The Registered Practical Nurse (RPN) Role in an Academic Acute Care Hospital: A Mixed Method Study of the Barriers and Facilitators to Practice

Background: Registered Practical Nurses (RPNs) are considered a critical component of high functioning nursing and interprofessional care teams. Therefore, it is important to ensure that RPNs feel valued within their roles within acute care settings. High acute care demands in tandem with unsupported workplace environments can lead to increased levels of job dissatisfaction, burnout, and ultimately impact retention. Identifying and examining the barriers and facilitators that enable RPNs to be optimally equipped within acute care are critical towards ensuring success in their role. In this study, we explore the experiences of RPNs and perspectives of nurse leaders on RPN integration into an acute care setting. 

Methods: A mixed method study among RPNs (n = 10) and nurse leaders (n = 10) was conducted. This included administration of the Assessment for Collaborative Environments (ACE-15) tool to measure interprofessional integration, collaboration, and teamwork. Semi-structured interviews were also held with all participants to explore both the lived experiences of RPNs in the acute care environment and the perspectives of nurse leaders who had supported the onboarding and integration of RPNs. 

Results: Our inductive content analysis identified 5 themes: preintegration process, nursing team dynamics, RPN role clarity, challenges to RPN integration, and benefits to RPN integration. ACE-15 data showed no significant differences in the level of teamness and internal disagreement between RPNs and nurse leaders (t (17) = 0.37 and p = 4.60). RPNs reporting a higher level of teamness described a more positive integration experience than those who reported a lower level of teamness. 

Conclusion: The integration of a new role to existing teams brings both benefits and challenges which are experienced uniquely by RPNs and nurse leaders. Nurse leaders can utilize findings of this study to better prepare their staff and units for the integration of new roles into their models of care.

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