issue and the administrator commented that it made more financial sense to staff more LPNs rather than to pay overtime to an RN for “almost every shift.” Supportive policies and practices. Participants at three acute care sites reported that LPN responsibilities were in the process of expanding. At a high scope site, a team leader mentioned that newly hired LPNs were being trained on central lines “right away” to get “them up to scope as soon as possible,” though this was not a formal policy of the facility. Two low scope sites were planning to train LPNs on the administration of IV medications. Senior administrators for both sites noted that further changes to LPN responsibilities were being considered. One site planned to add central line care, physician orders, and lab reports to the LPN role. At the other site, management was exploring the possibility of having LPNs work in specialized units such as Emergency and Labour and Delivery. The third low scope site had permitted LPNs to contribute to Minimum Data Set (MDS) reporting and had also permitted LPNs who were certified in IV administration to perform this competency. Supportive system factors. One administrator reported an innovative solution to problems posed by a local RN shortage. The administrator sought – and received – a letter of understanding from the United Nurses of Alberta. The agreement allowed LPNs to take on greater leadership responsibilities and a broader range of tasks within their scope of practice. Even though team leadership was included in the provincial LPN competency profile, the letter was seen by the administrator to be an essential component of implementing this change. As the team leader on the long-term care wing, LPNs received staff reports, assigned HCA tasks, gave all medications, managed IVs, and received reports from physicians. If a competency was out of their scope of practice or if an issue arose, the LPN contacted the RN on the other wing. This letter of understanding had been in effect for several years, and had produced, in the view of the administrator, “beautiful” results.
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Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012