Doctor of Philosophy
Hibbert, Kathryn M.
There is confusion regarding the practice expectations of Registered Nurses (RN) and Registered Practical Nurses (RPN) for employers, educators, nurses, nursing students, and the public, in Ontario, Canada. As the entry-to-practice competencies (ETPC) serve as a guide to the curricular content of nursing programs, a critical discourse analysis of the entry-to-practice documents available to the public was performed to: 1) attempt to understand the meaning and intent of the ETPC, 2) to answer the question of what are the differences in practice expectations for RN versus RPN graduates, and 3) how can role clarity be improved through this process. Critical discourse analysis affords the opportunity to understand these documents, not just through the words on the page, but understand the social, cultural, political, and contextual forces and processes that led to their creation by the nursing regulators in Canada. However, there are competency interpretation documents available only to nursing educators embarking on the College of Nurses of Ontario (CNO) program approval process, which are not made readily available to nurses, the public or employers. These interpretation documents provide a clearer picture of the key differences and similarities between RN and RPN practice expectations. Despite this increased clarity, some language use and sentence construction confound even a seasoned educator as these words have different meanings depending on the context and common understanding of the meaning. As a useful tool for nursing practice, a table of comparison was made to guide nursing educators, employers, nurses, nursing students, and the public to make visible these differences and similarities in both the competencies and the interpretation documents. This analysis also suggests that the College of Nurses of Ontario make the interpretation documents available to a wider audience to support the link between nursing practice and nursing education to create a living curriculum that can be responsive to the ever-changing needs of the profession.
Summary for Lay Audience
There are different types of nurses that practice in Ontario, Canada. There is confusion about the roles and practice expectations of Registered Nurses (RN) and Registered Practical Nurses (RPN) for patients, employers, the public, and nurse educators. To provide an approved nursing education program, all schools must ensure that they teach a list of elements, called entry-to-practice competencies, which Nursing Regulators in Canada determine what students must learn. There are two separate lists for RNs and RPNs; however, even these have similarities to each other, which creates more confusion. This research project compared both documents, the meaning behind the listed competencies, and the social and political forces that influenced their creation, in an attempt to more clearly understand the differences. As well, there was an analysis of interpretation documents, created by the College of Nurses of Ontario (CNO) that help the nurse educator to understand the meaning of each of the competencies listed. However, these are not available to employers or others that may be interested in the differences between RN and RPN roles. Despite the interpretations provided, some words used and sentence construction increased confusion, even for a veteran nurse educator, as the words have different meanings depending on the situation and understanding of the word. As a helpful tool for nursing practice, a summary table of the findings illustrates the differences and similarities serves as a guide to aid role clarity for educators, employers, nurses, nursing students and the public. This work also suggests that the College of Nurses of Ontario, who writes these interpretations, make the documents available to the various groups mentioned to improve client safety and protect the public. Nursing professionals need to have a greater understanding of how the competencies undergo routine revision and how the interpretation documents, and the intent behind these interpretations, are created; so, effective nursing programs can adapt to the ever-changing needs of the health care system and nursing practice.
Seabrook, Elizabeth M., "A Search for Role Clarity: A Critical Discourse Analysis of the RN and RPN Entry-to-Practice Competencies That Shape Nursing Curriculum in Ontario, Canada" (2023). Electronic Thesis and Dissertation Repository. 9286.
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