[Sharon]

From your Activity #6 – Think about where you have in the past or currently work in consultation with another category of nurse when caring for patients. Activity #6 – RPN/RN Consultation – complete the table and provide an example for each situation.

[Katie]

When I think back to the first 10years of my career when RN/RPN caseloads where considered different in community dt scope of practice. You would see a wound care clt that required packing, if the wound base was not visible them the RN would take over the clt care. This policy has know changed and if the RPN has the knowledge, skill and judgment, which is confirmed through annual recertification of skills then because standards have changed the RPN would continue to see this clt if assigned on their schedule.

When decline noted, escalation process would be engaged and WRN sought for consultation, in our organization many of our WRN are also RPNs with increased scope of practice through SWAN/IIWCC, they also work in conjunction with HCCSS NSWOCs with are extended scope RNs as part of their own escalation process. A Leadership Model has been developed to ensure clears lines of communications and requirements for each level.

[Maame]

1. RPN receives advice from RN. RPN continues to provide all aspects of client care; no change in patient assignment

Resident is coughing, has a fever and has a running nose. RN advises RPN to do the necessary vitals signs, apply cold compress to forehead, adminster a covid rapid /PCR testand set up isolation catty at the resident’s room until results come back in.

2. RPN receives advice from RN. Some aspects of care are transferred to RN; no change in patient assignment.

Male resident has cathether in he is always pulling out and is a very difficult resident to deal with. In that case the RPN will not re-insert the cathether but will assist the RN in reinserting it back in.

[Johanna]

1. RPN receives advice from RN. RPN continues to provide all aspects of client care; no change in patient assignment.
This scenario occurs 99.9% of the time in my practice setting (LTC).
For example: a resident develops respiratory symptoms. The RPN reviews the resident’s status with the RN. The RN assesses the resident and calls the practitioner. New orders are received and the RPN continues to care for the resident.
2. RPN receives advice from RN. Some aspects of care are transferred to RN; no change in patient assignment.
This scenario may occur in an acute psychiatric setting.
For example: a newly admitted patient is withdrawing from alcohol. The RN assesses the patient using the CIWA tool (tool for managing alcohol withdrawal). The RN administers Ativan according to the CIWA and hospital policy. The RPN continues to manage all other aspects of the patient’s care.
3. All care is transferred to the RN; patient assignment formally changed to RN.
This may occur in a post-surgical setting.
For example: a patient quickly begins to desaturate, BP drops, BS increases, LOC declines. Care may be transferred formally to an RN.

[Katie]

Having not had any clinical experience in an acute care setting I find it very interesting to see the different dynamics at play. The administrative structure seems to be in place to ensure that it is clear to everyone involved what role expectations there are.

[Jeanette]

1. RPN receives advice from RN. RPN continues to provide all aspects of client care; no change in patient assignment.
Hospital setting: Patient complains of breast tenderness, redden area and warm to touch
Talk with charge nurse and put a call in to Dr. Dr completes exam and new orders are made.
RPN still cares for patient.

2. RPN receives advice from RN. Some aspects of care are transferred to RN; no change in patient assignment.
Hospital setting: Nurse receives order from Dr to administer Lasix IV. You consult with RN as she can “Push” the Lasix as you also have to administer the next antibiotic IV.
RN administers the Lasix but you still provide the care for the patient.

3. All care is transferred to RN; patient assignment formally changed to RN.
Hospital setting: Patients condition is rapidly changing, Increase blood sugars patient level of consciousness decreased and vitals are dropping.
Patient care transferred to RN.

[Author]

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