RPNs in triage
I am an RN working in the emergency department. My facility is considering hiring RPNs as triage nurses. It is my understanding that RPNs look after less complex clients. Does this breach the standards and guidelines set out by the College?
The College’s RN and RPN Practice: The Client, the Nurse, and the Environment practice document outlines key practice descriptors for both RN and RPN categories to assist nurses, employers and others to make effective decisions regarding the utilization of nurses and list examples of three areas of practice that are not appropriate for autonomous RPN practice.
RNs and RPNs study from the same body of knowledge. An RN studies for a longer period, allowing for greater foundational knowledge in the areas of clinical practice, decision making, critical thinking, leadership, research utilization and resource management. As a result of these differences, the level of autonomous practice of RNs differs from that of RPNs.
The complexity of a client’s condition and the stability/predictability of the environment influence the nursing knowledge required to provide the level of care the client needs. A more complex client situation and less stable environment create an increased need for consultation and/or the need for an RN to provide the full range of care requirements.
In the triage role, the nurse assesses the urgency of care needed by the client. It is impossible to predict how many clients will present to the emergency department and what their health care needs will be. Therefore in triage, the predictability is very low causing the complexity and risk of negative outcomes to be unknown.
As a result, the triage nurse requires in-depth assessment, critical thinking and decision-making skills. For these reasons, the triage role is better suited to an RN and is beyond the level of educational preparation of an RPN.
There are other nursing roles in the emergency department that may be suitable for RPN practice. Such areas of practice would still require some consultation with the RN and health care team.