Thursday, January 17, 2013

What is the difference between a PSW, RPN, RN, and NP?

Only nurses can insert a catheter,
PSWs are assigned to empty
and replace the bag.
Basically, it is education and, therefore, scope of practice. The healthcare team of front line workers consists of Personal Support Workers, Registered Practical Nurse, Registered Nurse, Nurse Practitioners. RPNs, RNs, and NP are governed in Ontario by the College of Nurses of Ontario.
Each province and territory has control of its healthcare system. This is why Quebec, for example, is moving forward on legal medical aid in dying in Canada.

Personal Support Workers
PSWs are unregulated workers. There is no way of checking their credentials, or determining if they have been disciplined, or whether they have education in various specialties. Their knowledge, skills and abilities vary with the individual, determined, largely, by their employer.

I have written previously about the scope of practice for PSWs, formerly Health Care Aides (HCA) who have a certificate in order to work in healthcare, or home care. They work under the direction of the Charge Nurse in hospitals, retirement homes, long-term care, in private homes, and for the many for-profit agences that deliver home care. There are not permitted to do any invasive procedures. They are not licenced to administer drugs, or do anything that invades a body. That does not mean that a supervisor will not assign these tasks. In fact, in the circles I travel, this can be common in particular settings. This is where we must speak truth to power, and where watchdog agencies fall through.
Nurses give prescribed pharmaceuticals
Nurses change dressings

The CNO keeps statistics of its nurse members. You must be a member of the College in order to practice in Ontario. The scope of practice of nurses in Ontario (PDF) is regulated:

ii. Controlled Acts Authorized to Nurses
The Nursing Act, 1991 authorizes nurses to perform
three controlled acts. They are:
1.  performing a prescribed procedure below the dermis or mucous membrane
2. administering a substance by injection or inhalation
3. putting an instrument, hand or finger:
◗ beyond the external ear canal
◗ beyond the point in the nasal passages where
they normally narrow
◗ beyond the larynx
◗ beyond the opening of the urethra
◗ beyond the labia majora
◗ beyond the anal verge, or
◗ into an artificial opening in the body.

The nurse is accountable for:
■ her or his actions and decisions
■ knowing and understanding the roles and responsibilities of other team members, and collaborating, consulting and taking action on
client information when needed  
■ taking action to ensure client safety, including informing the employer of concerns related to the
conduct and/or actions of other care providers,
■ collaborating with clients, with each other and with members of the interprofessional care team
for the benefit of the client.

Ontario purports to be increasing the numbers of nurses, something crucial to providing home care to alternate level of care (ALC) patients in hospital, who require home nursing care. The numbers, however, demonstrate that they are increasing the numbers of the lower end of the competency scale, which may be dangerous for those at home who require more complex care.

But registered nurse numbers slide as employers embrace cheaper options

From RPN & RN Practice (PDF)
Nationally, the number of nurse practitioners doubled to 2,777 between 2007 and 2011. However, they still represent only one per cent of all RNs.

  • number of RNs employed in Ontario had been rising steadily for years, topping out in 2010 at just under 94,000. 
  • By 2012 that had fallen to 92,879 360,000 nurses working in Canada 
  • Nationally, the number of nurse practitioners doubled to 2,777 between 2007 and 2011.
  • Renfrew County: number of nurses fell by 2.3% between 2007 and 2011 
  • Counties south and east of Ottawa gained 129 between 2007 and 2011 (up by 9%) 
  • Renfrew County: 985 nurses per 100,000 population 
  • Southeastern counties: 729 nurses per 100,000 residents.

Legislation under which nurses are Governed
From RPN & RN Practice





Phiddy said...

When you write about the number of new RNs starting to practice... and everyone thinks what great numbers these are. Please remember the number of older nurses getting ready to retire is HUGE! They are part and parcel of the baby boomers.
Just saying.

Jennifer A. Jilks said...

I don't think that is what I said, Phiddy. We are hiring more RPNs, fewer RNs, and we are short nurses in most areas of Ontario.
In the years I've been involved intimately with senior healthcare, we have been said to be short nurses by 25%. You cannot read a newspaper without seeing ads for nurses and PSWs.

Phiddy said...

I guess I didn't say exactly what I meant in the comment I left earlier. I was commenting on the rise overall of RNs. Most of what I was writing about was under the topic heading; "Ottawa adds 1000 in 4 years". It all sounds good but, the retiring RNs are leaving holes everywhere nurses are needed. Hope I am explaining myself better this time around. And, yes I see the ads all the time for RNs, RPNs and PSWs.