Understanding Licensed Practical Nurses' Full Scope Of
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Understanding Licensed Practical Nurses’ Full Scope of Practice Research Study FINAL REPORT Submitted to: College of Licensed Practical Nurses of Alberta Authors: Rena Shimoni, PhD Project Director and Co-Principal Investigator Gail Barrington, PhD Contact: Co-Principal Investigator Russ Wilde Director, Learning Resource Services Bow Valley College Email: [email protected] Date: September 28, 2012 Executive Summary amended March 26, 2013 Applied Research and Evaluation Page 1 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 Acknowledgements This project was funded by Alberta Health (formerly Alberta Health and Wellness) – Workforce Division. Their support is acknowledged with gratitude. We are deeply indebted to Linda Stanger, Executive Director/Registrar, College of Licensed Practical Nurses of Alberta (CLPNA) for providing Bow Valley College (BVC) with the opportunity to conduct this study and for her ongoing support. We wish to acknowledge the following individuals and their organizations for their generous support and guidance of the project by serving on the steering committee. Anita Paras, AH Kim Campbell, NorQuest College Bernard Anderson, AH Liz Ross, AHS Bruce West, ACCA Mary Anne Fish, BVC Donna Hogg, CARNA Myrna Ross, LPN Representative Dr. Bill DuPerron, BVC Noreen Linton, AHS Dr. Greta Cummings, University of Ruth Wold, LPN Representative Alberta Dr. Jeanne Besner, Independent Sheli Murphy, Covenant Health Consultant Elizabeth Taylor, CRPNA Teresa Bateman, CLPNA Gerald Karegyeya, AH The support and assistance of Deb Gordon, Senior Vice President & Chief Nursing and Health Professions Officer, Health Professions Strategy and Practice, Alberta Health Services is acknowledged with gratitude. Applied Research and Evaluation Page 2 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 Dr. Dean Wood conducted the review of policy related to LPN Scope of Practice. Most of his report is integrated into various sections of this document. The full report is available upon request at Bow Valley College. The following leaders are thanked for participating in interviews with Dr. Wood and sharing their knowledge and insights: Karel Bennett, Director, Health Sheli Murphy, Vice President Rural Health Services Professions Unit Health Workforce and Executive Lead for Professional Practice and Division, Alberta Health Research, Covenant Health Brenda Huband, Senior Vice President – Anita Paras, Workforce Planner, Workforce Calgary Zone, Alberta Health Services Research and Planning, Alberta Health Noreen Linton, Associate Chief Nursing Sandra Vanderzee, Director Office for Professional Officer, Vice President Health Practice, Covenant Health Professions Strategy and Practice, Alberta Health Services A comprehensive research study requires approvals, input, and guidance from many individuals, and we express a sincere thank you to Senior Vice Presidents, Vice Presidents, the Executive Director Research, and the Research Directors and Committees from Alberta Health Services Zones for their assistance in accessing the six sites to carry out our case studies. We feel privileged to have worked so closely with such an outstanding research team from the Office of Applied Research and Evaluation at Bow Valley College. The team approach utilized in all phases of the implementation of the study allowed us to benefit from multiple perspectives and insights, and the intelligence, commitment, dedication, and positive spirit (and Applied Research and Evaluation Page 3 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 sense of humour) of each and every team member made the intense research process interesting and enjoyable while contributing to the high quality of the research at every stage. Applied Research and Evaluation Page 4 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 Thank you so very much to: Violet Smith LPN, Project Manager Agnes Ray, Project Officer Augusto Legaspi PhD, Researcher Sarah VanDusen MSc, Researcher Scott Henwood MA, Researcher Kaylee Ramage BA, Research Assistant Jassandre Adamyk-Simpson, Research Assistant Nikki Gorembalem, Research Assistant (STEP Student) Natalia Rostova, Administrative Support Lisa Thompson-Dobo, Transcriber Dr. Sean Clarke, inaugural holder of the Susan E. French Chair in the School of Nursing at McGill University, has worked as a nurse research consultant and provided excellent input and advice throughout all phases of the project. His collaboration is highly appreciated. Thanks are due to Dr. Milosh Raykov for his participation in the early phases of the study and in the development of the LPN survey. Thanks to Frederic Bertrand and his team at Science-Metrix, Inc. for their important contribution to this study. Applied Research and Evaluation Page 5 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 We would especially like to thank all those who facilitated and participated in the study, including licensed practical nurses, registered nurses, site administrators, patient care managers, unit managers, health care aides, acute care patients, long-term care residents, family members, and other members of the health care teams, all of whom so willingly and enthusiastically contributed their views to this study. Rena Shimoni, PhD, Project Director and Co- Gail Barrington, PhD, Co-Principal Principal Investigator Investigator Office of Applied Research and Evaluation, Barrington Research Group, Inc. Bow Valley College, Calgary, Alberta Calgary, Alberta Applied Research and Evaluation Page 6 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 Table of Contents Acknowledgements ......................................................................................................................... 2 Table of Contents ............................................................................................................................ 7 Executive Summary .................................................................................................................... 9 Study Overview ......................................................................................................................... 15 Structure of the Report .............................................................................................................. 17 Review of the Literature ............................................................................................................ 18 The Regulatory and Professional Environment ........................................................................ 31 Public and Employer Policies ................................................................................................... 35 Methodology ............................................................................................................................. 39 Findings of CLPNA Membership Survey ................................................................................. 60 Findings of the LPN Cross-Case Analysis ................................................................................ 90 Findings of the Policy Study ................................................................................................... 124 Key Findings, Conclusions, and Recommendations ............................................................... 134 APPENDICES ............................................................................................................................ 150 Appendix A. Data Collection Matrix ...................................................................................... 151 Appendix B. Logic Model ....................................................................................................... 155 Appendix C. CLPNA Membership Survey ............................................................................. 156 Appendix D. Case Study LPN Interview ................................................................................ 165 Applied Research and Evaluation Page 7 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 Appendix E. Case Study LPN Consent Form ......................................................................... 172 Appendix F. Site Report Validation Survey............................................................................ 175 Appendix G. Patient Experience with Nursing Care Survey .................................................. 176 References ............................................................................................................................... 183 Applied Research and Evaluation Page 8 of 193 Final Report: Understanding Licensed Practical Nurses’ Full Scope of Practice September 28, 2012 Executive Summary In February 2011, the Office of Applied Research at Bow Valley College was commissioned by the College of Licensed Practical Nurses of Alberta (CLPNA) to conduct a research study: Understanding Licensed Practical Nurses’ Full Scope of Practice. The study was funded by Alberta Health (AH), with the goal of providing objective, research-based evidence focused on LPNs in typical health care settings and exploring the factors that promote and/or inhibit successful LPN scope utilization. The following questions were investigated: