[Sharon]

Where there any surprises with the results; both yours and the research results, please share one finding that you were surprised about and why?

[Katie]

When I looked at my own results, it was clear that I have my own disconnect with the state of the RPN program, as a 1994 certificate graduate the programs have come leaps and bounds but even as a Clinical Manager I do not have a clear understanding of what the current program entails. I am sure I am not alone in this.

[Jeanette]

Katie,
I really value your honesty about how things have changes in the RPN scope of practice. You and many others do not have a clear understanding of the changes . Lots of work places don’t keep up to date on the changes within the scope of practice. It really makes it hard for newer nurses who are taught all these great skills and a work places says you can’t do it because it’s not in your scope.
I am taking this course to facilitate change in my current work place.

[Johanna]

I was surprised how question #17 aligned with my own experience. “There is a wide variability in how the full scope of the role of RPN is enacted (e.g. unit to unit, regionally, by program).”
I was surprised to realize that I have experienced this wide variability in my own work experience. I the last nursing home that I worked at, RPNs were directly supervised by an RN manager. Our charting was monitored, and our nursing judgements were often questioned. This resulted in creating a culture of self-doubt and dependence, where RPNs were encouraged not to work to their full scope of practice.
At the home I currently work in, RPNs are encouraged to think of the role as “care managers” and “unit managers”. We are encouraged to handle any issues that arise with the PSWs and other staff that work on our unit, and only notify managers if we need to escalate an issue. We collaborate with RNs, the NP, resident families, and our physician, and take an active role in planning the care of the residents.
The structure of the two homes was much the same, but the culture of the two homes was very different, resulting in a different work experience.

[Katie]

Its wonderful to hear that there are other care setting that are working towards RPN realizing their full scope of practice. In community nursing we still do struggle at time with RNs coworkers who do not understand our role and what we bring to the table. I think with time a lot of them have seen how vital a role we play when the opportunity was given. No longer to you see RN or RPN caseloads in community nursing, it comes down to each individuals knowledge skill and judgment.

[Jeanette]

In my position I had the task of looking at the RPN scope of practice. After reading this article and doing my own research I was quite surprised how far the RPN role has come over the years.
What surprises me most is that a work place can acutely deter a RPN from working to their top of scope, by not being educated on the scope of practice of a RPN. I see how this can cause tension in a work place between the 2 roles. In my career I have seen the the struggles with the RPN role becoming autonomous. From my experience it was the RPN’s were there to help the RN’s. It is beneficial for the work place to know the current up to date scope of the RPN’s to utilize their staff appropriately.

[Maame]

One finding I found surprising in regards to the research results and my own results were that nursing faculty weren’t clear of the RPN role. I personally felt that since nursing faculty were clear of the RPN’s role due to fact that they teaching future nurses. It’s imperative for nursing faculty to know the role of an RPN because new nurses should know what is expected of them.

[Norma]

Role optimization of Registered Practical Nurses is one the most important pieces of work that the association has done in my view. Being an RPN for the last 30-plus years, I can say that there have been great changes that have happened, and still, much movement needs to occur in this area of understanding the role and utilization of RPNs.
To your point Katie, the current program is now a 2-year diploma and some schools have even increased it to 2.5 because of the full curriculum that is being delivered. The RPNs coming out of the college programs today have depth and breadth of knowledge like never before and are prepared to meet the growing demands and complexities of the patients they serve. Johanna, you are right to point out that organizations have not kept pace with the changes, and in some cases, policies still are reflective of a time when RPNs were still under the delegation of RNs before RHPA (Regulated Health Professions Act, 1991) and the Nursing Act, 1991 comes into effect. RNAs become RPNs (Registered Practical Nurses). To your point, Jeanette, role clarity amongst RNs and RPNs can and does cause tensions within the practice settings. We receive all our initial education and knowledge within our programs and if you took your program at a time where not working autonomously then you generally still hold those views today. Maame, you are right we need to ensure that those teaching at the onset of the nursing programs have a clear understanding of the roles to ensure that once in practice all nursing knowledge is optimized to meet the needs of our healthcare system. Great discussion everyone!

[Author]

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