Assignment and workload. At three of the four sites that offered acute medical services, staff assignment was largely based on patient complexity. Those patients who were deemed more complex were typically assigned to RNs, while LPNs were assigned the less complex patients. However, at two of these sites, LPNs reported that their assignment to more complex patients had allowed them to practice higher level skills, even when RN assistance was required. Staff assignment was also said to be at the discretion of the charge nurse on duty. Many participants associated LPN scope utilization with RN workload. RNs were often required to assist LPNs with patient care when tasks were deemed beyond their scope at that site, either due to site policies8 or to individual LPN levels of training. LPNs at two sites expressed frustration over not being permitted to give IV medications (although this competency is within their scope of practice) and this policy was seen to cause more work for RNs. Participants from the three low scope sites and from one high scope site indicated that if LPNs were able to practice to a fuller scope, RNs would be “freed up” to focus on other tasks. As one RN commented, greater scope utilization for LPNs would improve the delivery of care “because the time I would have spent to go and do the LPN’s meds, I can spend it with my patients.” At Site 3, where expanded responsibilities for LPNs were being contemplated, a number of LPNs, RNs, and a manager supported this approach as a way to alleviate the RN workload. RNs have said it would be much easier if we were able to practice to full scope, so that we can look after our patients and they can, you know, look after theirs. I have already seen the positive outcomes for patients.
- LPN, Site 3
8
Throughout this chapter, references are made to facility practices or policies that promote or inhibit the ability of LPNs to practice to full scope. It is important to note that, in most cases, the researchers did not know whether references to policies related to formal facility policies or simply to informal policies or typical practice.
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Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012