BLOOD MATTERS THE ROLE AND SCOPE OF THE LPN Douglas Bungay, MN RN Director of Professional Practice and Policy College oflicensed Practical Nurses of Nova Scotia
Disclosure I have no involvement with the industry and therefore I have nothing to disclose nor can I identify any potential conflicts of interest.
Evolution of LPN Practice Certified Nursing Assistant program began in 1957. Primary focus was to quickly train an assistant to the Registered Nurse as a strategy to address the RN shortage. in Nova Scotia
Evolution of LPN Practice 1959 2002 Various educational requirements of the CNA program. A CNA s became Licensed Practical Nurses or LPNs in 1997* to be consistent with western Canada. LPNscontinue to work under the direct supervision of an RN. in Nova Scotia
Evolution of LPN Practice in Nova Scotia 2002 LPNs achieve selfregulation with the Passing of the LPN Act and Regulations, 2002. TheAct supported the creation of the College to replace the Association and Licensing Board. With self regulation, LPNs gained autonomy and accountability, however still practice under the supervision of other care providers.
Evolution of LPN Practice in Nova Scotia 2006 An new LPN Act is proclaimed. The new act moves the entry to practice educational requirement from a certificate to a college diploma (24 months). Supports the implementation of a Continuing Competence Program (CCP). Mandatory education requirements for every LPN are instituted as part of the CCP timeline.
Evolution of LPN Practice in Nova Scotia 2006 The words `under the supervision` are removed from the scope of practice statement and LPNs achieve greater autonomy through contextual practice. LPNs are authorised to practice independently, in consultation or with guidance or direction from a variety of care providers. Work kbegan to harmonize LPN Entry to Practice Competencies across the country (completed 2010).
Evolution of LPN Practice in Nova Scotia 2008 2012 The first diploma prepared LPNs graduate with the most technical competencies ever. LPNs are given the authority to care for clients receiving blood products, however have little authority to manage the product itself. New Entry to Practice competencies come into force. The national licensing exam is evolved to includethese as testable items. LPNs are given the authority to initiate peripheral IVs and blood products.
Evolution of LPN Practice in Nova Scotia 2015 LPNs are autonomous practitioners who practice in collaborative relationships with other care providers and have core nursing knowledge to independently care for clients with an established plan of care.
RN and LPN Practice LPN practice is grounded in core nursing knowledge. RN practice is grounded in in depth nursing knowledge.
Three Factor Framework of Contextual Practice Assessment of the three factors is required to determine if the LPN is the most appropriate care provider to engage in a particular practice or intervention. Practice environment Individual competence Needs of the client
Contextual Practice Capacity to make care decisions independently varies based on the needs of the client and resources in the practice environment. As client predictability/resources increase, so does the independence of LPN practice. As client predictability/resources decrease, so does the independence of LPN practice (and they must consult with other care providers to make care decisions.)
Scope of Practice: Its not only about the intervention Variability in clients responses to interventions or availability of resources in the environment may impact tthe LPNs ability to predict and manage the outcomes of their actions.
Blood Transfusion Process Since 2012, LPNs have the authority to initiate peripheral IVs and blood products, in appropriate contexts.
Blood Transfusion Process: Appropriate Contexts The LPN has the necessary competence to perform required interventions and accurately predict and manage the clients responses to the intervention or the outcomes or their actions. The client has a well defined plan of care with established outcomes and is responding to interventions consistently and in an manner which can be readily predicted. The practice environment hassufficient sufficient resources in place (human, equipment and policy) to assist the LPN or support the client should it become necessary.
Blood Transfusion Process LPNs can play a vital role in the transfusion process. However, it is important to understand the contextual nature of their practice to ensure the rightcare provider is in the right place at the righttime. time.
Questions practiceconsultant@clpnns.caca