RPN/LPN/RNA all the same??? - page 7

I've been looking for information on nursing and the different levels of nursing. I'm getting a little confused. Are RPN/LPN/RNA all the same??? Also, I heard from a friend that Practical Nursing is going to be phased out in... Read More

  1. 0
    FYI, I've extracted the relevant bit but the entire document is self-explanatory.

    I do not work under the supervision of a RN. I am responsible for my own practice. The RNs on my floor work with their own patients as I work with my own. We assist each other as required.

    The only RN involved in "delegating" to me is the Charge RN who makes up the shifts staffing assignment.

    Role and Scope of Practice
    LPNs in Alberta practice autonomously and assume full responsibility for their own practice. As trusted and respected professional nurses, LPNs serve individuals, families, and groups, assessing their needs and providing care and treatments as appropriate.
    LPNs are accountable for their own nursing practice and as any professional, are expected to seek assistance when the needs within their practice go beyond their competence level. There are many roles within Alberta for LPNs in areas such as: acute care, long term care, community, primary care clinics, education, occupational health and safety, public health, and leadership.
    LPNs advocate for clients related to all areas of practice including human, physical, and financial resources necessary to provide safe, quality nursing care. LPNs work collaborative with clients, families, and the health care team to ensure continuity of care and quality health service delivery.

    Regulated Professional Nurses
    As a self-regulating profession, LPNs must meet registration requirements set out by the College of Licensed Practical Nurses of Alberta (CLPNA) under the Health Professions Act LPN Regulation (2003). This includes initial registration upon completion of an approved practical nurse program or equivalent. It also includes annual renewal of registration, participation in continuing competence activities, and being actively engaged in the practice of the profession

    So, I'm really not sure what you are trying to tell us.

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  2. 3
    I am seeking to understand the scope of practice of the various types of nursing in Canada.

    I have been in nursing education for over 35 years and if I can't get it I think it must be really confusing to newcomers.

    I never suggested that LPN's cannot direct their own practice indeed they are required to do so but it is the scope of practice that is at issue.
    LPN's however, (at least from what I read here) must have the patient care either delegated to them or work under the supervision of the RN or some other health care provider. Either that or the scope of practice is one of assistance to another professional.
    This quote was from my reading of the scope of practice of the various LPN roles across Canada not that of the LPN in Alberta specifically.
    The only RN involved in "delegating" to me is the Charge RN who makes up the shifts staffing assignment.
    My point exactly and that is, there is an RN in charge of the LPN's assigned patients, but because the LPN is a self regulating profession the RN in charge does not need directly supervise or be constantly directing you.
    You do your own assessments (within the scope of practice) and make decisions regarding patient care based on those decisions. That is the autonomy of a self regulating professional.
    The scope of practice of an LPN is entirely contained within the scope of practice of an RN.
    An RN can enter into a therapeutic relationship with a client and plan and provide nursing service independently. The RN does not need to be part of a team and the patient does not need to be under the care of a physician or other health care provider. I think what I am saying is that an RN can be a primary care provider but an LPN cannot...at least that is what I am getting from the research I am doing.

    There is a difference between assuming full responsibility for your practice and assuming full responsibility for a patient. When an LPN assumes responsibility for a patient they do so within their legal scope of practice. There has to be another professional responsible for this patient if the needs of the patient become more complex and are outside the scope of practice of the LPN.

    An RN can assume full responsibility for the patient regardless of the complexity of their needs.

    Isn't that what you got from reading these scope of practice statements?
    Last edit by RN_Canada on Jan 9, '09
  3. 0
    So by your understanding, a floor RN works under the supervision of the Charge RN. If this is the case, I wish you would let my Charge know this because the LPNs on my floor are getting very tired of being assigned to far more complex patients than the IENs and RNs with under two years floor experience.
  4. 2
    Everybody works under somebody's "supervision" in the workplace.
    However, when referring to "scope of practice" the RN like the LPN does not have his/her practice supervised because of the autonomy of their practice, and further it is not required for an RN to be supervised under their scope of practice.

    .. I wish you would let my Charge know this because the LPNs on my floor are getting very tired of being assigned to far more complex patients than the IENs and RNs with under two years floor experience.
    If new RN's are being assigned to less complex patients it is because their current competencies require it but over time they should be developing more and more competencies in their skill set and assigned to more and more complex patients.

    The entry level competencies for an RN in Canada are that the RN works with stable patients independently and unstable patients with assistance. But that is an entry level competency.

    Also complex and unstable are not the same thing. Complex refers to the number of variables that must be considered when planning and providing care, and stable refers to the predictability of outcomes. An LPN should be assigned to patient with a lower number of variable (less complex) and who is expected to react in predictable ways (stable)

    Surely your own entry level competency set was considered in your patient assignment when you were a new graduate and your competency set has probably increased over time?

    If the RN's you refer to are not developing increasing competencies over time to work with more complex patients that is an issue that you need to take up with your charge RN. What is the point of paying them an RN wage if they are doing LPN level work? This type of situation can only create bad feelings among the nurses.

