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RN vs. LPN

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					   What is the
   difference
between RNs and
     LPNs?

 Monica Franey, Keri
 Anne Gallant, Amber
       Galley
        What is the Issue?
 Knowing and not knowing the
  differences between the RNs and LPNs
  entry level competencies, education,
  scope of practice, and the effects it has
  on client outcomes. It becomes an issue
  when there is a lack of knowledge that
  exists on the part of the RN and the
  LPN about where the overlap in both
  scopes of practice occurs.
          Class Objectives
 Preliminary understanding of historical,
  ethical and economic implications
 Gain a perspective of the impact that
  education has on a nurses level of
  competency
 Identify credentialing of nurses in Canada
 Understand the scope of practice for both
  LPNs and RNs
 The role of communication and its importance
 Understand how nursing competencies affect
  patient outcomes
          Did You Know?
 Estimated 95%
  of technical
  skills (tasks) are
  shared between
  RNs and LPNs
                          Definitions
 Registered Nurse (RN) – Receive legal authority to use the
  title “registered nurse” through provincial and territorial
  legislation and regulation. RNs practice in all provinces and
  territories in Canada and across the full range of clinical care,
  education, administration, research and policy settings (CNA,
  2007). RN can include diploma nurses currently within the work
  force, bachelor of nursing (BN) and bachelor of science in
  nursing (BScN).
 Licensed Practice Nurse (LPN) -Graduate of an approved
  practical nursing program or equivalent; have successfully
  completed the Canadian Practical Nurse Registration Exam
  (CPNRE) or equivalent; and hold a current license to practice.
                 Ethics
 “I believe that nurses can influence
  change in all areas due to the trust that
  Canadian public puts in them. But
  nurses have to honour this trust and
  bring their knowledge and professional
  relationships to the table to effect
  change” (CNA, 2007).
                      Ethics
 Nurses act in a manner that is consistent with their
  provincial legislation, standards of practice, code of
  ethics, and other relevant legislation. These are
  necessary to provide safe, competent and ethical
  care
 Competence is the integration and application of
  knowledge, skills, attitude and judgment required for
  safe, ethical and competent performance in an
  individual’s nursing practice
 Collaboration and consultation are essential elements
  of safe, competent, ethical nursing practice
 The Economics of Nursing
“Nurses are a good investment for the
health system. More than 250,000
registered nurses are working on the
front lines of care in Canada saving
lives, promoting health and reducing
costs to the health care system”
   The Economics of Nursing
 Currently many health sector are undergoing
  restructuring in favor of cost reduction.

 Aiken (2008), states that research shows
  investments in nursing has lead to better
  patient outcomes, however nursing is a
  constant target for cost reductions.
                  History
 During the early 19th century, education,
  experience, and personal attributes held by
  nurses at that time varied greatly
 Apprenticeship occurred during an era before
  nursing schools
 In 1874 hospital schools began to grow
 In 1932 the CNA studied the situation and
  concluded the need for more education but it
  was hard to achieve such goal during the
  great depression and World War II
Education
The need for more education…

Globalization
Changing Patient Characteristics
Science & Information Technology
Increase Complexities of Health Care
Policy, Standards


(Hegarty, J., Condon, C., Walsh, E., Sweeny, J. (2009) The Undergraduate
Education of Nurses: Looking to the Future. International jounral of nursing
education scholarship. 6(1), P. 1-11)
 Diploma Program (LPN’s)        Baccalaureate (RN’s)
 Two year program             Four academic years

 Provides a limited body      Provides a blend of biological and
of foundational                 social sciences, humanities, and
knowledge (CASN)                professional nursing courses
                                (St.FX academic calendar)
 Educated to provide          Educated to provide care to
care to individuals,            individuals, families, groups,
families, and groups            populations, and communities
throughout their life span,     through out their life span,
across the continuum of         across the continuum of health
health (CASN)                   (CASN).

