Nursing as a Profession: The Role of the Practical Nurse

Objectives

  • Role of the Practical Nurse
    • Understand the structure and function of a nursing unit in acute or long-term care.
    • Identify various care locations where nursing care is delivered.
    • Differentiate among roles of RN, RPN, and PSW by examining their scope of practice, regulations, and contributions to the interprofessional team.
    • Formulate a personal concept of the role as a practical nurse.
    • Outline the purpose of the CNO Scope of Practice practice standard when accepting and assigning case assignments, focusing on authority, context, and competence.

Nursing Roles Overview

  • Family of Nursing
    • Two primary categories of care providers:
    • RPN – Registered Practical Nurses
    • RN – Registered Nurses (also includes Nurse Practitioners)
  • RPN Characteristics:
    • Professionals combining knowledge, skill, and judgment.
    • Experts in bedside nursing care.
    • Practice can be autonomous, playing a valuable role in the healthcare team.

Client Continuum

  • Less Complex Cases:
    • More predictable, low risk for negative outcomes.
    • Managed by RPN or RN.
  • More Complex Cases:
    • Highly unpredictable, high risk for negative outcomes.
    • Require increasing consultation and collaboration from RNs.

Scope of Practice

  • Assignment Considerations: (CNO, 2023)
    • Authority:
    • Nurses should understand their legislated scope of practice, including controlled acts and authorizing mechanisms.
    • Context:
    • Nurses must evaluate if their practice environment supports their activities and has resources for safe client care.
    • Competence:
    • Nurses must ensure they have the knowledge, skill, and judgment to perform activities competently.

Case Studies Analysis

  • Case Study 1: Mrs. Smith

    • Age: 42
    • Diagnosis: Diverticulitis, UTI
    • Post-op: Day 2 after total hysterectomy
    • Medications:
    • Cefotaxime IV
    • Sennosides PO
    • Tylenol PRN
    • Lorazepam PRN
    • Morphine IV/PO
    • Diazepam PO
    • Vital Signs:
    • 136/87, 73 bpm, 36.2°C, 14 breaths/min, 97% SpO2
    • Current Condition: Needs support for ADLs and frequent reassurance.

  • Case Study 2: Ms. Best

    • Age: 67
    • Diagnosis: Non-insulin dependent diabetes mellitus, hypotension, breast cancer.
    • Treatment: Palliative care with IV NS at 25cc/hr
    • Medications:
    • Cefotaxime IV
    • Flagyl IV
    • Pantoprazole IV
    • Morphine IV infusion @ 1mg/hr
    • Midazolam IV PRN
    • Fleet PRN
    • Gravol IV PRN
    • Vital Signs:
    • 80/54, 36.1°C, 10 breaths/min, 65 bpm, 86% SpO2
    • Current Condition: Unresponsive, requiring total care.

Career Opportunities

  • RPNs can work in various healthcare settings where nursing care is required, demonstrating versatility in their roles and responsibilities.