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Adapting to the new workplace reality: maximizing the role of RNs within a collaborative nursing practice model.

Editor's note: This is the first of six articles looking at how registered nurses can best adapt to changes in the mix of nursing care providers in the health care system. The topics in the series are: "Professional Nursing Practice: Requisite Capacities," Professional Nursing Practice: Rule of Three," Professional Nursing Practice: Continuing Competency; Organizing Nursing Care," "Directing Care," and "Working Together." It is the hope of the Practice and Policy Department that each article will provide information to registered nurses on how to interpret professional nursing practice from a registered nurse point of view, to assist the registered nurse in understanding her/his professional role and responsibilities in the context of a collaborative practice setting which includes other nursing care providers.

Related articles on information contained in any of the five articles may be offered along the way, such as this month's "Ask a Practice Advisor" question on the difference between assigning and delegating. In each issue of Info Nursing, a follow up capsule on how to consider putting the information to work in professional practice will also be offered. While this series is mostly aimed at RNs working in institutions, some of this information is also applicable in community or other settings.

This series of articles derives directly from information presented in the fall of 2005 to 263 clinical leaders in a series of 12 workshops held throughout the province. The workshops were originally developed and presented by Annette LeBouthillier (former practice advisor at NANB) and Noreen Richard (former director of practice and policy at NANB). Before taking her new position with Region 7, Ms. LeB-outhillier prepared the majority of the information for these articles.)

Professional nursing practice: requisite capacities

Systemic changes to the health care system and service delivery models are both being driven by and affected by the number, deployment and utilisation of nursing resources. The ongoing changes to the skill mix and service delivery models create new working relationships between registered nurses (RNs) and other nursing care providers. RNs need a clear understanding of how these changes affect their professional practice as they are increasingly required to work through others to achieve patient outcomes.

As part of the surveillance system for patients in the acute care setting, nurses play a key role in the survival and the recovery of patients (Aiken, Clark, & Sloan, 2000; Aiken, Clark, Sloan, Sochalski, & Silber, 2002; Aiken, Clark, Cheung, Sloan, & Silber, 2003; Clark & Aiken, 2003; Crossan & Ferguson, 2005). Questions about the overlap in RN and LPN scopes of practice have increased substantially everywhere. To describe the scope of nursing is not to refuse to share responsibilities or to refuse to collaborate with others. On the contrary, it means to better define that scope and to determine and to recognise the limits and strengths of each provider. This article outlines the requisite capacities for professional nursing practice.

A professional practice framework, in development at NANB since 2005, lists the requisite capacities of the registered nurse's practice (see Table 1).

"Requisite capacities" are those capacities that are essential for professional nursing practice to occur. For example, in relation to continuing competence the registered nurse is required, by the standards of practice [NANB (2005) Standard 3], to: "3.2 continually assess ... practice to identify learning needs and opportunities for improvement; ... and 3.4 use reflective thought and feedback from others to implement changes in own practice." Achievement of requisite capacities leads to a greater probability of desired patient outcomes.

Nurses must remember that their level of education prepares them not only to collect information about a patient's condition, but also to interpret its meaning, to plan appropriate interventions and to evaluate whether appropriate patient outcomes were reached. Nurses must remember that their practice is knowledge based which requires active and continual knowledge development that is pertinent to the patient population for which they are caring.

The registered nurse is also required to work in collaboration with others while maintaining the responsibility for the organization and direction of nursing care. Due to human resource shortages world wide, nurses can no longer work in isolation of other nursing care providers (regulated and unregulated) and other health care disciplines. In this regard, nurses must know and adapt strategies that local resources and agency policy support in order to assure best evidence-informed care.

Nurses, at times, feel uncomfortable directing the nursing care provided by other regulated nursing care providers. Many nurses were educated and worked in environments when staffing was mostly all RNs, and therefore have not had the opportunity to develop the skills required for assigning, delegating and supervising care delivered by others (to be discussed in future articles). Again, these become needed knowledge-based skills, along with associated leadership, decision-making and judgment.

