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Enhancing RN/LPN collaborative practice: an update on mandatory adult physical assessment education for LPNs.

In 2004, the Association of New Brunswick Licensed Practical Nurses (ANBLPN) board of directors approved a mandatory upgrading program for LPNs, which would require them to complete the adult physical assessment course. It was determined that the mandatory upgrading program would begin in January 2007 and finish in December 2011. This requirement must be met in order for LPNs to be eligible for registration renewal in 2012. The decision to implement a mandatory upgrading program was based on national, provincial and individual LPN considerations.


Regulatory bodies for LPNs have been working to bring uniformity to the practical nurse profession within Canada for several years. Adult physical assessment courses have been delivered as part of an LPN mandatory upgrading program in several provinces and is now required for licensure. As a result, the program competencies are now part of the competencies tested on the national licensing exam for practical nurses.


Because the practical nurse profession has evolved over the last decade, a competency gap has been created between ANBLPN's established membership and the more recent graduates who have entered the profession. To address this, the adult physical assessment course will provide all LPNs with specific knowledge, skill and judgment regarding physical assessment and will encourage critical thinking skills. Many employers and the provincial government have been working with ANBLPN to support this upgrading program.


Many LPNs have expressed fear of becoming adult learners and noted financial limitations as a barrier to participating in continuing education. ANBLPN has worked to address these concerns through the mandatory upgrading program, therefore, the impact of these barriers on LPNs will be minimized in the future. This meets an important objective of ANBLPN which is to promote excellence in practical nursing by promoting continuing competency through the delivery of quality educational programs.

The adult physical assessment course is delivered in three parts:

* Theory: The theory is delivered in a self-learning workbook over a specific period of time. To complete the theory requirements of the course, the LPN must achieve 80% on a theory exam.

* Laboratory: The laboratory session focuses on assessment techniques and is taught over two-days with a pass/fail demonstration exam.

* Clinical laboratory assignment: The LPN must complete a head to toe assessment with a patient. Once the assignment is completed, it is turned in to the ANBLPN office where it will be evaluated. Upon successful completion, a certificate is awarded.


The ANBLPN does have expectations regarding the outcomes of the adult physical assessment course:

* For LPNs: It is ANBLPN's expectation that LPNs will be able to identify normal verses abnormal when conducting a physical assessment. When an abnormality is noted, the LPN is expected to seek out the appropriate care provider (registered nurse, physician, etc.) to assess the abnormality and provide further direction.

* For employers: The ANBLPN advocates that employers support LPN practice at its full competency level within the LPN scope of practice. The employer, who ultimately determines the "scope of employment," is expected to consider this within the organization's policy and procedures, which should reflect the care requirements of the patient, the competencies of the care provider and the practice setting/ supports that are available.

* For the LPN profession: ANBLPN developed this course from an Association perspective for the purpose of promoting professional development of practical nurses and educating them to meet the national practical nurse profile. The acquired skills may not be utilized in every practice environment, however, practical nurses completing the adult physical assessment course will be able to contribute to the nursing care team and the delivery of patient care by providing more competent and in-depth assessments in all types of environments. It is strongly felt by the ANBLPN that the result of the adult physical assessment course will only have a positive impact on the ability of the LPN to provide nursing care, benefiting the rest of the nursing care team, their employer and most importantly, the patient.

It is anticipated that by the end of 2007, 600 LPNs will have completed the adult physical assessment course. On average, there are six to eight workshops being held every month in various locations around the province. Support that has been offered to LPNs from their RN colleagues as they complete the mandatory upgrading program has been appreciated.

RNs and LPNs work collaboratively as a team to provide safe, quality care that maximises benefits to clients. When the RN and LPN are working together in the provision of patient care, the working relationship must be built on trust and mutual respect. Central to building trust in the RN/LPN collaborative working relationship is an understanding of each other's roles and capabilities.

Editor's note: At the time of writing this article, Jodi Hall was director of education/ practice at ANBLPN. Ms. Hall is currently the administrator/CEO at Orchard View Nursing Home, Gagetown, N.B.
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Title Annotation:Registered Nurses/Licensed Practical Nurses
Author:Hall, Jodi
Publication:Info Nursing
Geographic Code:1CANA
Date:Sep 22, 2007
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