It s All About Synergies

Transcription

1 It s All About Synergies Understanding the role of the Registered Practical Nurse in Ontario s Health System Annette Weeres, RN, BScN, MN Holly Smither, RPN, September 26, 2014

2 Agenda Overview of RPNAO Role Clarity Project Resources Useful in Achieving Role Clarity

3 It s all about Synergies... Synergy Defined as the combined effort being greater than the parts: the working together of two or more people, organizations, or things, especially when the result is greater than the sum of the individual effects or capabilities. (Merrian Webster)

4 Why do we need Role Clarity? Who is Accountable for the Patient?

5 Project Goals To engage nurses, nurse leaders, and health care experts to share their knowledge and successes in creating collaborative environments that support a strong, appropriate role for the RPN To develop a report/resources with relevant tools that will support nurses, nurse employers, and the public to gain clarity about the role of the RPN To prepare documents and resources useful to RPNAO in ongoing information dissemination activities. 5

6 Expert Panel Members Name Role / Affiliation Anne McKenzie RPN Care Coordinator; St. Elizabeth Healthcare ; Dawn Serrick RPN Donna West RPN Joanne Greenwood RPN Sue Bellinger RPN Julia Scott RN Lisa Hildebrand RN Mary McAllister RN Nancy Lebefre RN Assistant Director of Tenant Care; Brampton Holland Christian Homes Direct Care, Huron Perth Health Alliance; Stratford Direct Care; Rideau Family Health Team; Ottawa Direct Care; Simcoe Muskoka District Health Unit (retired) Vice President Clinical Services & CNE; Grey Bruce Health System Manager, Emergency; Niagara Health System Associate Chief, Nursing Practice; The Hospital for Sick Children Chief Clinical Executive, and Senior Vice President Knowledge & Practice; Saint Elizabeth Healthcare Nancy Purdy RN Sheila West-Merker RN Associate Professor, Ryerson University Associate Dean, Humber College 6

7 A Large Scale Consultation Online Survey using innovative recruitment methods Focus groups with leaders of nursing teams RPNAO Pre-conference workshop participants

8 The Demographics...who replied N=1101 What is your professional designation: Frequency Percent RN RPN Total Faculty Respondents N=48 Teaching Role (choose all that apply) Faculty Both College and University programs Frequency Percent 9 2 Faculty / College program Faculty / University program Professional Designation Frequency Percent RN RPN 2 4 Total Number of years in Nursing Career breakdown Frequency Percent.5-5years (early) years (mid) years (late) Total Highest level of professional education completed Frequency Percent RPN Diploma RPN Certificate RN Diploma BScN Grad. Program Total

9 Knowledge of the RPN Role and Scope of Practice The role of the RPN is clear Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Number Admin RN RPN Nursing Faculty The RPN can perform the same controlled acts as the RN Admin RN RPN Nursing Faculty

10 SCOPE Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Number RNs are familiar with the scope of the RPN role. Admin RN RPN Nursing Faculty The RPN role has evolved to include practices that were previously exclusive to the RN role. Admin RN RPN Nursing Faculty RPNs are familiar with the scope of the RN role. Admin RN RPN Nursing Faculty

11 Comments Many RPN's did not understand the changes in their scope that occurred several years ago and are still somewhat resistant to practicing to full scope - they feel like it's added work or assuming the work of the RN. Nurses are still very task orientated and have trouble distinguishing heavy tasks from higher patient acuity. Sometimes with the "older" RN's. They don't understand how the "new" RPN program has changed and the knowledge and experience that the "new" RPN has and is capable of doing. Sometimes we are still referred to as "just an RPN" I expect an RPN to know what they aren't allowed to do in an institution. Clinical Educator RPN RN

12 Teamwork and Respect The RPN is regarded as an equally contributing member of the health care team. Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Admin RN RPN Nursing Faculty The culture of the practice setting determines whose knowledge is valued, who gets listened to. Admin RN RPN Nursing Faculty Number

13 Comments I have been teaching in clinical placements for many years with students and I am seeing more positive changes in the culture of acceptance for changing roles. Nurse Educator My experience has been that RN' s (especially new BScN RN's) have no idea what the RPN role is, and do not respect the RPN judgement or assessment skills. RPN I once had a nurse manager tell me I was too intelligent to be a RPN, I was RN material. I found this really insulting because to me it suggested RPN's were stupid. RPN

14 The Role of Leadership Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Number Those in leadership positions (e.g. Unit manager, CNE, Directors) have a good understanding of nursing scope of practice. Admin RN RPN Those in leadership positions have a good understanding of the difference between RPNs and RN Admin RN RPN

15 The Role of Educators Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Number Clinical Educators are able to explain the difference between RPNs and RNs Admin RN RPN Nursing faculty are able to explain the difference between RPNs and RNs. Admin RN RPN Nursing Faculty Nursing faculty have a good understanding of what is meant by nursing scope of practice. Admin RN RPN Nursing Faculty

