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Nursing Practice > Ask Practice
Page modified February 02, 2010
Nursing Standards
Outreach Program
RPNs practising in a Doctor's Office
Q
I am an administrator for a busy family practice office. We employ several RNs and plan to add RPNs to our team. Can RPNs perform specific procedures, such as taking a client history, venipucture or giving an immunization injection? Can they provide telephone nursing service?
A
RNs and RNs work under the same legislation and have the same authority to perform specific procedures authorized to nursing. But having the authority to perform a procedure does not automatically mean it is appropriate for the nurse, either RN or RPN, to do so. RPNs and RNs study from the same body of nursing knowledge. RNs study for a longer period of time allowing for a greater depth and breadth of foundational knowledge. The more in-depth education prepares RNs to care for clients who are complex, with less predictable outcomes, and who are at high risk for negative outcomes. In comparison, the RPN curriculum covers the same categories for a shorter period. This prepares RPNs to care autonomously for clients who are less complex with more predictable outcomes and lower risk for negative outcomes.
RPNs have the knowledge and skill to take a client history and perform an assessment, and can develop the ability to do a focused assessment tailored to a specific client population. RNs have the knowledge and skill to use advanced data collection techniques to assess more complex clients, such as assessing a client in emergency triage.
If specific data collection is required, it may be helpful to have clear guidelines highlighting what information is required. The RPN can use the guidelines to individualize the assessment for a specific client and still work within her/his competencies.
RPNs can give an immunizing agent by injection and perform venipucture provided there is a medical order or directive in place, and the RPN has the knowledge, skill and judgment to do so, including the ability and resources to manage outcomes.
RPNs should not be providing telephone nursing service with clients that may potentially involve complex care needs and unpredictable conditions, such as triage. However, they are able to provide telephone support with a specific health focus (for example, immunization). Providing telephone nursing requires advance communication skills and competencies to overcome the additional barriers to data collection. For this reason, telephone nursing may not be appropriate for the novice RPN or RN.
Before performing a procedure, a nurse should consider the acuity and complexity of the client care needs, the resources available, the potential outcomes, and the nurse’s knowledge, skill, judgment and ability to manage the outcomes.
To determine whether a nurse should perform a specific procedure, consider the following.
- What knowledge and experience does the nurse need to perform the duties required?
- Does your office have opportunities and resources for a nurse to obtain and maintain their competencies in the skills required?
- Will the RPN be able to consult with an RN about practice issues, fluctuating acuity and complex client care issues?
- Will an RN or physician be immediately available for the RPN to transfer care of a complex client and/or unexpected outcome?
References
- Telepractice practice document
- Regulated Health Professions Act, 1991
- Decisions About Procedures and Authority, Revised 2006 practice document
Last Updated Feb. 2010
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