Standards of Practice

Richard is a registered nurse (RN) who works on a medical surgical unit in an acute care tertiary hospital. The staff mix on the unit is comprised of both RNs and licensed practical nurses (LPN).

Today, he is working the day shift in the charge nurse role and one of his accountabilities is to develop the client care assignment for the unit.

Reflecting on the 2019 RN Standards of Practice

Richard knows he is obligated to meet the 2019 Standards of Practice for Registered Nurses. He also understands that Standard 2 indicator 2.7 states that each registered nurse demonstrates this indicator by assigning and delegating nursing activities in accordance with client needs, the roles and competence of other providers and the requirements of the practice setting.

What Factors Should Richard Consider when Making the Unit Assignment?

The first factor Richard should consider is the predictability of the clients. For example, he should ask himself which clients have predictable outcomes and which client outcomes are not as predictable. The predictability of clients is a determining factor because it dictates what the collaborative RN/LPN assignment will look like.

Within the collaborative assignment, the LPN provides care to clients who have more predictable or established outcomes and the RN provides care to clients with less predictable outcomes. The RN will also collaborate with the LPN if the client becomes less predictable and to ensure the plan of care is updated to reflect the client’s current care needs.

A second factor Richard should consider is the scope of employment and agency policy because this may also have an impact on a client assignment. For example, a nurse may require additional employer-based education about a VAC Dressing before caring for clients with that specific need.

When making a client assignment, a third factor Richard should think about is the context of practice. This includes factors such as the experience of the staff working, the acuity of clients and the level of care required.

After Richard completes the initial assignment, taking into account the factors outlined above, he should collaborate with the RNs and LPNs throughout the day and make changes to the assignment if client needs change.

For the other RNs and LPNs working with Richard, it is each or their individual accountability to conduct ongoing assessments of the clients’ conditions and to notify Richard if there is a change in the clients’ acuity in order to re-evaluate the assignment if needed.

For more information on Knowledge-Based Practice, continue to explore Standard 2 within the 2019 Standards of Practice for Registered Nurses. If you have any questions in meeting this standard of practice, please contact a Nurse Consultant at practiceconsultation@nanb.nb.ca.

Margie, a registered nurse (RN), who works on a med/surg unit in a small community hospital is a preceptor for Jessica, a recently hired licensed practical nurse (LPN). Three of their clients have just been discharged and they will be receiving a new admission as soon as the bed is ready.

How could Margie and Jessica work together to meet Standard 2, indicator 2.3?

(2.3 monitors the effectiveness of the plan of care and revises the plan as needed in collaboration with the client and the health care team)

Answer

The RN and the LPN need to understand each other’s scope of practice. They can then collaborate to maximize efficiency when completing client care and developing the new client’s plan of care.

Although it is Margie’s accountability as the RN to interpret the information gathered and develop the plan of care, there are many ways that Jessica can contribute to this process.

For more information on Knowledge-Based Practice, continue to explore Standard 2 within the 2019 Standards of Practice for Registered Nurses. If you have any questions in meeting this standard of practice, please contact a Nurse Consultant at practiceconsultation@nanb.nb.ca .

Meet Arjun

Arjun is a new graduate who has accepted his first job as an RN and is working on a general medicine unit. He understands the importance of developing the plan of care but is confused about his role when working collaboratively with an LPN.

Meet Cheryl

Cheryl is an experienced LPN with 20 years of experience working on the general medicine unit. She enjoys working with new graduates. She is a trusted and valued member of the nursing team and she understands her role clearly regarding collaboration in care planning.

Reflecting on the 2019 RN Standards of Practice

On Friday morning, Arjun and Cheryl are working collaboratively to provide care to 10 clients. They both listen to the morning report and learn the following: 3 clients will be discharged home; 1 client is awaiting placement in an alternate level of care unit and 3 clients have an established plan of care. The three clients with established care plans were admitted three days ago and are meeting their plan of care. One client has been unstable through the night and the two remaining clients who were admitted overnight are now stable and are meeting their short-term goals.

How will Arjun meet the 2019 Standards of Practice for Registered Nurses and specifically, the following indicators in Standard 2?

• 2.2 establishes the initial nursing plan of care based on a comprehensive assessment.
• 2.3 monitors the effectiveness of the plan of care and revises the plan as needed in collaboration with the client and the health care team.

What Should Arjun Do?

The first and most important step will be for Arjun and Cheryl to take a few minutes after the morning report to formulate a plan to ensure all 10 clients are cared for according to the plan of care. For example, they will need to determine:

• Who is the most appropriate nurse to provide discharge care to the three clients going home?
• If a plan of care includes long term goals, have they been established for the newly admitted clients or does this still need to be completed?
• The needs of the three-day post-operative clients and who is the most appropriate nurse to meet these needs?

The questions can be answered when Arjun and Cheryl look at the context of practice. The context of practice includes the patient population, the nature of the of care required, complexity and frequency of healthcare interventions, client’s response to the interventions, service delivery models, medication systems, employer policies, educational support, staffing and other resources. Arjun and Cheryl will need to look at all of these factors to determine how they will organize the care needed to provide safe, quality care to their 10 clients.

To know more about working within the intradisciplinary team, please see the following NANB documents:

• Nursing Intraprofessional Collaboration Guidelines: LPNs and RNs Working Together
• Practice Guideline: A Collaborative Approach to Assigning, Delegating and Teaching in Health Care

For further information on Knowledge-Based Practice, continue to explore Standard 2 within the 2019 Standards of Practice for Registered Nurses. If you have any questions in meeting this standard of practice, please contact a Nurse Consultant at practiceconsultation@nanb.nb.ca .

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