Standardizing the Scope of Practice for RPN/LPNs - Will I ever see it in my lifetime?

[OttawaRPN]

Getting quite frustrated with the vast difference in scope of practice from one institution to another. And even more bizarre, from one program to another within the SAME institution.

I work in a large tertiary care hospital which employs thousands of nurses (not sure of the percentage of RNs vs RPNs) with my home unit being Orthopedic Surgery. Within any of the surgical units, RPNs work to full scope including starting IVs, taking blood for culture and hanging IV meds but if I were to float to any of the medical units, I would not be allowed to do any of this. Same CEO, same administration, same everything. Do RNs have this problem? Of course not. I find it degrading and insulting and when I float to a medical unit, I have to remind myself where I am, and if I inadvertently "forgot" where I was and god forbid started an IV, would my administration support me? Of course not. This is unsafe and unfair practice, and these inconsistencies all across the province are getting old. Do LPNs in the other provinces have this problem?

And one rural hospital I work at, RPNs give meds on med/surg but not on CCC where they are nothing more than glorified PSWs. And they wonder why they can't recruit new grads. However a compelling argument from some of the old school CCC nurses is "why would I want to take on more responsibility if they're going to pay me the same wage?" Kinda hard to argue with that.

The CNO does NOT define skill sets for nurses but rather if they have the knowledge, skills and judgment to perform the task safely and ethically. It is the hospitals that are setting us back. The RN scope of practice is not unfairly restricted by such nonsense, why so are the RPNs??

[NotReady4PrimeTime, RN]

I think you would find that the RN scope pf practice does have similar restrictions. In Alberta, there are a number of special competency certifications that we RNs are required to obtain and maintain in order to legally perform certain skills. For example, I have SCCs in direct IV drug administration, cytotoxic drug administration, neuromuscular blockade administration, IV inititation, restoring patency of intravenous access devices, EVD management, c-spine stabilization, blind insertion of nasojejeunal feeding tubes and defibrillation/cardioversion. In the case of direct IV drug administration, the only circumstances under which I could legally perform that skill outside my own unit is if I'm on one of the floors as the code team nurse. If I floated to one of the floors, I could not. The one time I was called to another floor to tPA a PICC line, I had to obtain a specific order on the patient's chart that stated "tPA 0.5 mg/ml to be instilled to each port of PICC by janfrn, per protocol." But I do hear your frustration.

[Fiona59]

I've experienced it. Got over it.

In my hospital only RNs in ER, ICU, Recovery, CCU are permitted to do IV push. No floor nurses. Logic is if they are that sick the patient should be in an Obs or ICU bed. Lately, the docs have been writing orders for specific drugs IV and then when the staff read the info before mixing the meds, it's an IV push drug. So, we page them and tell the to come and give the med. They're ticked but nobody is risking their practice permit for them.

CLPNA has worked with the government to constantly expand our scope of practice. Fine, but the minute we mention we want to be paid for our added scope they don't want to know us and tell us wage issue belong to the union. Somehow they manage to expand the scope after the contract is signed so we are stuck for four years. I know LPNs that refuse to start IVs because "we aren't being paid enough and the RNs are making more so let them".

The scope on some of the units I work on is so close it come down to piercing blood or travisol bags. Patient assignments are fluid. LPN, RN, LPN we all care for the same patients. Acuity isn't factored into it. The actual nurses experience is often the deciding factor. I've heard charges say they'd rather have xxLPN look after the patient than yyRN because the LPN has five years on the floor and the RN has two.

With the education of PNs know being the old diploma for RNs (and I've had RN educators tell me this more than once) the pay and skill gap needs to be fixed soon.

[OttawaRPN]

In my hospital only RNs in ER, ICU, Recovery, CCU are permitted to do IV push. No floor nurses. Logic is if they are that sick the patient should be in an Obs or ICU bed. Lately, the docs have been writing orders for specific drugs IV and then when the staff read the info before mixing the meds, it's an IV push drug. So, we page them and tell the to come and give the med. They're ticked but nobody is risking their practice permit for them.

I'm surprised by this. IVP is a basic skill for RNs here so any RNs in any and all units can (and do) push. Many of our IV meds come up from pharm in a syringe (for example Ancef 1 g diluted in NS) so attach a needle and you're ready to go. RPNs have to mix into a mini-bag and hang above the drip chamber, which is a pain in the a$$ if the patient only has a saline lock with no established IV running but policy dictates....

As for special competency certifications, there are many such pathways for RNs to pick up added skills but there is nothing taught in their basic training that they're unable to practice on the units (unlike the RPNs.) We do have PICC nurses, VAC nurses, ET nurses who have advanced training, and as such, are considered experts in their field.

My frustration stems with being disallowed to utilize skills learned in my core training simply because administration feels the need to stranglehold our profession presumably because of the stigma that we're not "real" nurses.