What are RPNs doing these days? An exploration of the scope of practice and role identity

By , Jan Marie Graham, Katherine Pachkowski, Candice Waddell, and Heather Friesen
March 2018
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What you need to know

This research identified the skills, tasks, and activities routinely expected of RPNs in a variety of work places and explored their sense of professional identity.

Why this research is important

Approximately 1000 Registered Psychiatric Nurses (RPNs) care for Manitobans living with mental health issues or psychiatric disorders in an array of settings that require a variety of and some specific skills. Brandon University’s Bachelor of Psychiatric Nursing graduates are required to meet entry-level competencies to be licensed with the College of Registered Psychiatric Nurses of Manitoba (CRPNM). These competencies guide the work of all RPNs. In 2016, the Department of Psychiatric Nursing was undertaking a curriculum review. Simultaneously, specific community partners questioned the preparation of students to complete specific skills (for example, intravenous insertion) that have not traditionally been part of RPN practice. The researchers wondered how often RPNs were expected to perform skills and tasks that were not within their traditional roles and whether the expectations affected their professional identity.

How the research was conducted

Data was obtained through a simple survey using Survey Monkey. Initially, graduates from 2011 and 2015 were targeted but a poor response rate was achieved. Inclusion criteria for the study were expanded to include all active, practicing RPNs. A total of 96 participants responded to the 14-question survey which included a list of tasks/skills that respondents had to rate and had an opportunity to write comments. Two focus groups were conducted using seven guiding questions to clarify and confirm findings.

What the researchers found

Approximately half of the respondents graduated prior to 2011with the earliest graduating in 1973 and several reporting they had graduated in 2017. Most participants worked in community mental health (22.6%), locked acute care psychiatric units (13.1%), personal care homes and long-term care facilities (11.9%), and in the addictions field (7.1%). Other employment areas included: emergency departments, working with those people who have developmental challenges; insurance companies, Worker’s Compensation Board, and primary health clinics. Regardless of the setting, the most common daily activities included: therapeutic relationship (91.6%), behavior management (72%), mental health assessment (71.4%), health promotion (64.5%), individual counselling (62.2%), and teaching related to mental health (69.7%). Activities/skills that the respondents reported they never engaged in included: intravenous insertion (86.6%) and management (73.5%), central lines (86.4%), naso-gastric tubes (85.1%), feeding tubes (72.7%), electro-convulsive therapy (67.7%), subcutaneous needle insertion (65.7%), and catheterization (61.2%). When asked which skills were central to RPN practice, respondents included: mental health assessment, health promotion related to mental wellbeing, building and maintaining a therapeutic relationship, counselling, behavior management, patient teaching related to mental health, intramuscular injections, assisting people with day-to-day living, medication administration, and management of risky or potentially harmful behavior. Paperwork and administrative tasks, rigidity of systems, and staffing shortages were identified as barriers to role fulfillment by some RPNs. Other RPNs did not feel there were any barriers but felt that all skills and tasks were important to client care. Respondents were asked the open-ended question “In your opinion, what unique contributions are made by RPNs to health care teams?” Specialized knowledge was the primary theme that emerged and was related to wellness strategies, a holistic approach to care, building therapeutic relationships, supporting recovery, and advocacy. 75% of the respondents were satisfied with the proportion of duties they performed in their workplace that represented their unique set of skills, and 81% of the respondents felt valued, recognized and supported in that setting. Only 67% of the respondents agreed that their educational program had prepared them well for their work setting.

How this research can be used

Specific skills and tasks such as intravenous insertion and management of feeding tubes were not common expectations of RPNs. Respondents reported valuing enhanced skills and tasks as part of the holistic approach to client care. Based on the findings, we concluded that regardless of the setting, RPNs feel they are contributing a unique approach and are valued by the health care team for their level of expertise.

The results of this study clarified role expectations of RPNs. Findings have been shared with CRPNM to inform entry-level competencies and standards of practice and the Faculty of Health Studies at Brandon University to inform future planning at a provincial and university level.

Findings have been shared with CRPNM to inform entry-level competencies and standards of practice and the Faculty of Health Studies at Brandon University to inform future curriculum planning.