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Page modified November 01, 2006

RPNs administering conscious sedation

Q

I work in an oral surgeon's office. We are in the process of hiring another nurse and the surgeon wants to hire an RPN. The role involves administering conscious sedation and I don’t think RPNs can do this. Am I correct?

A

You are correct. There has been some confusion in the past between members of the College of Nurses of Ontario and the Royal College of Dental Surgeons of Ontario about whether administration of conscious sedation is within the scope of RPN practice. The College of Nurses clarified its position in the revised Medication practice standard.

Administration of conscious sedation by any route (as well as deep sedation and general anaesthesia) and the monitoring of the sedated client are beyond the scope of the RPN role and the basic preparation of RNs.

The Regulated Health Professions Act, 1991, does not differentiate between RNs and RPNs in administration of oral and IV medications or substances by injection or inhalation. However, having the authority to perform a procedure does not automatically mean it is appropriate to do so. The College’s position on conscious sedation considers the complexity of care needed due to the potential for rapid and unpredictable movement from one level of sedation to a deeper level. The resulting risk of negative outcomes has an impact on the skills required by the nurse (depth of autonomous assessment, monitoring and problem-solving).

Basic RN preparation provides the foundational knowledge necessary to develop the required specialized competencies to manage this client situation safely. RPNs have the competency to administer medications that produce minimal sedation (anxiolysis), such as lorazepam 0.5mg sublingually, and to monitor these clients.

For further information about the nurse’s role in administering sedation, see the Medication practice standard.

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