1. Dianne Martin RPN, RN, BScN Brenda Mundy RPN, RN, PNC(C)

2.  What is scope of practice  The difference between the RN and the RPN  Decision making-who is the appropriate care provider  Accountability  Enhancing scope of practice for the RPN at a large community hospital

3.  Outer layer Public Hospitals Act Regulated Health Professions Act  Middle layer Organizational policies and procedures  Inner layer Registration category Education level Experience

4.  Invasive aspect of care requiring a certain level of knowledge and skill in order to perform it  13 Controlled Acts common to all professionals under the RHPA

6.  Corporate and/or Departmental  Policies, procedures etc.

7.  Registration category  Educational preparation  Experience What is nursing knowledge and how do you get it?

8. The CNO three factor framework guides the practice of nurses in determining the appropriate care giver CLIENT NURSE ENVIRONMENT

9.  Differences in education  Differences in Registration category  Experience  The nurse’s own knowledge, skill, and judgment

10.  Complexity of care needs  Predictability of outcomes of client care  Risk of negative outcomes in response to care

11. consider:  Possible changes in health condition,  Timing; and  Nature of the outcomes

12. Ask:  Are the care needs well defined?  Are there multiple issues?  Does the client require frequent monitoring?  Is there a risk of negative outcomes?  Are there support systems in place?

13.  Practice supports  Consultative resources  Stability and predictability

14.  Both registered with the College of Nurses of Ontario  Both entitled to use the protected title “nurse”  Both have the same legislated controlled acts  Both are accountable for their actions  Both work collaboratively to support client care

15. RNs  4 year baccalaureate degree  May care autonomously for clients with complex needs in unpredictable settings RPNs  2 year diploma  Care autonomously for predictable clients with stable environments  May work collaboratively in less stable environments with more complex patients

16. RNs  Highly complex patients  Unpredictable setting  Few or no practice supports RNs and RPNs  Moderately complex patients  Many supports, predictable setting RPNs  Less complex client  Resources available  Stable environment

17.  Complexity of care needs  Predictability of outcomes  Ability to manage negative outcomes  Knowledge, skill and judgment required to assess for and deal with the risks involved  Resources available in the environment for collaboration and/or assistance  Opportunity to maintain competence

18. RPNs at Southlake have indicated they would like to start IV’s 1. Outer layer-legislation 2. Middle layer-Southlake policies 3. Inner layer-personal scope

19. The venous access team, which includes RPNs, inserts PICC lines. Is it appropriate to include this skill for the RPNs on the team 1. Outer layer-legislation 2. Middle layer-Southlake policies 3. Inner layer-personal scope

20.  Professional scopes are broad and overlap  Ask who is the best professional to provide this care to this patient in this situation?  Understand the scope of your colleagues

21. “Nurses are accountable for their decisions and actions and the consequences of those actions. Registered Nurses (RNs) and Registered Practical Nurses (RPNs) are not accountable for the actions of other health care providers or other nurses.” College of Nurses of Ontario

22.  Your accountability is always yours  No one can assume responsibility for your actions  Know your limits  Respect your colleagues’

23. Enhanced scope of practice for RPNs  Maintenance of IVs-hanging of solutions up to 40 meq KCL  Flushing of saline locks  Administration of IV antibiotics  Administration of IV blood products Next:  Initiation of IVs

24. College of Nurses of Ontario (CNO) Professional Standards 2002 http://www.cno.org/docs/prac/41006_ProfStds.pdf http://www.cno.org/docs/prac/41006_ProfStds.pdf CNO learning modules Professional Standards http://www.cno.org/prac/learn/modules/profstands/in dex.htm http://www.cno.org/prac/learn/modules/profstands/in dex.htm CNO RNs and RPNs working together http://www.cno.org/prac/work_together.htm http://www.cno.org/prac/work_together.htm CNO practice guideline Utilization of RNs and RPNs http://www.cno.org/docs/prac/41062_UtilizeRnRpn.pdf http://www.cno.org/docs/prac/41062_UtilizeRnRpn.pdf