Work as a team member         Work as a independent
                                practitioner or team member in
in all setting (CASN)           all settings. (CASN)
               RN degree (St.FX university)

Biology 105, 115;                           Comprehensive Health Assessment
Chemistry 150;                                 275
Introduction to Professional Nursing 105,   Nursing Research Methods 300,
Health Promotoin and Learning 115,
                                            Nursing of adults II 305,
                                            Nursing of Chlidren 315,
Psychology 100;                             Mental Health Nursing 345,
Religion 120                                Perinatal Nursing 355
Human Anatomy and Physiology 251 &          Legal and Ethical Issues in Nursing
    252;                                       330 or 336;
Human Nutrition 261 & 263;                  Nursing of Adults III 405 + Clinical
Community Health Nursing 205,               Nursing of Adults IV 416, + Clinical
Introduction to pharmacology 235,           Trends in Health Care 491,
 Healthy Aging 245,
                                            Leadership and Research 493;
                                            9 credits open electives; 9 open
Nursing of Adults 251,                         electives
Developmental Psychology 260,
                LPN diploma (NSCC)

Anatomy and Physiology
Alzheimer Disease & Other Related Dementias
Growth and Development
 Health Information Literacy and Research Skills
Introduction to Nursing profession –
 Pharmacology/Administration of Medications
 Health Assessment of the Healthy Adult
 Alterations in the Health of Adults
 Alterations in Mental Health
 Family and Community Nursing
 Oncology Nursing and Palliative Care
 Health Promotion
 Professional Practice
 Introduction to NS OH&S Act (Occupation Health Act)
Nursing skills I&II
                 Baccalaureate Nursing

 The baccalaureate nursing curriculum combines
  academic and professional theory with nursing
  practice, fostering:
                Scholarly inquiry
                Creativity
                Critical thinking
                Moral reasoning
                Self-directedness
                Commitment to lifelong learning
                Personal growth through reflection and introspection
                Positive interpersonal relationships
                Critical inquiry
                Sensitive response to human values
                Professional excellence

   (St.FX academic Calender)
   Why is a baccalaureate
education important for RNs?
 The skills and knowledge required to perform the complex,
  critical health-care tasks of a nurse are most effectively taught
  in a baccalaureate program.

 Canadians rely on RNs for support during life-and-death
  decisions and situations.

 RNs develop and implement multi-faceted plans for managing
  chronic disease, treating complex health conditions and
  assisting transition from the hospital to the community.

 RNs provide health education and strategies to improve health.

 RNs assess the appropriateness of new research and technology
  for patients and adjust care plans accordingly.
  (CNA)
 Baccalaureate degree broadens the
  scope of practice, and provides the
  nurse with a better understanding of a
  more holistic view, and recognizes
  influences that affect both patient and
  health care delivery such as: cultural,
  political, economic, and social issues
  (AACN, 2010).
   Entry Level Competencies
 Nurses practice within their own level of
  competence and seek direction and
  guidance from other health
  professionals when aspects of care
  required are beyond their individual
  competence (PEI Health Sector Council
  et al.)
Entry Level Competency of the
        RN in Canada
 Professional Responsibility and Accountability
 Accountability
 Knowledge-Based Practice
   Specialized body of knowledge
   Competent application of knowledge
 Ethical Practice
 Service to the Public
 Self-Regulation
Entry Level Competency of the
      LPN in Nova Scotia
 Provides Safe, Competent and Ethical Nursing Care
 Recognizes One’s Own Role in Influencing and Facilitating
  Change
 Recognizes One’s Own Responsibility in Continuous Learning
 In Consultation, Performs and Refines Client Assessments
  Consistent With One’s Own Scope of Practice
 In Consultation, Collaborates in the Development of a Client-
  Focused Plan of Care
 Intervention: Implementation
 Intervention: Communication
 Intervention: In Consultation, Teaches and Verifies Learning
 Evaluates Client Progress
 Organizes Care Delivery
 Partnerships (CLPNNS, 2005)
        Controls of Practice
 There are four levels which control
  nursing practice:
      Legislation
      Standards of Practice
      Employer Policies
      Individual Competence
           Scope of Practice
 Scope of practice is:
   The range or roles, functions, responsibilities and
    activities nurses are educated and authorized to
    perform;
   Knowledge and skills nurses have as individuals.


