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Last modified: Sept. 23, 2005

Long-term care teleconference: RN and RPN Roles

Highlights for September 14, 2005

The College of Nurses of Ontario has initiated a series of teleconferences to further explore the realities of long-term care practice settings and to provide opportunities for nurse leaders to engage in collective problem solving.

The third teleconference in the series was on RN and RPN roles, and the discussion was focussed around questions submitted prior to the session by participants. The College received a number of questions regarding workload issues. While this topic has traditionally been regarded as a labour issue, the College is becoming increasingly concerned from a regulatory perspective. And while there is no exact answer as to the most appropriate nurse-client ratio, there is increasing evidence in the literature of the relationship between workload and the delivery of quality care. The College welcomes your letters and calls regarding your concerns about this issue.

Below is a list of the themes and the discussion points raised by participants.

RN and RPN role differences

Subjects that were discussed included:

  • All nurses (RNs and RPNs) are expected to complete a client assessment and analyze, as well as synthesize, client data. RPNs must have the competencies to complete an assessment to help identify client care needs and outcomes of the care provided.
  • RNs, drawing on a more in-depth theoretical and clinical knowledge base, can carry out a broader, more in-depth assessment, and are expected to be able to analyze and synthesize client data to a greater extent. All nurses are required to consult with the appropriate health care professional when client care needs are not within their knowledge or skill.
  • CNO no longer maintains a skills list for RNs and RPNs; both have the same authority in legislation to perform controlled acts. Although both categories may be capable of performing a client care intervention, the technical performance alone is not sufficient. Other factors that need to be considered are: the complexity and unknown factors of the client care needs, the availability of environmental supports, the risk of negative outcomes associated with the care provided and the nurse’s own knowledge and skill in performing the skill.
  • Effective January 1, 2005, RNs now graduate with a baccalaureate degree in nursing and RPNs graduate with a two-year practical nursing diploma. Nurses who graduated prior to this date are not expected to upgrade to a diploma or degree however, bridging programs are available for RNs and RPNs.

Accountability

Comments and strategies shared by participants included:

  • The accountabilities of an RN who sometimes has to work as an RPN when the facility is short-staffed. (The RN in an RPN role is responsible for fulfilling the job requirements of the RPN. However, she/he is accountable to utilize the knowledge of her/his registration category.)
  • Challenges regarding administering medications in a specific time period and meeting College standards and the draft Ministry of Health and Long-Term Care standards. (Strategies that were shared included: have a care plan in place; and meet with a pharmacy consultant and change facility policy regarding timelines.)
  • There is no legislation or labour law stating a safe ratio of clients to nurses. Nurses should advocate with facility management and/or their union for an appropriate staff-client ratio to ensure safe and effective care.
  • The College doesn’t advocate the use of NANDA or any other type of formalized nursing diagnosis. It is left to the facility to decide on a formalized nursing diagnosis.
  • Employers are accountable for the performance review and support/remediation of unregulated care providers (UCP). Nurses working with UCPs are accountable for supervising as needed and intervening as required to ensure clients receive safe, effective and ethical care. This may include supporting learning, demonstrating care, taking over the care, discussing best practice and reporting to employer.
  • Creating consistency on the unit by having a primary nurse being accountable for the main items regarding client care instead of the role being passed off to different nurses.

Collaboration

Knowledge shared by participants included:

  • RNs need the necessary skill set to effectively communicate within a multidisciplinary health team. For example, nurse leaders using conflict resolution when issues arise between co-workers.
  • It is important to have clear role descriptions for each team member and for nurses to understand each other’s roles.
  • The challenge of having your voice heard by facility management regarding practice issues. (Strategies that were shared included: having regular RN, RPN and UCP meetings with management; keep minutes of meetings so there is a recorded history of decisions; managers staying visible by regularly visiting all units; and posting an agenda with blank spaces ahead of the meeting so that all staff can add items to the agenda that they would like discussed.)

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