Nursing Leadership

Nursing Leadership 21(4) November 2008 : 56-72.doi:10.12927/cjnl.2008.20288
Nursing Research

Registered Nurses and Licensed/Registered Practical Nurses: A Description and Comparison of Their Decision-Making Process

Sheryl Boblin, Pamela Baxter, Kim Alvarado, Andrea Baumann and Noori Akhtar-Danesh


In many parts of Canada, nursing care is provided by registered nurses (RNs) and licensed/registered practical nurses (L/RPNs). The profession, regulatory bodies and employers are struggling to define their similarities and differences in their attempts to ensure patients are receiving the right care by the right care provider. An understanding of the decision making of nurses presents one way of differentiating between their overlapping roles. Nursing decision-making is a complex cognitive process. Assessment occurs and problems are postulated. Possible alternatives, with their risks and benefits, outcomes and likelihood of outcomes are identified. Preferences and values are considered, and an intervention is selected. The best way to implement an intervention is determined, implementation follows and evaluation takes place. In this research, a triangulated design was used to examine and compare the decision-making process of RNs and L/RPNs. Analysis revealed that nurses consider themselves to be frequently involved in elements that are part of the decision-making process. Nurses attribute the difficulty encountered to the context within which decision making occurs. Differences exist between the RN and L/RPN in the frequency of their involvement with most of the elements of the process. Differences in difficulty encountered with these elements were less pronounced.

Decision-making is integral to all aspects of patient care. It is a complex cognitive process, involving the selection of an intervention or action from one or more possible alternatives. Much of the research on nursing decision making has focused on the registered nurse (RN); little is known about decisions made by the licensed/registered practical nurse (L/RPN). In addition, much of the recent research has examined factors that influence decision making without looking at differences between these two categories of nurses. This paper presents the results of a study that included both RNs and L/RPNs. A triangulated methodology involving quantitative and qualitative methods was used. Data were collected from RNs and L/RPNs through a survey and focus-group interviews. This paper describes the decision making as reported by RNs and L/RPNs and compares the decision-making process described by these nurses.



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