RPN/LPN/RNA all the same??? - page 5

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... Read More

  1. by   RN_Canada
    There are only 3 types regulated nursing professions in Canada

    RPN = Registered Psychiatric nurse
    LPN = Licensed Practical Nurse or Registered Practical Nurse
    RN = Registered Nurse

    All are self regulating professions but self regulation does not mean independent practice. Regulations seem to be different across the country yet every LPN writes the same exam hmmmm.........

    I have been unable to locate the scope of practice statement for LPN's in Alberta that articulates the limits and conditions on practice or restricted activities. This is very clearly defined in the legislation in BC so I am waiting on the College of LPNs Alberta for some clarification.
  2. by   RN_Canada
    Just an update on my investigations regarding scope of practice

    In BC LPN scope of practice states specifically that the LPN works under supervision of an RN. This does not mean direct supervision but there must be an RN available and who is assigned to that patient as well as the LPN.
    This is not well understood by many employers and indeed by LPN's and RN's alike.
    This does not mean that the LPN is not an independent slef regulating profession..they are. An LPN is responsible for their own practice but should be practicing within their legislated scope of practice which stipulates "under supervision".

    I still have not finished my investigation on this issue but for now I know for sure this is not the case in all provinces.

    IN Alberta for instance "under supervision of an RN" is not stipulated in the legislated scope of practice however, the act does restrict certain activities. Even after training for that skill, if an LPN performs this restricted activity then there must be a professional who can legally perform that activity within their scope of practice available for consultation.
  3. by   loriangel14
    I wonder if it is different in different provinces. I am an RPN and I carry my own assignment, no RN is assigned to my pts and they do not supervise my work. Of course they are available if I have a question about anything.
  4. by   RN_Canada
    As I said ....it is different in every province.

    I think a major contributing factor to the situation in BC is that the LPN course is ONLY 1 year in length. (actually less than 52 weeks)

    these graduates write the same exam as the LPN's who go to school for much longer and they pass at the same rate.

    Which only proves that an exam does not measure everything we need to measure.
  5. by   Fiona59
    Exams are written so that those with the basic education can pass them. Like the diploma RNs write the same exam as a BScN grad.

    BC educated LPNs used to have to upgrade their basic education in several areas when they moved provinces. I know that the A&P they received did not CLPNA standards and a few modules were required (they were issued a restricted licence) to practice.

    I've worked in both provinces and there is a difference in what a new grad in BC understands from what I was expected to know as a new grad. Differences in assessments, drug knowledge.

    Some provinces just require a more indepth knowledge base to practice.
  6. by   linzz
    It really does sound like BC has differing RPN requirements than Ontario and Alberta. I was on a college website and this college is requiring that any RPN's who want to upgrade from certificate status to diploma status must be working to full scope of diploma practice which would be a medical or surgical area in a hospital. It makes me curious as to what the motivation behind this is. That's just Ontario though, I am guessing other provinces do things differently.
    Last edit by linzz on Jan 6, '09 : Reason: added words
  7. by   Fiona59
    Alberta is just grandfathering us. Our employers and CLPNA have provided us with education to meet the changing scope of practice over the years. Many PNs here already had the university transfer credits that are now included in the diploma.
  8. by   RN_Canada

    the current scope of practice for LPN's in BC is being reviewed and under this review the government has examined all LPN scope of practice statements which are listed at this link.

    From reading this it appears that the practical nurse scope of practice is under direction from another health care professional in all provinces.

    I am going to examine this further but that is the what I got from my first reading.

    This does not mean that the LPN is not self regulating, however, it does mean that the LPN ( or whatever the designation is in the particular province) does not provide care for patient independently.

    An RN or Registered Psychiatric Nurse can provide nursing services to a patient who is not under the care of a physician. They can enter into a therapeutic relationship with the client and provide nursing services without a medical plan in place and without any other permission other than the informed consent of the patient.

    Many (registered) nurses do this when providing family therapy, drug and alcohol counseling and other services.

    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.

    Is that the way you interpret this?
  9. by   Fiona59
    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.
  10. by   RN_Canada
    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
  11. by   Fiona59
    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.
  12. by   RN_Canada
    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.
  13. by   Spritz
    "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