1. Role Optimization Competency Based Approach to Clarifying Role of RNs Presented to RNs in LTC Invitational Symposium Jeanne Besner, RN, PhD Provincial Lead, Health Systems and Workforce Research Unit, AHS

2. 2 Outline RN Scope of Practice –Definition of Terms Optimizing Nursing Roles – Competency based approach Impact

3. 3 Scope of Practice - Definition Knowledge & skills acquired through education Same for all RNs regardless of setting of practice Reflected in entry-to-practice competencies Legislated Professional Role Defined in code of ethics, professional practice standards Role enactment Application of knowledge within parameters defined by context, experience, capabilities, population characteristics

4. 4 RN Scope of Practice More than an activity supporting medicine (International Council of Nurses, 1995) Optimum health and wellbeing of individuals, families, groups, communities, populations (CNA, 2007) Value added to health care delivery is entry to health, even through episodes of illness, crisis, and/or transition Yardstick by which professional accountability is judged and privilege of self-regulation is granted

5. 5 RN Scope of Practice (continued) Key clinical role functions of RNs Comprehensive assessment, planning, intervention & evaluation Biological, psychological, social, cultural, spiritual Identification of real/potential risks to patient/family Basis from which to identify teaching/support needs Leads to enhanced self-care capacity Determination of monitoring/surveillance needed to mitigate risks, prevent complications/injuries By whom, over what period of time, at what frequency & intensity Coordination of care, communication with & involvement of interprofessional team members across care continuum

6. 6 Consistent themes identified over many years: RNs unable to differentiate role from that of LPNs Factors contributing to role ambiguity –Model of care Patient assignment versus care assignment Elements of RN role “carved off” and given to other RNs (e.g. discharge planning) Focus on performance of bio-medically related tasks Changes in entry to practice requirements (education) Not implemented in practice Gap between what ought to be and what is Effective utilization of nursing knowledge = closing the gap Findings from Research

7. 7 Optimizing RN Role Competencies reviewed with groups of RNs –Linked individual competencies to evidence from research –Created new understanding of “RN Scope” –Highlighted knowledge gaps & contextual issues requiring attention

8. 8 Competencies & Evidence from Research Definition of Nursing (focus on health & wellbeing) –Actual focus on management of illness Articulate role/responsibilities within health care team (#3) –Role confusion, role ambiguity Displays collaborative interactions within nursing & team (#6) –Role tension and less than ideal relationships within nursing Uses conflict resolution strategies to create healthy relationships (#11) –Evidence of conflict avoidance Questions and challenges questionable orders, decisions, actions (#15) –Team work opposed when colleagues “incompetent”

9. 9 Competencies & Evidence from Research (2) Has knowledge base about health care issues (#20) –Lack of focus on risk factors related to condition, age or social factors Understands role of PHC & population health (#31) –Failure to assess role of social determinants on health Engages clients in holistic assessment (#36) –Focus on bio-medical management Collaborates with others to identify client needs/goals (#42) –Absence of explicit communication about client goals

10. 10 Competencies & Evidence from Research (3) Collaborates with clients to develop plans of care (46) –No explicit plan of care for patients –Patients not engaged in discussing goals Anticipates health issues & consequences (#49) –Little evidence of explicit risk mitigation strategies Facilitates client ownership of plan of care –Client/family often seen as “burden” versus “partner” Monitors effectiveness of case in collaboration with client and other members of team (#78) –Little evidence of collaboration within or across teams

11. 11 Impact of Discussions with RNs Realization that many issues identified through research over past many years could be avoided if RNs met entry to practice competencies RNs “inspired” and eager to optimize role –Identified learning needs –Recognized importance of time to reflect on practice –Identified strategies for increasing collaboration –More open to working collaboratively in teams –Excited by potential for enhancing contribution to quality patient care

12. 12 Questions? Jeanne Besner, RN, PhD Provincial Lead Health Systems and Workforce Research Unit Health Professions Strategy & Practice Alberta Health Services Calgary, AB T2W 1S7 Phone: (403) 943-0181 Jeanne.besner@albertahealthservices.ca