16 Comments It is up to the leadership to inform themselves, and their teams about the RPN role and how it is to be fully utilized on individual units. If the leaders are not clear, the units will most certainly not be clear Clinical Manager Leaders have a dramatic impact especially senior leadership that finalize the organization policies regarding RPN scope of practice Director/ Executive There is a blurring of role clarity between RN's and RPN's and it can be difficult to define when and why either an RN or an RPN is necessary. How do I determine a realistic staffing mix? With RPN's doing so much more, what does the RN do that is distinctive from the RPN? Leadership should always be updated about the new scope and then be able to inform staff of the changes and why. Clinical Manager RPN, Direct care

17 Organizational Practices RPNs are allowed to function to their full scope of practice (e.g. no old polices / restricting scope). Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Number Admin RN RPN Nursing Faculty Scope of practice and models of care are viewed as a priority in our organization. Admin RN RPN

18 ORGANIZATIONAL PRACTICE Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Integrating the new role (e.g. increased Standard ofpractice) of the RPN has been smooth. Admin RN RPN There is little difference in what RPNs are educated to do in their school and what they are allowed to do in the practice setting. Admin RN RPN Nursing Faculty There is wide variability in how the full scope of the role of the RPN is enacted (e.g. unit to unit; regionally, by program) Admin RN RPN Nursing Faculty Number

19 ORGANIZATIONAL PRACTICE Strongly Disagree/ Disagree Don t Know Agree/ Strongly Agree Organizational factors (e.g. Reorganization and job uncertainty) have had a negative impact on the way RPNs and RNs work together Admin RN RPN Nurse Faculty The nursing care delivery model in place (e.g. total patient care, primary nursing, team nursing) plays a role in determining the scope of practice for the RN and the RPN. Admin RN RPN Fiscal realities have resulted in replacing RNs with RPNs. Admin RN RPN Number

20 Comments A major issue contributing to ambiguity in my opinion is that the current practice environment contains 2 diverse groups of RPNs - those that were educated in the "old" system and have done some upgrades, and those that have graduated from "new" diploma programs. The "old" group is basically practicing like Personal Support workers Who give meds, versus "new" graduates who are anxious to practice at full scope but are held back by organizational policies. Nurse Educator The scope of practice for RPN's in the hospital where I work is excellent. I have avoided applying for positions in hospitals where I know that I cannot utilize my full scope of practice. RPN They want to work within scope of practice however the organizations limits them. On acute units with high acuity, we are setting up the RPN for failure as only a select few patients meet the criteria for predictable. Clinical Manager

21 If we don t get this right...

22 Key Messages Emanating from the Findings RPN role is viewed as valuable member of the health care team Phrase scope of practice is not well understood Many misconceptions and old truths exist, held by both RPNs and RNs, regarding the Registered Practical Nurse scope of practice Nurses educational background contributes to their current understanding of scope of practice

23 Key Messages Con t Leadership plays a vital role in setting expectations Nursing care delivery models based on principles of collaboration and partnership allow for optimal teamwork, respect and knowledge sharing Organizational practices play a key role Despite the inherent and significant degree of overlap between the RPN and RN roles, there is discomfort with the resulting ambiguity

24 Suggested practices for enhancing RPN role clarity and nursing team collaboration Shared learning opportunities for RPN and RN students within nursing educational programs; focus on collaborative models Development of organizational development strategies Research to increase our understanding of areas

25 Resources

26 Resources The Ontario Context Getting to the Facts Determining Team Knowledge and Understanding Assessing the Patient Factor Enhancing Nurse to Nurse Professional Communication How to Know it is Going Well

27 The Ontario Context

28 Getting to the Facts

29 Determining Team Knowledge RPNAO RPN-RCQ Confidential, easy and costeffective way to obtain staff input Can be done as initial assessment to determine specifics areas for focused interventions ongoing monitoring or evaluation to determine the impact of any interventions/strategies employed to address role ambiguity at the team, program, or organizational levels

30 Assessing Organizational Factors

31 Assessing the Patient Factor Clarifying Commonly used Terms Deciding on Acuity The Typical Patient/ Care Scenario PCNA Tool

32 Enhancing Nurse to Nurse Communication Working Together (NANB & ANBLPN, 2009) Nursing Huddles

33 Impacts of not getting it right??? not getting it right included the potential negative impacts on patient safety patient outcomes, role satisfaction (i.e. for both RPNs and RNs) and recruitment and retention of RPNs. There is the recognition that scopes of practice will continue to evolve overtime to meet the evolving needs of patient populations and the health care system and increased clarity regarding roles and responsibilities are essential in order to support decision making and optimal utilization of nursing resources (Collaborative Nursing Practice in Alberta, 2003)

34 Questions/Discussion? Contact Info: