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Here’s an article from the Red Deer Advocate about how health authorities need to utilize LPNs to their full scope.

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Scope of Practice for LPNs….What Activities Can We Perform?

Educating the Public About Skills Performed By LPNs in Alberta by Angela Arp

Since I graduated from the Licensed Practical Nursing program in Alberta in 1986, the profession has seen many changes over the years. My program was only 9 months long then, now it’s 2 years long and a diploma program.

People need to be kept abreast of the changes to the scope of practice of LPNs and that includes other health care professionals. With the shortage of nursing staff all over the Province I think it’s time to utilize LPNs to their full capacity.

The following are the skills that LPNs are allowed to perform according to their scope of practice, many which are now part of the basic program. I had to take numerous courses to upgrade my skills to keep in par with the new grads. There are many questions regarding whether LPN’s can mix medication in IV bags, the answer is yes, the only stipulation is that LPN’s may not do “direct” IV pushes when it comes to intravenous therapy. So LPN’s can start IV lines if they take additional training.

The CLPNA has identified three levels of authorization:

Basic: restricted activities taught in the basic practical nurse program

Additional: restricted activities aquired through on the job training, experience or post basic education

Specialized: restricted activities requiring advanced education recognized by CLPNA

Restricted Activities authorized for LPNs in 2003 Regulations:

1) LPNs may administer anything by invasive procedure on body tissue below the dermis: * subcutaneous injections-basic authorization * intramuscular injections -basic authorization since spring 2001 -additional authorization for all other LPNs * intradermal injections -basic authorization since 2005 -additional authorization for all other LPNs * inserting an apparatus to supply medication or fluids -additional authorization. Example would be starting IV’s, soft sets, butterflies These authorizations are very broad and allow LPNs to administer any medication via these routes. Employers may then set in policy any medications that may not be appropriate for the LPN to administer from one practice environment to another. (Vaccines are authorized under the Immunization Specialty).

2) LPNs may insert or remove instruments, devices, fingers or hands (basic authorization): * beyond the pharynx * beyond the opening of the urethra * beyond the labia majora * beyond the anal verge * into an artificial opening of the body * beyond the point in the nasal passages where they normally narrow. Some examples of the competencies: suctioning, catheterization, vaginal creams, anal suppositories and enemas, tube feeds and suctioning a tracheotomy, insertion of nasal gastric tubes.

3) LPNs may insert liquid under pressure into ear canal (additional authorization): * for the purposes of removing wax from ears * when another authorized professional is available to provide assistance if necessary. College of LPNs of Alberta Revised May 2, 2007 Example: an LPN working in a physician’s clinics or outpatient-emergency units may be trained on site to syringe ears.

4) LPNs may administer diagnostic imaging contrast agents (additional authorization): * with written or verbal direction from an authorized professional who is on site and available to assist. Example: LPNs working in a diagnostic imaging clinic with other health professionals or on a medical unit prior to a diagnostic procedure.

5) LPNs may administer nitrous oxide (additional authorization): for the purposes of anesthesia or sedation: * if an authorized professional is on site and immediately available to assist. Example: LPNs working closely with a physician who is resetting a fracture.

6) LPNs may provide psychosocial intervention (basic authorization): * as a member of a multi-disciplinary team * under the direction of an authorized practitioner. Example: LPNs working for community mental health or AADAC in addictions counseling providing treatment as part of a team.

7) Dialysis Specialty (specialized authorization) Inserting or removing instruments, devices, fingers or hands into an artificial opening into the body: * for the purposes of performing Dialysis Example: LPNs are hired through the Northern or Southern Alberta Renal Program and are specifically trained to provide the full range of treatment in Dialysis.

College of LPNs of Alberta Revised May 2, 2007

(8) Orthopedic Specialty (specialized authorization) Setting or resetting a fracture of a bone: * for the purposes of inserting and removing orthopaedic devices and applying casts * with verbal or written direction from authorized practitioner who is available to assist. Example: LPNs who have completed approved CLPNA education in Advanced Orthopedics and apply casts in outpatient, emergency or cast clinics.

9) Advanced Foot Care (additional authorization) Cutting a body tissue, administering anything by invasive procedure on body tissue or performing surgical or other invasive procedures on body tissue below the dermis: * for the purposes of removing a corn or callus as part of the provision of foot care Example: LPNs who have completed an advanced education course in foot care may practice independently.

10)Operating Room Specialty (specialized authorization) * for the purposes of performing activities under the direction of an authorized practitioner who is performing surgery. Example: LPNs who have completed CLPNA approved education in the Operating Room may practice within any surgical setting.

11) Immunizations (specialized authorization) Administering vaccines for the purpose of providing immunizations under the following conditions: * the recipient of the immunization is 5 years of age or older * the employer has protocols respecting immunizations * an authorized practitioner is available for consultation. College of LPNs of Alberta Revised May 2, 2007 Example: LPNs who have completed the Immunization Certification Course may work within any setting administering vaccines.

Health Professions Act RESTRICTION Despite any of the authorizations to provide restricted activities, LPNs must only perform the restricted activities they are competent to perform, are appropriate to their area of practice and the procedures being performed.

Although it appears there are many changes to scope of practice for LPNs there are only 3 new competencies added to the HPA LPN Regulation. * Intramuscular Injections * Intradermal Injections * Administering a vaccine: to any person 5 years of age or older.

Under past Regulation LPNs performed a number of activities that are considered restricted in the new regulations therefore these areas have been specified in this regulation (i.e., nitrous oxide, ear syringing).

Information courtesy of CLPNA

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