 Scope of Practice evolves from practice
  decisions before, during and after a
  technical skill or task rather from technical
  skill or task itself
 Scope of Practice of the LPN
 Licensed Practical Nurses (LPNs) are most
  efficiently utilized making care decisions for
  patients with predictable (identified,
  unchanged, predictable) challenges and/or
  known health outcomes via an established
  POC which has been created by or co-created
  with the RN.
  Scope of Practice of the RN
 Registered Nurses (RNs) are most
  efficiently utilized making care decisions
  for patients with complex (new,
  changed or complex) challenges and/or
  unknown health outcomes.
      Role and Scope of the RN and
                  LPN




Douglas Bungay, 2010)
              Predictable vs. Complex
                  LPN                 LPN/RN               RN
            PREDICTABLE                ACUTE             COMPLEX
          Patients whose          Patients whose        Patients whose health
          health challenge is     health challenge is   challenge is not well
          known and               not always well       known and frequently
          trajectory of           known and             changes. Even
                                  changes often,        though there is some
          care/recovery has       however has some      degree of
          little variation from   degree of             predictability by
          others with same        predictability by     process, variations in
          health experience       process, but          care, patient needs
                                  variations often      (technical and/or
                                  occur in individual   psychosocial) are
                                  patients.             often significant.
                                                        Patients whose health
                                                        challenge is
                                                        consistently variable.
Douglas Bungay, 2010)
  Consultation and Collaboration
         Communication
 Collaboration:
      “ongoing communication and
  decision making with the goal of
  working toward identified client care
  outcomes. It respects the unique
  contributions and abilities of each
  member”
 Consultation:
      “seeking advice or direction from a more
  experienced or knowledgeable nurse or other
  health professional. The client’s care needs,
  the nurse’s job description and the nurse’s
  individual competence influence both the
  amount of consultation required and who to
  involve in the consultations”
           Collaborative RN and LPN
                  Relationship




Douglas Bungay, 2010)
                        Nursing Process
                                  RN                            LPN

    Assessment          Interprets new actual     Reviews identified problems
                        and potential problems    and recognizes changes

      Planning          Integrates findings       Evolves the POC toward the
                        into a POC                patient goal

     Intervene          Coordinates actions       Facilitates and enacts actions
                        designed to mitigate or   as necessary
                        reduce identified
                        problems
      Evaluate          The POC, including        Patients response to
                        patients responses to     interventions to make sure goals
                        interventions             are being met.

Douglas Bungay, 2010)
             Decision Making
 LPNs DO NOT have an initial planning
  component in their legislation and therefore
  cannot independently develop initial plans of
  care.
 They collaborate with the RN in the development
  of the initial POC, although the final accountability
  for it rests with the RN

                         RN
          Assess, Plan, Intervene, Evaluate
                         LPN
             Assess, Intervene, Evaluate
      Differentiated Decision Making




Douglas Bungay, 2010)
  Differentiated Practice: LPN
 Decision Making and Outcomes
 Make ongoing care decisions
  independently about predictable
  patients or patient problems

 An ongoing decision is required for
  identified, same or predictable patient
  problems
   Differentiated Practice: RN
 Decision Making and Outcomes
 Make in-depth nursing care decisions
  independently regardless of context

 A in-depth decision is required for new,
  different or complex patient problems.
Douglas Bungay, 2010)
                  Scenario

 An LPN is caring for ND, an 89 year old
  female client living home alone. She has a
  medical history of CHF, arthritis, and
  COPD. The LPN regularly visits ND in her
  home assisting her with the administration
  of bronchodilators. The LPN also assesses
  the effectiveness of her medication,
  provides emotional support, and teaches
  the client to watch for increased SOB. ND’s
  health care needs are well defined and
  established.
 The plan of care for
  ND and her care
  needs are predictable
  and well established.
         Changing Circumstances

 Upon providing care, the LPN observes
  that ND is becoming SOBOE. ND informs
  the LPN that activity has become difficult
  for her due to her SOB, and that she has
  been spending an increased amount of
  time in bed.
 The LPN
  determines that
  the RN must be
  consulted.
   Continuing Consultation and Assessment

