A key part of our job is advocating for a strong health system, protecting patient safety, and standing up for the interests of our members and the 45,000 RPNs across Ontario. Over the past several years, RPNs have told us how current regulations governing the scope of practice create frustrating barriers that prevent them from delivering the best quality care to patients.
Currently RPNs can only perform certain controlled act procedures with an order. We have heard from RPNs, patients, families and other care pro- viders across the province that giving RPNs the ability to initiate proced- ures they already have the experi- ence, expertise and authorization to perform will help ensure people who need help get it without delay. That’s why, for the past several years, RPNAO has been calling for the government to make modest changes to scope of practice to bring better care to our most vulnerable people and better value to our health system.
We’re happy to report that our calls have been answered!
After ongoing advocacy from RPNAO, earlier this summer, the Ministry of Health and Long-Term Care directed the College of Nurses to move forward with changes to RPN and NP scope of practice by June 2020.
What Are the Changes?
In an effort to streamline care pathways, improve access to minor and routine care in the community, and increase patient choice in where to obtain health care services, the Ministry of Health has directed the Council of the CNO (College of Nurses of Ontario) to make the necessary regulatory amendments to authorize RPNs to independently initiate the following procedures:
- Irrigating, probing, debriding and packing of a wound below the dermis or below a mucous membrane;
- Venipuncture to establish peripheral intravenous access and maintain patency, using a solution of normal saline (0.9 percent), in circumstances in which the individual requires medical attention and delaying venipuncture is likely to be harmful to the individual;
- Those that, for the purpose of assisting an individual with health management activities, requires putting an instrument beyond the individual’s labia majora and for the purpose of assessing an individual requires putting an instrument, hand or finger beyond the individual’s labia majora; and
- Those that, for the purposes of assessing an individual or assisting an individual with health management activities, require putting an instrument or finger beyond an artificial opening into the individual’s body.
Currently, an order is necessary to allow RPNs with the appropriate knowledge, skill and judgment to per- form these procedures and in accord- ance with the CNO practice standards. RPNs are accountable to assess the appropriateness of the intervention for a particular patient and for their particular situation, even with the order. In many cases, especially in re- mote and rural communities, prescrib- ers such as MDs, NPs and RNs rely on RPNs’ knowledge, skill and judgement to determine whether an order is appropriate. In some cases, the RPN is not able to get in touch with the prescriber in a timely fashion. This ap- proach ultimately delays patient care, creates duplication, adds additional burden and unnecessarily takes the prescriber away from other vital care.
Authorizing RPNs with the knowledge, skill and judgment to initiate these acts directly will relieve administrative burdens on both RPNs and current pre- scribers of these procedures and ensure that patients can receive the best care possible in a timely fashion.
How Many RPNs Will Be Impacted?
Many of these procedures require RPNs to have additional, specialized knowledge and training beyond their basic nursing education. For this rea- son, a significant number of RPNs will not experience a change in their prac- tice as a result of these scope changes. Generally, only RPNs that already have additional and specialized education in specific practice areas will be impacted.
What’s Next?
Over the coming months, we will continue to work closely with the Ministry, the College of Nurses and other health system partners to realize these changes in a way that ensures patient safety, supports RPN practice and delivers better value to our health system. As further informa- tion becomes available, we will keep our members informed.
