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Using Licensure to Create Role Clarity August 4, 2006

Posted by manthey in Academia, Professional Practice.
Tags: , , ,

Jean Harry, in reaction to my post of July 28th,  feels that the term “ratios” is troublesome:

You can make a ratio out of any two things, but it doesn’t give any hint to the complexities or potential affect on the outcomes. There must be a better way to describe how intertwined all of this is. People latch on to ratios because it’s concrete, but it minimizes the important stuff. Staff mix is another area of struggle. Not only in terms of RN/LPN, but mix of RN’s with differing educational preparation. In Vermont, the number of both LPN and ADN programs & graduates outnumber BSN. We are creating new issues on top of those we already have.

I agree that the “ratios” is misleading … and that the variety of entry points into practice is increasingly confusing. We need to analyze work complexity in terms of knowledge and skills needed for safe Nursing Interventions in a particular patient population that are sophisticated enough that also take into account the workplace relationships that impact utilization of support staff. I think that by going back to the basics over and over again (knowledge and skills coupled with effective interpersonal relationships) … rather than trying to differentiate by broad credentialing, we will be able to see the forest for the trees.

For example, when an LPN works as a care pair or a care partner with the same RN over a period of time, his/her contribution to the RN’s workload changes substantially. Likewise, coupling a new AD or BSN with an experienced clinician rather than having them work straight nights significantly increases the speed with which they get on board.

Personally, I like the structural clarity that comes from licensure delineations to guide differentiation … and this leads me to my current absolute conviction that the major difference between RNs (of all types of preparation) and LPNs (and other skilled technicians) lies in the decision-making role. RNs are licensed to make decisions about the amount degree and kind of care patients will receive. Period. No one else has the license to do so. When we step up to the plate and incorporate that in job descriptions, work expectations, nursing education, etc, I think the role of support staff (and appropriate skill mix for any unit) consequently will be clarified. Nursing is a practice profession and RN’s need to be able to combine care giving with care management in order to acquire the complex knowledge about their patient necessary for good decision making

Finally, I guess the diffusion of educational programs (now with the post-baccs, practice doctorates, etc) increases the challenges we will be facing in the coming years. I hope that by focusing on knowledge and skill requirements for patient care, within the structure of licensure healthy workplace cultures, we will have the guidance necessary to maximally utilize the knowledge, skill and talents of every member of the staff. I am optimistic that if we keep focusing on what is right for patient care, what is fundamentally sensible and legally appropriate; we will be able to minimize the confusion of the future challenges to resource utilization.


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