 When the LPN visits and cares for ND a
  week later, her status declines. She
  informs the nurse that her SOB has
  worsened and the LPN observes edema to
  both of her legs. ND now requires oxygen
  and a steroid inhaler.
 The outcomes of
  her health status
  are more complex
  and the level of
  care is no longer
  considered
  predictable.
        Patient Outcomes
 In todays increasingly complex health
  care environment, research
  demonstrates indisputably that patient
  safety and outcomes are depended on
  the educational preparation of
  professional nurses. (CASN, 2010)
            Patient Outcomes
 A nurses knowledge base plays a critical role in
  patient health outcomes and patient safety.
 A great deal of evidence shows that quality nursing
  care provided by RN’s is associated with clients
  achieving optimal health outcomes and a reduction in
  adverse effects.
 The CNA FactSheet: The Value of Registered Nurses,
  outlines several articles which state how RN’s achieve
  better patient outcomes.
     Nurse Staffing and Patient
              Safety
 There is strong evidence that nurse-staffing levels affect patient
   safety.
 Nurse staffing ratios have an impact on patient outcomes, medical
   errors, complication rates, rescue rates, patient mortality, length of
   hospital stay and nurse turnover.
 Fewer RNs lead to an increase in adverse events such as pressure
   ulcers, medication errors, infections (usually urinary tract or
   wound), falls and reduction in patient satisfaction.
 Patient fall rates are reduced by increased the total number of
   nursing hours/patient or increasing the percent of nursing hours
   received by RNs.
 The greater the ratio of nurses to patients and the increased
   number of RNs in the skill mix of staff results reduces adverse
   patient outcomes.
(College of Registered Nurses of Nova Scotia, 2008)
 When an RN implements educational
  interventions, client health outcomes improve.
  Studies have shown that when an RN provides
  education;
              Increase smoking cessation
              Improve clients parenting skills
              Improve pre-natal and post-partum outcomes
              Increase clients confidence in managing their illness
              Increase clients confidence in performing self-care.

(College of Registered Nurses of Nova Scotia, 2008)
             Conclusion
 As a professional class we need to be
  able to identify our scope of practice
  and the scope of practice of other
  health care professionals. With
  collaboration and consultation we can
  improve the health care system and
  consequently patient outcomes.
                          References
   American Association of College of Nursing (2010). The Impact of Education on
    Nursing Practice. Retrieved from :
    http://www.aacn.nche.edu/media/factsheets/impactednp.htm.
   American Registered Nurses of Prince Edward Island.(2010). Exemplary Care:
    Registered Nurses and Licensed Practical Nurses Working Togather. Retrieved
    from: http://www.arnpei.ca/images/documents/RNsand
    LPNsWorkingTogather.pdf
   Canadian Nurses Association. (2009). Fact sheet: The value of registered
    nurses, Ottawa: Author.
   Canadian Nurses Association. (2011). Registered Nurses Education. Retrieved
    from: http://www.cna-nurses.ca/CNA/nursing/education/default_e.aspx
   Canadian Nurses Association. (2007). Frame work for the practice of registered
    nurses in Canada. Retrieved from: http://www.cna-
    aiic.ca/CNA/documents/pdf/publications/RN_Framework_Practice_2007_e.pdf
   Canadian Associaion of Schools of Nursing. (2010). The case for Healthier
    Canadians. Nursing Workforce Education for the 21st Century.
   College of Licensed Practical Nurses of Nova Scotia (CLPNNS). (2005).
    Entry-level competencies for licensed practical nurses. Retrieved from:
    http://www.clpnns.ca/regulation/regulationPDFs/CLPNNS_Ethics_Stand
    ards.pdf
   College of Registered Nurses of Nova Scotia (CRNNS). (2009). A
    discussion paper on scope of nursing practice for registered nurses in
    Nova Scotia.
   College of Registered Nurses of Nova Scotia. (2009). Entry-level
    competencies. Retrieved from: http://www.crnns.ca/documents/Entry-
    Level_Competencies2009.pdf
   Douglas Bungay RN MN Professional Practice Leader. (2010).Optimized
    practice. CNSA Atlantic Conference. Halifax, NS
   Government of Nova Scotia. (2006). Registered Nurses Act. Statutes of
    Nova Scotia, c.21, s.1.
   College of Registered nurses of Nova Scotia. (2008). Registered nurse-
    sensitive      outcomes, Halifax: Author. Retrieved from:
          http://www.crnns.ca/documents/Fact%20Sheet%20%20RN%20S
    ensitive%20Out          comes%20-%202008.pdf
   Hegarty, J., Condon, C., Walsh, E., Sweeny, J. (2009) The
    Undergraduate Education of Nurses: Looking to the Future.
    International jounral of nursing education scholarship. 6(1), P. 1-11).
   Nova Scotia Community College (2011). Practical Nursing Program
    Overview
   PEI Health Sector Council. Exemplary care: Registered nurses and
    licensed practical nurses working together.
   Rheaume, A., Dtkeman, M., Davidson, D., Ericson, P. (2007). The
    impact of health care restructuring and baccalaureate entry to practice
    on nurses in New Bruswick. Policy, Politics & Nursing Practice, 8, 130-
    139.
   St.FX University. (2011). Academic Calender.

				
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