but as the 3-factor framework has been utilized more throughout the different settings of healthcare, it is more now the level of education, the skills set, and the comfort of the nurse. I feel it should be up to the nurse themselves of their judgement of comfort of taking care of their patients. As an RPN, I know I will always have the responsibility as anyone else to take care of a patient, but if I am unsure of something I will always lean on the more seasoned RPN or even the RN for a second opinion for clarification, but at the end of it all, it is my judgement call to ensure I carry out the standards set out by the CNO.

[Marilyn]

Great conversation!

This is just a reminder that to keep the conversation going, you must have one original post and a response to your peers for each discussion.

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