Adapting to the new workplace reality: maximizing the role of RNs within a collaborative nursing practice model.
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. http://www.anblpn.ca/plugins/subm_ 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. http://www.nanb.nb.ca/pdf_e/ Publications/General_Publications/StandardsofRegisteredNursesE.pdf
NANB & ANBLPN. (2003). Working together: a framework for the registered nurse and the licensed practical nurse. Fredericton, NB: Author. http://www.nanb.nb.ca/pdf_e/Publications/ General_Publications/RNLPN% 20(e)1.pdf
NANB (1984). Nurses Act: An Act Respecting the Nurses Association (Rev. 2002). Fredericton: Author. http://www.nanb.nb.ca/pdf_e/Publications/ 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 profession 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
|Printer friendly Cite/link Email Feedback|
|Title Annotation:||registered nurses|
|Date:||Mar 22, 2007|
|Previous Article:||NurseOne: RHA 4 nurses now have access to the portal.|
|Next Article:||Capsule on practice.|