The legislated scopes of practice of both regulated nursing care providers are outlined in Table 2. To make good decisions about the assignment of patient care, registered nurses need to understand clearly the extent of their scope and that of licensed practical nurses. Nurses also need to be reminded that it is their level of knowledge and legislated mandate which differentiates them from other nursing care providers and enables them to interpret assessment data and plan appropriate interventions to meet the patient's needs.

In this first of six related articles on the topic of collaborative nursing practice, an introduction to the requisite capacities for registered nurse practice, also needed to meet challenges of the changing workplace, has been offered. In order to be able to continue to provide safe and quality nursing care, the registered nurse must continue to apply sound evaluation skills, best judgment based on evidence-informed practice, and must more than before exercise a leadership capacity. Because of the registered nurse's education and competences, as well as the legislated relationship with other care providers, the registered nurse retains responsibility for direction or planning of care. Future articles will touch on some of the responsibilities employers have in supporting registered nurse practice for the benefit of the patient.


Aiken, L., Clark, S., Cheung, R., Sloan, D., & Silber, J. (2003). Educational levels of hospital nurses and surgical patient mortality. JAMA, 290, 1617-1623.

Aiken, L., Clark, S., & Sloan, D. (2000). Hospital restructuring: does it adversely affect care and outcomes? Journal of Nursing Administration, 30, 457-465.

Aiken, L., Clark, S., Sloan, D., Sochalski, J., & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288, 1987-1993.

Association of New Brunswick Licensed Practical Nurses [ANBLPN] (1977). Licensed Practical Nurses Act (rev. 2002). Fredericton, NB: Author. advanceddownload.cfm?id=78

Clark, S. & Aiken, L. (2003). Failure to rescue. American Journal of Nursing, 103, 42-47.

Crossan, F. & Ferguson, D. (2005). Exploring nursing skill mix: a review. Journal of Nursing Management, 13, 356-362.

Nurses Association of New Brunswick [NANB]. (2005) Standards of Practice for Registered Nurses. Fredericton, NB: Author. Publications/General_Publications/StandardsofRegisteredNursesE.pdf

NANB & ANBLPN. (2003). Working together: a framework for the registered nurse and the licensed practical nurse. Fredericton, NB: Author. General_Publications/RNLPN% 20(e)1.pdf

NANB (1984). Nurses Act: An Act Respecting the Nurses Association (Rev. 2002). Fredericton: Author. General_Publications/Nurses-Act_E&F.pdf
Table 1. Requisite Capacities for Registered Nurses' Practice

Continuing Inherent Decision making Understanding
Competence ownership of about profes- of accountabili-
 professional sional matters ties of each of
 role and work of the the partners

Continuing Organizing Directing Collaboration
Competence patient care nursing & working
 Work with others

Table 2: Legislated scope of practice

Registered Nurses

Nurse is a person who has met the qualifications
for registration as a nurse pursuant to the Act,
the bylaws and the rules of the Association and
is entitled to engage in the practice of nursing
in N.B. "Nursing is defined as the practice of
nursing and includes the nursing assessment
and treatment of human responses to actual
or potential health problems and the nursing
supervision thereof" (Nurses Act, 1984).

Licensed Practical Nurses

"Practical Nurse means a graduate of an approved school of
practical nurses who, being neither a registered nurse nor
a person in training to be a registered nurse, undertakes
the care of patients under the direction of a registered
nurse or duly qualified medical practitioner, for custodial,
convalescent, sub-acutely ill and chronically ill
patients, and who assists registered nurses in the care
of acutely ill patients, rendering the services for which he
or she has been trained" (LPN ACT, 2002.)

By the staff of the Practice and Policy Department
COPYRIGHT 2007 Nurses Association of New Brunswick
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:registered nurses
Publication:Info Nursing
Geographic Code:1CANA
Date:Mar 22, 2007
Previous Article:NurseOne: RHA 4 nurses now have access to the portal.
Next Article:Capsule on practice.

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