Nursing News

RPNs are autonomous nurses with comprehensive knowledge of mental, physical, developmental, and emotional health care. RPNs provide health care to individuals, families, groups, and communities with complex psychosocial, mental health, addictions, and physical needs. RPN practice uses a holistic approach to health and illness and work collaboratively with clients and other health care team members to coordinate client-centered care.

RPNs are educated to develop, implement, and evaluate the plan of care for clients with mental health conditions, with or without underlying physical conditions. As with all nurses, RPNs are expected to collaborate with other health care providers to meet the needs of the client and when the needs of the client exceed their scope of practice.

Although new to New Brunswick, RPNs have been in practice in other parts of Canada for many years. RPNs are currently regulated in Nova Scotia, Newfoundland and Labrador, Prince Edward Island, Manitoba, Saskatchewan, Alberta, British Columbia, the Yukon and Northwest Territories and Nunavut.

*In Ontario, Licensed Practical Nurses (LPNs) are referred to as Registered Practical Nurses (RPNs). Registered Practical Nurses (in Ontario only) and Registered Psychiatric Nurses are difference designations of nurses.

LPNs, RNs, RPNs, and NPs are different designations of nurses with the profession of nursing. There are shared competencies between each designation; however, RPN education has a greater focus on comprehensive and advanced mental health competencies. RPNs have their own unique code of ethics, standards of practice, and entry level competencies.

The introduction of the RPN does not change the legislated scope of practice of other nurses. RNs and NPs can and will continue to work in mental health and addictions settings, and there is no expectation that they become an RPN.

RPNs graduate from a baccalaureate program or a three-year equivalent diploma in psychiatric nursing. A Master of Psychiatric Nursing has been offered at Brandon University in Manitoba since 2011.

The breadth, depth and focus on mental health and addictions and advanced therapeutic relationships and communication distinguish psychiatric nursing education from other nursing programs.

Graduates must pass the Registered Psychiatric Nurses of Canada (RPNC) Examination to be eligible for registration and licensure as an RPN. There are eight approved RPN education programs (primarily in Western Canada). There is no approved psychiatric nursing education program in New Brunswick.

While the focus of RPN education is mental health and addictions, RPNs also have foundational knowledge of biological and physical sciences. Recognizing that many psychiatric clients have medical co-morbidities, RPNs have general medical and surgical nursing competencies and may further develop their general medical surgical competencies with additional post entry level education via their employer.

Currently, all four Atlantic provinces are discussing the possibility of offering an RPN education program. We will continue to keep interested candidates updated on this initiative as it progresses.

The professional scope of practice of RPNs in NB will be determined by the future CNNB bylaws. The bylaws regulating the RPN would mirror the Nursing Act language used for RNs and NPs and be informed by the roles, functions and accountabilities RPNs are educated in and authorized to perform in New Brunswick.

The scope of practice for an RPN includes the provision of nursing services to plan, implement and evaluate mental, psychosocial and physical health care by applying psychiatric nursing knowledge, skills, and judgment. Similarly to RNs and NPs they would be required meet at least of the following criteria:

• they are taught in a registered psychiatric nursing education program approved by a nursing regulator in Canada; and
• they have entry-level competencies, Code of Ethics, and standards of practice that would be approved by the CNNB Board.

RPNs entry level practice includes advanced competencies related to mental health care. NPs and RNs can also attain these advanced competencies with additional post-entry level education and/or clinical experience.

The following are examples of RPN practice, but is not an exhaustive list:

• Assisting clients to achieve, maintain and restore their optimal physical, mental, emotional, social, and spiritual health.
• Assessing, formulating a nursing diagnosis, planning, providing, and evaluating treatment and interventions.
• Educating students, clients, and others.
• Advocating with or on behalf of clients.
• Counselling clients.
• Coordinating, monitoring, delivering, and evaluating nursing services.
• Managing, administering, and developing systems and policies related to nursing and the provision of health care and psychosocial services.
• Engaging in research related to nursing, health, and the practice of registered psychiatric nursing.
• Accepting and making referrals to other health professionals.

While prescribing is in the broader professional scope of practice of RPNs, the regulatory mechanisms to enable RPN prescribing in New Brunswick have not been developed.

RPNs have foundational education in anatomy and physiology, microbiology, physical assessment, pathophysiology, and medical-surgical nursing assessment and intervention. This enables them to care for psychiatric clients with medical-surgical co-morbidities.

There is no restriction on the practice settings in which an RPN can practice. However, as with any other nursing designation, the RPN must assess their individual competence to ensure they have the competencies to provide the type of care in question, including understanding what to do if an adverse outcome occurs. This includes reflecting on whether the RPN has the necessary experience and expertise to make evidence informed decisions and manage the specific type of care effectively.

If the RPN identifies lack of competencies due to insufficient experience or expertise, it is their responsibility to inform their employer and collaboratively seek ways to acquire that skill to meet the needs of clients within their care setting.

All nurses should utilize the Three-Factor Framework when making decisions about who is the most appropriate nurse to provide care in a specific context.

All nurses must hold registration and licensure in the designation in which they are employed. Designations are not interchangeable.