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Last modified: September 25, 2006  

RPNs Initiating Wound Care

Q

Can RPNs initiate wound care when caring for clients in the community?

A

Yes they can, provided they have the competence and knowledge to perform the procedures safely.

RNs and RPNs have the authority to perform the three controlled acts authorized to nursing. One of the controlled acts is performing a procedure below the dermis. Nurses demonstrate competence by possessing the necessary knowledge, skill and judgment to assess the client and the situation, manage the client during the procedure and perform the procedure safely. They must also be able to manage potential negative outcomes or have access to resources to help them manage those outcomes.

RPNs have the authority to initiate this controlled act without a medical order; however, you must consider the agency’s policy and determine if cleansing, soaking and dressing are appropriate for the client at a particular time. Note, however, that nurses practising in a hospital are subject to the Public Hospitals Act, which necessitates an order from a physician. The College’s Decisions About Procedures and Authority, Revised 2006 practice standard outlines decision-making factors for initiating and/or performing procedures.

An RPN can provide care independently when the client’s care needs are not complex, the outcomes are predictable and there is a low risk of negative outcomes associated with care. If the client’s care needs are complex and/or the RPN cannot manage the outcomes, the RPN should not provide the care unless resources, such as an RN to consult with, are immediately available. If the care required is beyond the RPN’s competencies an RN must assume care of the client.

By taking courses on wound care, you can add to your foundational knowledge and integrate other aspects and techniques into the care you provide. In addition, employers should ensure that nurses have opportunities to maintain competence, and that appropriate supports and resources are in place.

For more information, refer to the College’s Utilization of RNs and RPNs practice guideline and the article "RNs and RPNs — Working Together".

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