GUIDELINES FOR INTRAPROFESSIONAL …

1 GUIDELINES for INTRAPROFESSIONAL collaboration : Registered Nurses and Licensed Practical Nurses Working Together October 2015 (1/19) GUIDELINES FOR INTRAPROFESSIONAL collaboration GUIDELINES for INTRAPROFESSIONAL collaboration : Registered Nurses and Licensed Practical Nurses Working Together October 2015 (2/19) Nurses Association of New Brunswick and Association of New Brunswick Licensed Practical Nurses, 2015. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without prior written permission from the publisher.

2 ISBN 1 895613-60-4 October, 2015 GUIDELINES for INTRAPROFESSIONAL collaboration : Registered Nurses and Licensed Practical Nurses Working Together October 2015 (3/19) Nursing care in New Brunswick is provided by two regulated groups of health care providers: registered nurses1 (RNs) and licensed practical nurses (LPNs). Although other unregulated health care workers provide services and collaborate with RNs and LPNs, this document limits itself to the collaborative working relationship between RNs and LPNs. This document will: Clarify the scope of practice of RNs and LPNs; Help RNs, LPNs and employers make effective decisions about the utilization and deployment of nursing resources in the provision of safe, competent and ethical care; Provide an overview of the practice expectations when both groups work together; and Demonstrate the contributions that both groups bring to nursing care.

3 Nursing is a profession that is focused on collaborative relationships that promote the best possible outcomes for patients. These relationships may be interprofessional, involving a variety of health care professionals working together to deliver quality care within and across settings; or it may be INTRAPROFESSIONAL , with multiple members of the same profession working collaboratively to deliver quality care (CNO, 2014). The Nurses Association of New Brunswick (NANB) and the Association of New Brunswick Licensed Practical Nurses (ANBLPN), the professional regulatory bodies for RNs and LPNs respectively, believe that to optimize patient-centered care and positive patient health outcomes there must be open and ongoing INTRAPROFESSIONAL collaboration between nursing care providers and a clear understanding of their respective scopes of practice.

4 INTRAPROFESSIONAL collaboration is evident when RNs and LPNs work as a team utilizing individual skills and talents to reach the highest of patient care standards. This requires that RNs and LPNs: talk with each other, share perspectives, plan together and provide care; be clear about their roles and the roles of other health care providers; and support and assist each other in the interest of providing the best possible patient care. 1 The term registered nurse includes nurse practitioner. GUIDELINES for INTRAPROFESSIONAL collaboration : Registered Nurses and Licensed Practical Nurses Working Together October 2015 (4/19) 1.

5 RNs and LPNs practise in a manner that is consistent with Legislation, Standards of Practice, Codes of Ethics, employer policies and scopes of practice. 2. Nursing is based on the integration of knowledge, skill, judgment, critical thinking and personal attributes. It cannot be limited to a list of tasks. 3. RNs and LPNs are responsible, accountable and liable for their own practice. An RN or LPN is not responsible for the actions of another provider. 4. When RNs and LPNs work together, the nursing care delivery model must support INTRAPROFESSIONAL collaboration . 5. The patients care needs, the scopes of practice of RNs and LPNs, and the practice environment guide decisions about which nursing professional is the most appropriate provider of patient care.

6 6. The complexity of a patient s condition influences the nursing knowledge required to provide appropriate nursing care. As a patient s needs increase, the breadth and depth of the competencies required to provide nursing care increase. 7. When patient acuity, complexity or variability increases, the need for consultation between RNs and LPNs also increases. 8. Effective and professional communication between RNs and LPNs is essential in order to achieve quality patient outcomes. 9. Expectations, including responsibilities and accountabilities related to assignment of nursing care, must be made clear at every level within organizations and be understood by RNs and LPNs.

7 10. Workplace policies, procedures and resources must be in place to ensure a quality practice environment that allows RNs and LPNs to work together effectively. GUIDELINES for INTRAPROFESSIONAL collaboration : Registered Nurses and Licensed Practical Nurses Working Together October 2015 (5/19) There are many similarities between RN and LPN practice. However, there are differences in the entry level competencies of each group as a result of differences in foundational education (see Table 1). Both RNs and LPNs are educated to provide safe, competent and ethical practice at the entry level when they graduate from an approved nursing education program.

8 For RNs, a baccalaureate degree education in nursing is required. For LPNs, a two year diploma education in nursing is required. Both nursing programs study from the same body of foundational knowledge. As the education required increases, so does the depth and breadth of foundational knowledge. After completing their entry-level education, RNs and LPNs continue to consolidate their knowledge and skills and build on their initial education to develop and maintain the specific competencies required to meet the needs of patients in their areas of practice. If RNs or LPNs change areas of practice, they may need to enhance their level of knowledge and acquire new expertise.

9 Table 1 lists some of the similarities and differences between the levels of education and context of practice of RNs and LPNs in New Brunswick. TABLE 1: COMPARISON OF EDUCATION LEVEL AND PRACTICE CONTEXT FOR RNs AND LPNs Registered Nurse Licensed Practical Nurse ENTRY-LEVEL EDUCATION Enters practice following completion of an approved nursing baccalaureate program. Successful completion of the NCLEX. Must be registered with NANB. Enters practice following completion of a recognized LPN diploma program. Successful completion of the Canadian Practical Nurse Registration Examination. Must be registered with ANBLPN.

10 PATIENT POPULATION Educated to provide care to individuals, families, groups, populations and communities throughout their life span, across the continuum of health. Educated to provide care to individuals, families and groups throughout their life span, across the continuum of health (see page 7 under scope of practice). ENVIRONMENT Practises as an independent practitioner or team member in all settings. Practises autonomously in collaboration and under the direction of an RN, physician, pharmacist or duly qualified medical practitioner in all settings. GUIDELINES for INTRAPROFESSIONAL collaboration : Registered Nurses and Licensed Practical Nurses Working Together October 2015 (6/19) Scope of practice refers to the activities that RNs and LPNs are educated and authorized to perform as set out in legislation and regulation and complemented by standards, GUIDELINES , policy positions and a code of ethics (CNA, 2015).