RPNAO 2012 Educator s s Conference June 4, 2012 Alice Cunnington RPN Karen Bruton, RN BScN CETN(C)
To review the implementation of enactment of full scope of practice for RPN s in a community based hospital setting Describe the needs assessment & strategic plan to implement initiative Examine the interprofessional model of care Review the process for education implementation Identify enablers, supports & tools utilized to support change Evaluate & identify strengths & weaknesses
1938-6 month practical nurse program initiated 1941-45 107 trained but then phased out after 5 yrs 1946 9 mth program, Toronto, Hamilton & Kingston 1947 - nurse s act changed Certified Nursing Assistant 1955-13 training centres and 950 CNA 1963 CNA changed to RNA 1967 - RNA education to 35 wks. Now 14,000 RNAs. 1975 50 educational centres. Now 31,000 RNAs 1993 - RNA program expanded 1.5 years. Called RPN 2002 entry to practice 2 year diploma program
Community based hospital (100 beds) Approx 70 RPNs ER, inpt units, Ambulatory clinics, OR, PACU 4 levels of nursing education RPN: Certificate/Diploma RN: Diploma/Degree Feedback from RPNs to increase scope of practice
Support enactment of full scope of practice To provide frontline clinical practice resources at the bedside Enhance quality patient care Enhance quality of the Practice environment
Community of Practice for health care professionals to address the need for mentorship in role socialization, leadership, research & scholarship To facilitate networking & adoption of evidence-based concepts in patient care Health professionals who are passionate about improving practice & patient care in their organization Through passion for expertise they have organizational and/or unit/program level influence with their peers They can provide ongoing resource support for bridging a gap between evidence & practice with strategies to implement specific best practice
Talked with RN s, RPN s, leaders Surveillance of procedures & practices Review of policies Competency survey for all RN s & RPN s Determine gaps in practice Discussion through committees
Simultaneously Northumberland Hills Hospital was developing an interprofessional model of care. In servicing & input by staff was a priority to ensure all stakeholders had input. A full day meeting with all stakeholders was held to develop a model of care. A model of care & terms of reference was developed from the input of staff
Once created it was presented hospital wide to all staff for further input
Supports in place to provide mentoring & leadership Budget allocation for implementation Identification of technical skills Scheduling for in-classroom education Sustainability of practices
Approved by Interprofessional Practice Committee Supported by organization 100% Two hour in-service for all RPN s 5 elearning modules through NHH elearning Centre Self learning package Ongoing in-services on CNO s Enactment of Full Scope of Practice all units, staff meetings One on one education when required Sign off check sheets on technical skills
In-services for all staff on Enactment of full scope of practice Discussion & questions encouraged Patient Nurse Environment
Promote an environment of openness for sharing perspectives Education through staff meetings, Unit Based Council meetings, forums, Committee meetings
Inservice given regularly throughout NHH Goal: to increase awareness of strategic plan Encourage support for initiative by discussion & input from staff Discussion of strengths, weaknesses & issues that might appear
Throughout implementation, emphasis to develop leadership skills at NHH through: Interactive learning Case scenarios Promote & enhance critical thinking skills Mentoring & supporting both RNs+RPNs
Acquiring telephone orders & giving assessments to physicians Taking critical results Checking of orders Hanging IV medications & added responsibility for IV therapy MORE
Increased responsibility for administration of IM /SQ/Sub-dermal medications including narcotics Initiate & check CADD pumps(sq narcotics) Checking of blood products To ensure safety & promote positive learning experiences the technical skills were phased in over several months
Agenda 2 hr session CNO s 3 factor model (Nurse, client & environment) IV administration presentation with active participation Interactive learning with case scenario Identified expectations to complete initiative Hard copy self learning package
Adult Learning Theory Support by colleagues (both RN s & RPN s), Professional Practice Leaders, allied health professionals, managers, directors Positive & supportive learning environment Physicians received a letter explaining expanded role. Patience & understanding was suggested to promote positive learning
Brochure developed on Mentoring& Supporting Colleagues CNO Guidelines Supporting Learners posted on each unit to review
Tools developed to support change & Practice policies & procedures updated learning packages Checklists brochures SBARD pads at nursing stations CNO Guide to Support Learners on each floor
IV package was developed & distributed to RPN s post in classroom session An excel spreadsheet was developed for all IV, IM, SQ, Sub-dermal meds at NHH and who can administer them
Situation Background Assessment Recommendations Documentation Pads on every unit for nurses to use for TOA (change of shift, transferring pt, etc), talking with physicians & colleagues Left side suggested items to have prepared & the right hand side to use to fill in notes (ie VS, chest sounds)
RN s would watch specific skills implemented by RPN s The RN would mentor & support the new practice with the RPN The technical skill would be signed off
Post in classroom evaluation One on one comments Interprofessional Practice Committee Leadership committees Perceptions identified With any new skills it can be stressful & daunting implementing new practices Some fear that they may not be needed as others can do their skills. OVERALL Successful implementation!!!
Biggest Impact to Practice-RPNs doing own MD orders Improved communication & rapport with physicians & other health care team members Most RN s supported the change especially after inservicing which enabled a positive mentoring approach Nurses dealing with own patient issues reduced potential mistakes Patient flow became more efficient Improved Critical thinking skills Increased collaboration with interprofessional practice members
Nurses have a misconception that they are responsible for their colleagues. Education & insight to the CNO standards implemented As with any role, once you accept responsibility, you are accountable for your competence, actions, and decisions. (CNO,2006)
some RPNs were not ready for the change & didn t want it lack of opportunity for RPNs working in non acute areas to maintain competence with technical skills Emergency Department-lack of education of capabilities of RPN s scope of Practice Few of the RN s were not supportive
Hiring new staff with different levels of educational backgrounds, skills, experience, competencies and type of past nursing environments Being aware of individual needs of new hires
Nasal gastric tube insertion Starting of IV s Central line care