RN & LPN Scope of Practice Siobhainn Lewis RN, MN Association of Registered Nurses of NL Janice O Neill LPN College of Licensed Practical Nurses of NL Presentation Date: January 21, 2014 Overview Accountability Scope of Practice Shared Scope of Practice / Collaboration Assignment of Care Talk about Myths Discussion Public Protection Support good practice, Prevent poor practice, and Intervene when practice is not acceptable. RN Act (2008) LPN Act (2005) 1
RN Act (2008) RN Act registered nurse means a person who is registered as a member of the association. ARNNL Council may, [establish] standards governing the practice of nursing, including standards of professional competence and of capacity and fitness to practise LPN Act (2005) practical nurse means a person who undertakes or performs duties or services relating to the care of patients that is consistent with his or her training as approved by the council, or a person acting under the direction of a registered nurse, a qualified medical practitioner or a member of a health care profession approved by the minister, who i. performs procedures or treatments prescribed or ordered by a registered nurse, medical practitioner or member of a health care profession approved by the minister, ii. undertakes or assists in the care of sub acutely ill, chronically ill, custodial and convalescent patients, or iii. assists registered nurses in the care of acutely ill patients. Primary Accountability First and foremost, our duty is to our residents, patients, clients We also have accountability to: employers co workers professional associations legislation 2
Definition ACCOUNTABILITY answerable to an authority for one s conduct or performance. Philpott, 1985 Definition SCOPE OF PRACTICE The range of roles, functions, and responsibilities and activities that RNs and LPNs are educated and authorized to perform. Scope of Practice sets the boundaries for practitioners Scope of Practice 3
Scope of Practice Scope of Practice Education Authorization Basic Continuing Formal Regulatory Body Legislation Employer Informal Overlapping Scopes of Practice COLLABORATIVE PRACTICE: working together working within ones scope respecting each other s contribution SHARED COMPETENCY: a competency of activity that members of a discipline share or have in common with other health care professionals (e.g., Vital Signs, medication administration) 4
Knowledge Base RN In depth nursing knowledge LPN Basic nursing knowledge PCA Basic care knowledge Same Terms Used Differently RN Assignment Same Delegation e.g., medical directives authorizing support worker Independent Practice Self employed RN LPN Assignment Same Delegation Formalized process by CLPNNL Independent Practice level of independence within scope of practice and employment Assignment vs. Delegation ASSIGNMENT: in scope of practice assigned person is accountable DELEGATION: outside scope of practice/employment accountability also retained by RN 5
Considerations in Assigning Care The Client complexity of client health status, care needs, and predictability of outcomes. The Nurse competence of individual practitioner. The Environment available and accessible resources, policies and procedures. Assignment Within their scope of practice, LPNs may provide care independently for sub acutely ill clients with predictable outcomes. However, the LPN would be required to consult with another healthcare professional (e.g., Registered Nurse) to assess the client s condition or practice environment when: the client is acutely ill, or a client s complexity increases, or the outcome of care is unpredictable, or the context of practice changes Assignment Predictable Unpredictable LPN Predictable RN Unpredictable 6
LPN Independence in Decision Making Meeting Outcomes Independent Practice Established Plan of Care / Baseline Partial Meet / No Change Collaborative Practice Fail to Meet Outcomes Guided/Directed Practice Predictable A patient: with progressive dementia who no longer recognizes his family member with a history of stroke and with a feeding tube inserted with neuromuscular disease with a stable health condition admitted to rehab with hip fracture and hip pain well controlled by Tylenol and otherwise in a stable health condition Predictable, But Chest pain in a patient with a known diagnosis of unstable angina Pain crisis in a patient with known variations in pain level and an effective treatment plan in place Patient with delirium when underlying cause, and expected patient response, is known and treatment plan in place. If patient is not responding to interventions as expected or anticipated, and outcomes become unpredictable, accountability for care must be transferred. 7
Unstable and Unpredictable a newly admitted patient whose care plan is not established A patient: who has a pressure ulcer deteriorating with damage to muscle and extending to bone structure with uncontrolled pain/psychological distress in respiratory distress/confusion/agitation not relieved with current interventions with new onset of grand mal seizure activity with new onset of acute illness (pneumonia) who is not yet responding to treatment and who s prognosis is unclear with behavioural patters requiring changes in the plan of care. LPN Independent Practice relates to independence in practice NOT self employment Requires the presence of: An established plan of care baseline expected outcomes nursing actions Basic nursing knowledge Ongoing assessment/review Evolution of the plan of care Facilitation of identified supports and services When Things Change When it is determined that the needs of the client are beyond the scope of practice of the LPN, the RN would assume accountability for the client s care and, in discussion with the LPN, determine which of the following options would be most appropriate: RN and LPN work collaboratively to provide the required care, LPN work under the direction or guidance of the RN, LPN relinquish care of the client to the RN. 8
CNPS InfoLaw Supervision CNPS InfoLaw (2012) Initial direction, periodic inspection and corrective action when needed. It is the active process of directing, assigning, delegating, guiding, monitoring an individual s performance of an activity to influence its outcome. Supervision DIRECT: The supervisor is immediately present to direct and guide performance of the procedure, activity or intervention, and guide performance or follow up on performance. INDIRECT: The supervisor is not immediately present during performance of a procedure, activity or intervention, but is available upon request to guide, evaluate, or follow up on performance. Let s Talk About the Myths It s my license on the line. I m the only RN in the building and I am responsible for everyone. Charge nurse notified Where can I find the list of RN/LPN competencies? I m expected to do everything. Now I am more accountable than ever. 9
Resources Association of Registered Nurses of NL (ARNNL) www.arnnl.ca 753 6040 or 1 800 563 3200 For RN s Canadian Nurses Protective Society (CNPS) 1 800 267 3390 www.cnps.ca College of Licensed Practical Nurses of NL (CLPNNL) www.clpnnl.ca 579 3843 or 1 888 579 2576 10