Can I perform an initial client assessment and initiate the care plan for new clients?

The professional scope of practice of the LPN (as written in the LPN Act) is such that determining the baseline nursing needs and initiating a care plan for a new client is a collaborative process with the RN in all practice contexts. The RN is accountable to ensure each client in the health care system has an appropriate and reasonable initial nursing care plan in place. Baseline needs are those which are identified when the client first accesses the health system or when previously identified needs begin to change or worsen.

Baseline needs are determined through a two-step process:

  1. Collection of client specific data through a variety of processes including a health assessment; and
  2. Interpretation of the data by identifying the client’s issues and initiating a nursing care plan to address, manage, mitigate or eliminate the client’s priority needs.

Collection of client specific data, including performing a health assessment, is well within your professional scope of practice. You are also authorized to develop a draft initial care plan. The draft plan must be reviewed and validated1 by the appropriate RN in an appropiate2 time frame. You may initiate standard interventions within the plan as appropriate before and during the validation process as long as it is appropriate 3.

Once the baseline plan is validated, you are authorized to interpret the ongoing client data by comparing your findings to the previous findings on the baseline plan to make sure the client is achieving the goals.

As long as your assessment findings are consistent with the goals of the plan, you may do this independently, updating the RN on a routine basis. When your findings are not aligned with plan goals or outcomes, you are accountable to consult with the RN and together decide the next best action.

More information about care planning can be found in the care Nursing Care Plan Practice Guideline.

Still have a question? Email a practice consultant at practiceconsultant@clpnns.ca .

 

1 The process of validation of a draft plan can vary from client to client and nurse to nurse. Minimally it involves a conversation about the LPNs assessment findings and proposed interventions and goals. During the conversation, the LPN is expected to provide enough detail and the RN is expected to ask enough questions so that they are both confident the plan is sufficient to manage the client’s needs. Additional client assessments may be warranted based on the conversation between the nurses or the findings of the LPNs assessment. However, there is no expectation either nurse duplicate the work of the other for the sake of doing so. When the RN is satisfied with the plan, it is said to be validated and this should be documented on the plan itself, in the client health record or according to agency policy.  Once validated, the LPN and RN share accountability for the creation of the validated plan.

 

2Appropriate time frames are determined based on the needs of the client: The more acute the needs of the client, the sooner the draft plan should be validated.

 

3 The appropriateness to implement interventions in a draft plan is based on the LPN’s assessment of the client, the risks associated with interventions, the resources in the practice environment and their ability to manage the outcomes independently. For instance, administering the same or near same dose of insulin to a client represents a lower risk than administering insulin to a client for the first time. This means on occasion; the RN may be required to validate portions of the plan sooner than others.