Key Findings of the Research- Review the key findings below and discuss in the forum if there is anything that you were expecting but is not listed
Make the scope clear wherever you work for both RNs and RPNs. I find the misconceptions and truths to be a bit out dated.
Some of the role clarity is needed at all times
Team work is needed
Education between the RNs and RPNs and the fact that no bridging anymore. Why would you not want a RPN to go for RN but the RPN has the work behind her and workplace education
Agree with making scope of practice clear for both RPN’s and RN’s. Without, this is where confusion/problems can occur.
When I worked in the hospital, it was made clear what the RPN’s role is, and what the RN’s role is. Both nurses worked collaboratively with one another, and the team work was great. The RNs essentially got the “unstable and unpredictable” patients, and the RPNs got the “stable and predictable patients”. If an RPNs patients condition changed/became worse, the nurse assignments would also change to reflect this, ensuring an RN took over the RPNs patient.
If I was uncertain about something, I was always able to ask an RN for assistance, and they were always happy to help and provide teachings/positive feedback.
On another note, the “older RPNs” I worked with at the hospital were kind of set in their old ways, and weren’t willing to learn new skills/procedures. I’ve heard some of them say “that is not in my scope of practice, so I am not doing it”. However, I believe that all RPNs should be willing to learn new things and expand their competence when they can.
Great discussion and points made by you both above!
How we education nurses is certainly something being widely discussed at larger tables given the shortage that we are experiencing. Collaborative learning models are being consider and even implemented in some parts of the country. The association is discussing career laddering for those that do want to bridge at every level to have a more seamless process for the learner to reaching their educational goals.
It has been mentioned that the terms can determine when assignments change however when we look at the quote from the CNO we can see that there is other aspects of the care that must be considered when assigning the right nurse to the right patient.
“Nursing is a profession that is focused on collaborative relationships that promote the best possible outcomes for clients. These relationships may be interprofessional, involving a variety of health care professionals working together to deliver quality care within and across settings; or it may be intraprofessional, with multiple members of the same profession working collaboratively to deliver quality care within and across settings”.
A great example of this is in mental health. I know that for example when mental health patients are about to get discharged they often have an exacerbation of their condition and end up in the PICU. If the nurse caring for them is an RPN who has established a strong therapeutic nurse relationship with them then she is often the best nurse to support their care in the unit while they are “unstable”. I happen to know that Ontario Shores utilizes RPNs in this way as appropriate.
So you can see that when assigning nurses to patients many aspects need to be considered.
Great start for Week one!
Norm thank you for the positive feedback. I agree with your post as well. The CNO should be where to start then work from there to improve the training and where are skills are defined.
I would have liked to see education and willingness to learn on there. As a nurse is it our duty to learn and teach. We are expected to share our knowledge and mentor where able in our practices. I feel like with time ever changing and our scopes broadening often we need to be expected and encouraged to complete education to be able to offer the highest skill set we an provide in our roles.
I want to discuss on the point above about older nurses mentioning its not in their scope. I see this all the time in my workplace. Its so frustrating because it now is in their scope they just failed to educate themselves on what their scope really is and learning the new things in healthcare. Its out duty to continue education to provide the best care. These members needs leaders like we want to be to show them their skills and bring the education forward to empower them. We are only as strong as our weakest link.
I cannot think of any additional findings I would have expected, but would like to comment briefly on each of the published findings.
The RPN role is viewed as a valuable member of the health care team in the provision of quality patient care.
— I truly believe that this would be dependent on practice environment; in primary care, where the acuity and expected outcome on any given day/appt are quite predictable, RPNs can be widely used within the care teams for a variety of patient needs. And while I understand that discussing RPN over RN relevant to fiscal responsibility may sometimes ruffle feathers, it can be vital to reaching a large number of patients on a daily basis – more nurses directly means more patients being seen. Within our organization the RPNs are in high numbers, and fulfill vital roles within the interprofessional teams.
Although frequently used, the phrase scope of practice is not well understood, with most nurses describing scope of practice in terms of tasks or what they are allowed to do in their practice settings
There continue to exist many misconceptions and old truths, held by both RPNs and RNs, regarding the RPN scope of practice, which contributes to role confusion and underutilization of RPNs (e.g. the misconception that RPNs must work under the direct supervision of RN).
—- In my experience in primary care, this was definitely the case in the beginning of my career; older NPs and RNs not understanding full scope, confusing differences in skill/initiation and denying RPNs to make autonomous decisions in client care. Underutilization indeed. Over time, with forward thinking people in management and gradual turnover of staff (with many newer, younger nurses entering the field and coming to our organization), a better understanding of scope was achieved (this still needs work), and lots of resources have been poured into our RPNs to increase skill training and knowledge building and has contributed to high functioning RPNs and valuable members of the care teams.
Leadership has a vital role in setting expectations regarding scope of practice, collaboration, and respect within the practice setting.
— absolutely, and for approx 8 years in our organization we had a non-nursing clinical services manager; while many of the nursing staff felt this was a detriment to the team overall (nursing only, not the interprofessional teams), it was very helpful having someone who was truly interested in learning about roles and scope, with no history of previously accepted misconceptions about nursing hierarchy. She became very familiar with the CNO website, practice consultants, and was an excellent advocate for full utilization of all nurses, working to each full scope.
Organizational practices (e.g., policies, procedures, role descriptions, models of care) play a key role in determining the appropriate utilization of RPNs.
— I absolutely agree. And this is why it is important to have knowledgeable leaders and managerial staff consulting with and letting nursing staff contribute to the development of organizational practices.
Given the significant degree of overlap between the RPN and RN roles, many nurses and nursing leaders are uncomfortable with the resulting ambiguity and would like a list of who can do what to cover all possible scenarios.
— I wonder if “uncomfortable” is the right word… perhaps uncertain would be more accurate; in a hospital or any acute care setting, I can see how not knowing how best to assign patients could make nurses and leaders uncomfortable or worried about making the wrong choices. Where black and white lists would simplify decision making. And determining “predictable outcomes” can be tricky as well, especially in the hospital setting where timelines are so important. Predictable in the next hour? morning? full shift? Education is key, in all health care settings, for al levels of employment. And nurses themselves need to know their scope, limitations, and how to determine their own competence when deciding “can I do this”.