KEP Report insufficient for Alberta nursing policy changes

The Knowledge and Education Project (KEP) report was a collaborative effort between the LPNs, RPNs and RNs. It was an interesting qualitative research process comparing the education and knowledge held by all three categories of nurse prior to graduation. It did not deal with actual real-life nursing situations, so there are limitations to it use in policy and decision making.

The language in the report about LPNs being trained to deal with “stable patients” is very unfortunate, and is sometimes being misinterpreted and not presented as the researchers intended. (CARNA Letter to the Editor of the Edmonton Journal, published April 18, 2010.)

The following article, Understanding KEP: A non-researcher’s guide (reprinted from the Spring 2010 issue of CLPNA’s CARE magazine), explains a more rounded context about the KEP report and its place in nursing evaluation.

Understanding KEP: A non-researchers guide

(Reprinted from the Spring 2010 issue of CLPNA’s CARE magazine.)

The recently released Knowledge and Education Project (KEP) report was the result of a collaborative project initiated by the Nursing Advisory Council of Alberta and included representation from the three regulatory colleges representing LPNs, RPNs, and RNs (College of Licensed Practical Nurses of Alberta, College of Registered Psychiatric Nurses of Alberta, and the College and Association of Registered Nurses of Alberta, respectively).

The project was initiated in an effort to better understand the knowledge base of the three categories of professional nurse in Alberta. It was hoped this research might assist decision makers in making staffing decisions. The KEP study was restricted to a qualitative review of the acquired academic knowledge held by novice nurses in all three categories who were close to graduation, but still students at the time of the study.

The research was designed to explore the breadth and depth of knowledge held by all three types of nursing students at point of graduation using review of curriculum and regulatory documents, interviews and focus groups with students, and interviews with educators. The research is not an evaluation of the practical bed-side skill of novice nurses in delivering patient care.

The KEP report provides some insight and reassurance about the entry to practice knowledge of new nursing graduates in Alberta. However, any generalization of the research beyond the evaluation of acquired academic knowledge of novice nurses would not be supported by the findings of the KEP study. Extrapolation of this research beyond its limited focus and findings would be inappropriate and possibly precarious. The KEP study in isolation is not a reasonable basis for making larger public policy decisions on professional nursing issues like roles, responsibilities, and scope of practice.

The CLPNA Council and Executive team had a presentation on the KEP project by Dr. Margaret Hunsberger, principle investigator. She was very clear and forthright about the KEP research project findings, limitations, appropriate application, and insights.

Dr. Hunsberger said the KEP research approach was not a quantitative statistically-based random selection test of a hypothesis. Rather it was a qualitative “naturalistic” research project that was context-based using observation and interpretation of the participants to reach conclusions.

She noted in naturalistic qualitative research approaches data interpretation depends on understanding the context, the language of participants, and the researcher’s ability to write with clarity and illumination. Dr. Hunsberger said considerable effort was made in the KEP project conclusions around understanding context, seeking patterns and finding trends in the observations of participant performance.

Based on comments and clarifications from Dr. Hunsberger, the good news is Alberta’s novice nurses, in all three categories, are appropriately educated for their current scope of practice and she encourages full utilization of all nurses. The data showed knowledge overlap and differences between the LPN, RPN, and RN novice nurses, but that would be expected based on differences in program length and focus.

An important clarifying comment from Dr. Hunsberger was about the interpretation of the KEP report Executive Summary comment that LPNs were “…best suited to deal with stable patients.” She noted that “stable patient” is used with its common sense meaning (not one of the bizarre definitions sometimes created) and indicated that a more sophisticated context about stability should include patient concerns, but go well beyond to consider the stability of the organizational and professional working situation of the LPN, the stability of employer and of government policy, all of which impact the ability of nurses to do their best work.

Dr. Hunsberger suggested another section of the research report may be a more appropriate context to consider the roles, responsibilities and scope of practices for LPNs. The KEP report notes (p. 67) the three categories of nurses have “…three different types of credential backed by three different knowledge bases, which have amongst them both significantly overlapping and significantly different responsibilities.” Also, noted at the same page:

“RPN students were strong in the area of psychiatric illness and medication, but less so in medical surgical areas. LPN students were as strong as RN students in knowledge of standard care and standard procedures, but not so with more complex clinical issues. RNs showed the widest range of nursing knowledge, and except for psychiatric areas, also the deepest knowledge.”

This KEP finding is a more useful context to help policy makers understand the different roles, responsibilities, and scope of practice of the various types of novice nursing provider in Alberta. The KEP study is a good, but limited start at improving and clarifying roles, responsibilities, and relationships in nursing care in Alberta. It answers some key questions but begs even more profound questions. The CLPNA thanks Dr. Hunsberger for her efforts throughout the KEP study. We hope her report heralds more health-system based research so Alberta can make systemic improvements that are evidence-based and not merely political or adversarial.

Thanks to Alberta Health and Wellness for funding the Knowledge & Education Project.

The complete KEP report and Executive Summary is available in the Resources section at www.clpna.com.

3 Responses to “KEP Report insufficient for Alberta nursing policy changes”

  1. I would like to extend a sincere thank-you to CLPNA and Ms Stanger in particular for the strides that have been made in recent years to further the visibility and viablity of the licensed practical nurse in our province.
    This blog in particular is but one example of the quality leadership provided by Ms. Stanger.

  2. I have felt, since becoming an LPN (and I have gone through many designations, Nursing Aid, RPN etc.) that there is an underlying concensus amongst the RN’s and the general public that the reason people become an LPN is that intellectually they could not complete the RN course. Therefore, second best was chosen.
    What needs to be made clear is that sometimes circumstances dictate which career you choose and stay in. I chose to be an LPN to see if I would like nursing, I stayed because it fulfills me. My expectations of fulfillment are not any less than that of an RN (diploma or degree). My career has allowed me to gain experience and knowledge far beyond that of simply book learning. I have worked with fantastic people who never felt I could not understand and continued to encourage me, even at the end of my career to learn and to challenge me. I have also worked with some who would have rather I stayed in my ‘niche’ and just worked in a nursing home.
    The dividing line between RN’s and LPN is getting fainter, I think, but there still is a lot of understanding, trust and teamwork to be done. This can’t be accomplished if we continue to undermine each other and hold on to preconceived notions.