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 Last modified Jan. 17, 2006  

RPNs practising in Doctor's Offices

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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 patient history, venipucture, giving an immunization injection, and can they provide telephone nursing service?

 

A

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 unstable or complex clients. In comparison, the RPN curriculum covers the same categories for a shorter period. This prepares RPNs to care autonomously for clients who are stable with predictable outcomes.

RPNs and RNs work within the same legislation and have the same authority to perform specific procedures authorized to nursing. That being said, having the authority to perform a procedure does not automatically mean it is appropriate for the nurse, either RN or RPN, to do so. Before performing a procedure, a nurse should consider the complexity of the client care needs, the resources available, the potential outcomes, and the nurse’s knowledge, skill, judgment and ability to manage the outcome.

The Guide To Decide practice guideline provides a framework to determine the appropriateness of any nurse performing a procedure. To determine whether an RPN should perform a specific procedure, consider the following.

  1. What knowledge and experience does the RPN need to perform the duties required?
  2. Does your office have opportunities and resources for RPNs to obtain and maintain their competencies in the skills required?
  3. Will the RPN be able to consult with an RN about practice issues and complex client care issues?
  4. Will an RN or physician be immediately available for the RPN to transfer care of a complex client and/or unexpected outcome?

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.

As stated in Telepractice, RPNs should not be providing telephone service that may potentially involve complex client care needs and unpredictable conditions, such as triage. However, they are able to provide telephone support with a specific health focus (e.g., immunization). Providing telephone nursing requires advance communication skills and competencies to overcome the additional barriers to data collection (e.g., not being able to see the client). For this reason, telephone nursing may not be appropriate for the novice RPN or RN.

 

References

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