    I really thank you for the opportunity to discuss this Fiona59 because it has helped me to develop a little more clarity.

    It is becoming more and more clear to me that some of the word we use like "supervision", "independent practice", "scope of practice", "complex", "stable" and "competency" are not well understood.

    It is also clear to me as the nursing shortage exerts more and more pressures on the system that employers will have to start paying more attention to a proper staff mix instead of just getting a "nurse" to do the job.

    It is my experience that there are a lot of RN's out there who do not work to the capacity that their scope of practice allows and that the system expects and needs of them. In other words the system is not getting its money's worth.

    This discussion however, is not based on specific nurses but rather on the concept of scope of practice in general.

    We have a long way to go with this in Canada.
    27400 and Spritz like this.
  5. 0
    "We have a long way to go with this in Canada"

    To add to that comment, each province and then within that province, down to each hospital there are HUGE differences. Example - As an LPN in BC, in my scope, I can hang a bag on NS with KCl - that KCl being in the bag at time of manufacture HOWEVER. the health authority where I work say No No, you can't do that so I must get an RN to hang this for me - which is rather ridiculous - there are many "little" things like that where LPN's can be better utilized if the health authority would wake up. In another health authority in BC, LPN's may be fine to hang that bag of NS with the KCl.
    Everyone needs to get on the same page and be consistent now just for those in the work force but patient care as well.
    Just my 0.02 worth
  6. 1
    LPN's in Canada are not being phased out, it is actually the opposite. The LPN program here in Nova Scotia is now 2 years long and you graduate with a diploma. Hospitals are hiring more and more LPNs because we are able to use more skills now and we are cheaper to hire than the RN's. The gov't here in NS just gave more money to the PN program so they can have more graduates.
    Fiona59 likes this.
  7. 1
    "lpns practice autonomously in alberta and are responsible for their practice. they work collaboratively with the health care team and can work independently in many settings. there are some restricted activities that define a level of supervision, otherwise you will not see delegation, supervision, or direction statements anywhere in relation to the lpn scope of practice. i hope this information is helpful."

    this is a direct quote from an email recently received from the college of lpns in alberta.

    i would seem that the scope of practice for lpn's in canada is not consistent in regards to the supervision issue. some provinces requires the lpn to work under supervision or direction and some do not!

    alberta along with ontario seem to have the broadest and most autonomous scope of practice for lpn's but then they also have the longest education period as well.

    i for one would not want this level of responsibility to be assumed by a graduate of a program with one year of education as we have here in bc. perhaps that is why the health professions council kept the supervision requirement when the lpn scope of practice was recently reviewed.

    i just wanted to set the record straight that fiona59 was absolutely correct.

    however, like i said before if canadian nurses are having difficulty with this it must be even more confusing for newcomers!
    Fiona59 likes this.
  8. 0
    Basically the PN education in Alberta is the old two year diploma RN that was hospital based.

    What has really upset the applecart out here was when Capital Health brought over BScN RNs from the Phillipines, CARNA refused to accept their credentials as the equivalent of the Cdn. BScN and determined their skills and education was the equivalent of the education/training of an AB PN. This was even disproved when these nurses arrived on the hospital floor after attending
    "an introduction to Cdn. nursing" at Norquest. Quite a few had skills that didn't even the level required of a new PN.

    So an experienced LPN in my hospital now grooms a local new grad BScN, LPN and IENs.

    We're tired, we're unhappy and we're still underpaid when you realize how fully our scope of practice is utilized. In active treatment, basically we cannot pierce the blood or travisol bag. An RN does this and then walks away from the LPNs patient. We do all the monitoring and follow up. What's the point. Even though we can insert NGs and understand the rationales, our facility restricts this to an RN skill set.

    Oh and the good news is we will soon be looking after our own PICCs and Central Lines.

    Can somebody tell me what the RNs will be doing when 99% of their job is being performed by the LPN or is this just Alberta Health Services way of saying the RNs are overpaid and plan to be hard on the next set of UNA negotiations.
  9. 1
    Hello gang,
    Just to let you know, I am an RNA in Quebec. Now, the title has been modified to LPN. Also LPNs in Quebec can now start an IV under certain conditions
  10. 0
    I have been a LPN for many years. I have worked in varous settings from Acute to LTC to Community.
    LPN role in all settings have changed with the times, its sad that some RN's have not changed their attitudes.
    Lpn's are a vital assest to any health care team, and without them the RN's would actually have to do their own work. Most RN's are over paid, lack actual experience, and have the I'm a Rn mentality, its to bad that LPN's still have to prove to them what they know and can do. Its sad that with this nursing shortage that we are facing hiring freezes with Alberta Health while they still build a hospital in southern Calgary. Who is going to work there??? You can bet that the hiring freeze will be lifted for LPN's, because we are just as knowledgeable and CHEAPER and we dont pack that RN attitude. They shouldn't make being a RN so difficult by having to get a degree because we already know just as much or more then they do. Its all just in the experience.

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