RPN/LPN/RNA all the same???

OgopogoLPN, LPN, RN · Dec 3, 2008

Practical nursing programs vary in length in Canada and yet they all write the same entry level exam.
BC has the shortest LPN education of only one year. I believe Ontario has the longest.
It is highly unlikely that LPN's will be phase out now that entry to practice for an RN is a baccalaureate degree. Rather it is more likely that the LPN role will be redefined.
I haven't checked the scope of practice for every province but I think I am pretty safe in saying that the scope of practice for an LPN says they must work under the supervision of an RN or physician and they cannot work independently that is they work as part of a team.
Scope of practice for an RN says that the RN can work independently, without supervision and can work with clients independently as a nurse. It is not a requirement that a medial care plan be in place for nurse to work with a client.

The term "under the supervision" is very hard to define or understand I think.

I'm an LPN at a LTC facility in BC. When I am doing assessments, interventions, med passes/treatments, etc, there is usually (not always) and RN in the building. But I am responsible for my own residents. The RN does not watch me, check up on me or my work. I report to her at the end of the shift. If I run into something that is beyond my knowledge or scope, I will call for the RN. Otherwise my only real contact with the RN is report at the end of the shift. Is that "under direct supervision"?

I also work in acute care and am paired with an RN and together we have 7-9 patients. I do my own assessments, meds, treatments etc. I do report to the RN (and am very glad he/she is there!!!!). I am apart of the team, but the RN is not in the room when I do my work, nor does she double check what I have done if I have not reported any problems. Is this "under direct supervision"?

Also, LPN's in BC can do home health. I'm not 100% sure how this works as I have not done it. But I would assume that the LPN would visit the stable clients who already have a care plan--created by an RN/in collaboration with the LPN. I imagine the LPN would also report assessement findings to an RN manager, but they are still visiting the client by themselves, so is this "under direct supervision"?

I guess what I'm trying to say is "under supervision" to me always sounds like someone is either watching what you do the whole time or double checking all your work when you're done. And this is definatley not the case for LPN's and RN' (at least where I work). Someone set me strait on what "under supervision" really means!!!

loriangel14, RN · Dec 3, 2008

It is much the same for me as well. I am an RPN in Ontario( registered practical nurse) and I work in a small hospital. While there is always an RN in the facility I am responsible for my own assessments, med passes and judgement and i am givem my own pt load. RNs get the same number of pts as the RPNs. If I run into something i am not sure of I will turn to the RN for guidance but they don't " check up" on me or directly supervise my work.

Fiona59 · Dec 4, 2008

Well, the CRNE is written at the level that diploma RN graduates can write it alongside BScNs, so I think the issue of whether a diploma or certificate PN writing the same exam should be considered moot.

I work active/acute treatment in Alberta. I work under my own license and carry my own malpractice insurance. No RN supervises my work or my fellow LPNs work who work in dialysis, the OR, the orthopedic clinic, public health, or homecare. My assessments are made without the requirement of having an RN "sign-off" on it.

I may never be charge in my hospital, but with the changes in my scope of practice in the last five years, I wouldn't be surprized if I'm piercing the TPN or blood bag within the next five.

The diploma PN has basically become the diploma RN in the province of Alberta and Ontario. As each province requires the two year diploma, it will become more and more apparent.

linzz · Dec 4, 2008

It's interesting this whole business of which clients are too unstable for an RPN to care for, it seems to be a very grey area. I had an interview once for a home care position and I asked the interviewer what types of training and orientation would be available, also what types of patients would I be caring for and about transferring care to an RN. Her response to the last question was that, in a perfect world, only stable patients would be given to RPN's but that was just not todays reality in home care.

RN_Canada · Dec 5, 2008

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.

RN_Canada · Jan 5, 2009

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.

loriangel14, RN · Jan 6, 2009

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.

RN_Canada · Jan 6, 2009

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.

Fiona59 · Jan 6, 2009

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.

linzz · Jan 6, 2009

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.

Fiona59 · Jan 6, 2009

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.

RN_Canada · Jan 9, 2009

http://www.health.gov.bc.ca/leg/hpc/review/part-i/scope-lpnurse.html#IIIA1

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?