Dianne Martin RPN, RN, BScN
Brenda Mundy RPN, RN, PNC(C)
 What
is scope of practice
 The difference between the RN and the
RPN
 Decision making-who is the appropriate
care provider
 Accountability
 Enhancing scope of practice for the RPN
at a large community hospital
 Outer
layer
• Public Hospitals Act
• Regulated Health Professions Act
 Middle layer
• Organizational policies and procedures
 Inner layer
• Registration category
• Education level
• Experience
 Invasive
aspect of care requiring a
certain level of knowledge and skill in
order to perform it
 13
Controlled Acts common to all
professionals under the RHPA
 Corporate
and/or Departmental
 Policies, procedures
etc.
 Registration
category
 Educational
preparation
 Experience
What is nursing knowledge and how do you get
it?
The CNO three factor framework guides
the practice of nurses in determining the
appropriate care giver
NURSE
CLIENT
ENVIRONMENT
 Differences
in education
 Differences
in Registration category
 Experience
 The
nurse’s own
knowledge, skill,
and judgment
 Complexity
of care needs
 Predictability
 Risk
care
of outcomes of client care
of negative outcomes in response to
consider:
 Possible
changes in health condition,
 Timing; and
 Nature of the outcomes
Ask:
 Are the care needs well defined?
 Are there multiple issues?
 Does the client require frequent
monitoring?
 Is there a risk of negative outcomes?
 Are there support systems in place?
 Practice
supports
 Consultative
 Stability
resources
and predictability
 Both
registered with the College of
Nurses of Ontario
 Both entitled to use the protected title
“nurse”
 Both have the same legislated controlled
acts
 Both are accountable for their actions
 Both work collaboratively to support
client care
RNs
 4 year baccalaureate
degree
 May care
autonomously for
clients with complex
needs in
unpredictable
settings
RPNs
 2 year diploma
 Care autonomously
for predictable
clients with stable
environments
 May work
collaboratively in less
stable environments
with more complex
patients
RNs
 Highly complex patients
 Unpredictable setting
 Few or no practice supports
RNs and RPNs
 Moderately complex patients
 Many supports, predictable setting
RPNs
 Less complex client
 Resources available
 Stable environment
 Complexity
of care needs
 Predictability of outcomes
 Ability to manage negative outcomes
 Knowledge, skill and judgment required to
assess for and deal with the risks involved
 Resources available in the environment for
collaboration and/or assistance
 Opportunity to maintain competence
RPNs at Southlake have indicated they
would like to start IV’s
1.
2.
3.
Outer layer-legislation
Middle layer-Southlake policies
Inner layer-personal scope
The venous access team, which includes
RPNs, inserts PICC lines. Is it
appropriate to include this skill for the
RPNs on the team
1. Outer layer-legislation
2. Middle layer-Southlake policies
3. Inner layer-personal scope
 Professional
scopes are broad and
overlap
 Ask who is the best professional to
provide this care to this patient in this
situation?
 Understand the scope of
your colleagues
“Nurses are accountable for their
decisions and actions and the
consequences of those actions.
Registered Nurses (RNs) and
Registered Practical Nurses (RPNs)
are not accountable for the actions of
other health care providers or other
nurses.”
College of Nurses of Ontario
 Your
accountability is always yours
 No one can assume responsibility for
your actions
 Know your limits
 Respect your colleagues’
Enhanced scope of practice for RPNs
 Maintenance of IVs-hanging of solutions
up to 40 meq KCL
 Flushing of saline locks
 Administration of IV antibiotics
 Administration of IV blood products
Next:
 Initiation of IVs
College of Nurses of Ontario (CNO) Professional
Standards 2002
http://www.cno.org/docs/prac/41006_ProfStds.pdf
CNO learning modules Professional Standards
http://www.cno.org/prac/learn/modules/profstands/in
dex.htm
CNO RNs and RPNs working together
http://www.cno.org/prac/work_together.htm
CNO practice guideline Utilization of RNs and RPNs
http://www.cno.org/docs/prac/41062_UtilizeRnRpn.pdf