Not One and the Same: How Personal Support Workers, Licensed Practical Nurses, and Registered Nurses Enact Collaboration in Long-Term Care

Abstract

BACKGROUND & PURPOSE Personal support workers, licensed practical nurses, and registered nurses are the primary care providers in long-term care. Research reporting on how these professions collaborate in long-term is limited. Understanding how collaboration occurs in long-term care may support and improve the care of residents. The purpose of this paper is to describe how personal support workers, licensed practical nurses, and registered nurses enact interprofessional collaboration in long-term care. RESEARCH DESIGN & METHODSA qualitative descriptive study using individual interviews with personal support workers, licensed practical nurses, and registered nurses working in long-term care (n = 13) was conducted. Data was categorized according to competencies from the Canadian Interprofessional Health Collaborative, National Interprofessional Competency Framework and then themes were identified to describe how collaboration is enacted. FINDINGS Analysis revealed that collaboration occurs according to five competencies (interprofessional communication, collaborative leadership, role clarification, team functioning, and patient-centred care). Four themes are presented: chain of command communication, leadership based on resident condition, (mis)understanding of roles, and respect within team functioning. These themes are presented because they are organizational aspects of collaboration as opposed to individual attributes and are, therefore, more helpful for those charged with supporting or improving collaboration within an organization. CONCLUSION Personal support workers, licensed practical nurses, and registered nurses naturally enact interprofessional collaboration is a manner that closely aligns with the Canadian Interprofessional Health Collaborative, National Interprofessional Competency Framework. Strategies to support and improve collaboration in long-term care should align with these competencies and take into account the nuances between personal support workers, licensed practical nurses, and registered nurses.

Areas of work‐life, psychological capital and emotional intelligence on compassion fatigue and compassion satisfaction among nurses: A cross‐sectional study

“…RNs also often take on supervisory or leadership roles, which may contribute to explaining why RNs perceive their workload to be more manageable and perceive greater rewards and fairness at work than LPNs. Furthermore, RNs are assigned more complex patient cases and are required to engage in higher levels of critical thinking and clinical judgement than LPNs (Thompson et al, 2021), therefore, potentially contributing to higher levels of compassion fa- (Montayre & Montayre, 2017;Thompson et al, 2021), they may feel a broader sense of gratification from caregiving (Jakimowicz et al, 2018), which could explain why LPNs reveal higher compassion satisfaction than RNs in the current study.…”

“…These differences might be explained by the different scopes of practice and the unique work characteristics of RNs and LPNs. While the complementary nature of LPNs' and RNs' scopes of practice requires a high level of interprofessional collaboration (Montayre & Montayre, 2017 ; Squires et al., 2019 ; Thompson et al., 2021 ), RNs take on greater levels of responsibility and clinical decision making, requiring more education and training, and as a result receive higher pay than LPNs (Thompson et al., 2021 ). Moreover, LPNs and RNs across Canada also typically belong to separate unions with different rules for seniority, overtime pay, pensions, etc.…”

“…In Canada, both RNs and LPNs are provincially regulated nursing professions that draw from the same clinical knowledge base, work collaboratively and share responsibility for coordinating and delivering clinical patient care (Canadian Institute for Health Information, 2021 ; Montayre & Montayre, 2017 ; Phillips et al., 2022 ; Squires et al., 2019 ; Thompson et al., 2021 ). However, due to greater education requirements, RNs' scope of practice is wider than LPNs and requires greater leadership, critical thinking and clinical judgement (Phillips et al., 2021 ; Thompson et al., 2021 ). Considering the different scopes of practice of RNs and LPNs, it is important to examine how both groups of nurses experience their work.…”

A cross sectional study of nurses' perceptions of nurse leaders' internal crisis communication during the COVID‐19 pandemic

“…The emotional support provided by nurse leaders has been shown to improve nurses' coping skills and reliance; it has also helped to develop mutual trust and commitment during the crisis (Digby et al, 2021;Simonovich et al, 2021). This T A B L E 3 Statistically significant results of chi-squared tests in units will increase interprofessional understanding, respect and trust (Thompson et al, 2021). It must be noted that there is a shortage of studies that examine different communication priorities, needs and expectations between registered nurses and practical nurses which also could explain such results.…”

“…Hierarchical ‘chain of command’ means of communication in health care organisations can explain this result. Improved non‐hierarchical communication patterns in units will increase interprofessional understanding, respect and trust (Thompson et al, 2021 ). It must be noted that there is a shortage of studies that examine different communication priorities, needs and expectations between registered nurses and practical nurses which also could explain such results.…”