[Sharon]

Now that you have reviewed the PCNA Utilization Toolkit, can you identify one benefit and one difficulty with the PCNA Utilization Toolkit? If your organization has used this tool, did you participate and did it change practice?

[Jaclyn]

After reviewing the PCNA Utilization Toolkit a difficulty I see with it is the time required for a review as well as the ever changing acuity of the patients and fast change over of patients of some units. The acuity of medical/surgical floors is always changing. The patient acuity of the floor can look vastly different from one day to the next with the amount of admissions and discharges therefore the toolkit would not be an efficient tool to use. A benefit of the tool is Appendix A, assessing the patient’s care needs. I find check lists or flow sheets are a quick and effective tool for nurses to use to determine the level of care and status of their patients. This could be useful in determining what nurse should be assigned to the patient. This is the first time ever seeing or hearing about this tool but I do feel some kind of checklist would be really helpful to a charge nurse when creating patient assignments.

[Jacqueline]

Benefit: help with staffing model, planning process.
Difficulty: not always able to fit a patient / condition into one category.
I can’t imagine the time taken to prepare and physically go through all of the outlined steps on this checklist and still have the same patients present of the floor. That is my immediate thought, who has the time to complete this? When I worked on the medical floor, we would have an overlapping handoff between all staff and charge nurses to identify any concerns and plan the next shift. Some of the “checklist” I believe may be completed behind the scenes prior to meeting up for a handoff. Some of the information or conditions are constantly changing so that would make it hard to predict what the exact need is or rather capture that on paper. I think the items highlighted on the check list are valuable tools to aid in nurse selection but the implementation of this particular tool may not be feasible on a busy hospital floor with ever changing needs.

[Veronica]

Hi Jacqueline,
I understand your sentiment , when I worked in a retirement facility I was out numbered I was the nurse for 3 units and each unit has 15-20 residents its true that most of them are physically and mentally able but still all of them needs meds and every shift things change, accidents happen thing like that and you have to do reports at the end of the shift. Who has the extra time to do these PCNA tool?

[Josephine]

On December 19, 2022, the College of Nurse of Ontario announced government reviews regulations to expand RPN scope of practice. The Ontario government is reviewing proposed changes under the Nursing Act, 1991 to expand the scope of practice for RPNs.The Ministry of Health and Long-Term Care is working to expand the scope of practice for NPs, RNs, and RPNs to increase the patient’s choice of access to healthcare services. The HHR Demonstration Project, 2009 highlights staffing is not dependent on the number of nurses providing care but involves having nurses with the right skills, experiences, and education, working within the right type of staffing model and the right mix of other healthcare providers. In my opinion, this is a great theory, but the reality is nurse administrators are utilizing staffing agencies, posting available shifts/wholes for pick up on a day-to-day basis, and paying overtime/double time and a half to meet minimal staffing levels. The biggest insult to the retention of nurses and the advancement of the profession remains to be Bill 124, legislation that limits our fundamental right to bargain for our wages. It is difficult to imagine the nursing crisis resolving while this bill remains active. Attempts at solving the problem are misguiding especially when the focus is on bringing in new nurses rather than incentivizing the existing workforce to return or remain.

If the government approves the regulations, RPNs who have the relevant competence will be able to independently initiate specific controlled acts without an order :

-Irrigating, probing, debriding, and packing of a wound below the dermis or below a mucous membrane

-Venipuncture in order to establish peripheral intravenous access and maintain patency, in certain circumstances

-Putting an instrument, hand, or finger beyond the individual’s labia majora for the purpose of assessing or assisting with health management activities

-Putting an instrument or finger beyond an artificial opening into the client’s body for the purpose of assessing or assisting with health management activities

If the government approves the regulation, CNO will begin developing resources to support RPNs to implement this scope of practice change.

“Nurses in Ontario are world-class. Recognizing that RPNs have the knowledge, skill, and judgment to further address needs in the health care system will hopefully expand access to safe care for Ontarians,” says Carol Timmings, Deputy Registrar and Chief Quality Officer.

[Veronica]

I never had the opportunity to participate in a PCNA. In the company I work with the RN will do the initial assessment of the client and set up the care plan.
Upon reviewing the PCNA Utilization toolkit, one benefit of using the toolkit is that it helps nurses to determine the level of care the patient needs and also easier to determine what nurse to be assigned to that particular patient based on the health status or the severity of the case.
One difficulty in using the toolkit is that its time consuming and if you have to do this every shift times the number of patients you are attending to then yes its more work for the nurse at the end of each shift. However, I can say that the toolkit is useful in determining what nurse can be assigned to a patient.

[John-paul]

Hi Everyone,

There seems to be a general sentiment that the tool would be great in theory, to help identify patients care needs, staffing needs etc., however that the amount of time it would take to implement would make its use challenging.

Although this may not be its intended use, I wonder if the toolkit could be adapted to spread the load a little? I think some pieces may be able to be incorporated in a flowsheet that staff could fill out which may work well in an electronic health record and maybe other pieces that would not work as well in a flowsheet could be completed by a charge nurse or unit manager? This would definitely take a fair amount of collaboration and coordination to bring the results of the tool’s assessments together, however I would love to hear if anyone else has any thoughts on this.

[Jacqueline]

I do recall we would meet daily and talk about each patient status, potential discharges and other moves, we would have the discharge planners, PT/OT, charge nurse, doc on call and some nursing staff present to openly talk about all of the factors impacting each pt. We had a standard set of questions to answer and facts to present. I am sure they have refined this process since I worked at the hospital but it was very beneficial to be part of the planning process.

[Alison]

Although I have never taken part in something quite this in-depth, the model and topics of discussion are similar to a shift report. I also see this as a hospital model with frequently changing patients and, possibly, staff.
The PCNA Utilization Tool seems like it would be very time consuming. I’m not sure that all parties involved could be gathered together a) before the patients in question changed status or moved location and b) for the required length of time to go over every detail of every patient being assessed.
The tool is very thorough and inclusive. It would work well in a setting such as LTC where the patients vary greatly in their needs but the environment is very controlled. The PCNA Utilization Tool is a great model to have a representative from management, RNs, RPNs and PSWs all sit together and discuss each patient monthly or quarterly.

[Author]

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