Suzie Blair, RN, & Meni Didimos-Bryant, RN, BScN ... · the two nursing categories (RN and RPN). • Identify resources available and how to access them. • Utilizing the CNO Practice

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RN & RPN Practice: 3 Factor Framework

Presented by: Suzie Blair, RN, & Meni Didimos-Bryant, RN, BScN

Professional Practice Specialists

Ontario Nurses’ Association www.ona.org

Our Union. Respected. Strong. United. 2

Objectives • Identify the legislation and governing body to which

nurses are accountable. • Nursing scope of practice. • Nurses responsibility – knowing the differences between

the two nursing categories (RN and RPN). • Identify resources available and how to access them. • Utilizing the CNO Practice Guideline – RN and RPN

Practice (the client, the nurse and the environment) in your workplace.

• Red Flags – Identify factors/trends and where to report and record them.


Legislation and Regulation

• Regulated Heath Professionals Act, 1991 (RHPA) • The Nursing Act, 1991 • CNO Practice Standards and Guidelines


Nursing Scope of Practice Scope of practice statement for nursing:

“The practice of nursing is promotion of health and the assessment of, the provision of, care for, and the treatment of,

health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain

optimal function.”


RHPA and Nursing Act 1991 Controlled Acts authorized to nurses to perform: • Performing a prescribed procedure below the dermis or mucous

membrane. • Administering a substance by injection or inhalation. • Putting an instrument, hand or finger beyond the:

External ear canal. Narrowing of the nasal passage. Larynx. Opening of the urethra. Labia Majora. Anal verge. Into an artificial opening in the body.

• Dispensing a drug.


Differences between RNs and RPNs Controlled Acts • The difference is in the initiation of the controlled acts. • Initiation in this context refers to: nurses using their

critical thinking skills and knowledge to decide independently if a specific procedure within a controlled act is required and performing it in the absence of an order.


College of Nurses - 3 Factor Framework

Environment

Client Nurse

http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/webcasts/rn-and-rpn-practice-the-nurse-the-client-and-the-environment-webcast/


3 Factor Framework The Client The Nurse The Environment

Complexity of care needs

Leadership – Understanding own competencies

Practice supports

Predictability of outcomes

Decision-making – Ability to consult as needed

Consultation Resources

Risk of negative outcomes

Critical Thinking – Application of knowledge, skill and judgement

Stability and predictability of the environment


The Client

• Complexity of care needs • Predictability of outcomes • Risk of negative outcomes


What Do You Need To Know?

Complexity, Predictability, Risk

• What is the client population?

• Are their care needs well defined?

• Are there multiple issues and are they overlapping?

• Do they require frequent monitoring or reassessment? • What are the possible changes in health condition, and the

timing and nature of the outcomes?

• Is there a risk of negative outcomes in response to care?

The Client


The Nurse – Practice

RN Practice

Increased need for RN

Consultation, Collaboration

Autonomous RPN/RN

Clients who are less complex, predictable, low risk for negative outcomes

Clients who are highly complex, unpredictable, high risk for negative outcomes


Nurse Factors

• Assessment • Planning • Implementation • Evaluation


Nurse Factors: Leadership

RPN • Demonstrates leadership

through representation on committees, preceptor to students and providing direction to Unregistered Care Providers.

RN • Assumes the role of leader

within the interprofessional team

• Leads the team to develop plans of care to achieve identified client goals when overall care requirements are more complex.


Implications for the Nurse in Charge

• Charge nurses have been found to have committedprofessional misconduct by the CNO for failing to provideadequate supervision to a nurse under their direction and/orescalation of workload concerns to managers.

• When in charge, it is better to have taken proactive steps tostop potential problems, rather than reacting to problemsafter they arise.

• The following actions can assist the charge nurse in fulfillingher responsibilities to lead the team and head off potentialproblems early (Slide 15).


The Charge Nurse Must know her or his role Be accountable for her or his actions in relation to others. Act as a resource by sharing knowledge and expertise.

Taking Charge Know who is most likely to need their help. Huddles. Ask the right questions. Be clear about who is responsible for what. Take action to stop unsafe situations. Be a leader. Assign the right patient to the right category of nurse. Allot and ensure enough time for consultation/collaboration.


The Environment 1. Practice Supports 2. Consultation Resources 3. Stability and Predictability of the Environment


All 3 Factors Must be Considered!

Environment

Client Nurse

http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/webcasts/rn-and-rpn-practice-the-nurse-the-client-and-the-environment-webcast/


All 3 Factors Must be Considered!

The application of the three-factor framework will help decision makers determine which roles and activities are NOT APPROPRIATE for autonomous RPN practice suited only to an autonomous RN. Examples include, but are not limited to the following: • Triage nurse • Circulating nurse • Administering conscious sedation or monitoring sedated

patients (includes deep sedation and general anesthesia) RN and RPN Practice, CNO


Trends/Red Flags

• Changing Models of Care • Fragmented Care • Changes in Skill Mix


Your PRWRFs Promote Change

Professional Responsibility Workload Report Forms (PRWRFs)

Highlight ONA’s Wins


Nurse Staffing Issues: Be alert to changes in…

• The proportion of RNs to other or less-qualified staff. • The number of RN nursing hours per patient per day. • The ratio of RNs to patients/clients. • The number of full-time equivalents (FTE). • The percentage of FT, PT and casual RN staff. • The mix of demographic characteristics, e.g. education

and experience.


Questions

• Provide specific scenarios to the professional practice specialists, and allow them to support you on the “next steps.”

• Keep the factors brief, concise and a minimum of two questions per scenario.


Resources • CNO Reference document: RHPA, 1991 • CNO Fact sheet: An introduction to the Nursing Act, 1991 • CNO Decisions About Procedures and Authority, 2014 • CNO Authorizing Mechanisms, 2015 • CNO Practice Standards, 2009 • CNO RN and RPN Practice: Client, Nurse and the Environment,

2014 • ONA RN/RPN Skill Mix Questionnaire (ONA exec site, grievances)

http://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/


RN/RPN Scope of Practice:

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Documents

Suzie Blair, RN, & Meni Didimos-Bryant, RN, BScN ... · the two nursing categories (RN and RPN). • Identify resources available and how to access them. • Utilizing the CNO Practice