Scope of Practice for the VN and the RN

The nurse’s leading position in the provision of the patient-centered care is predisposed by the increasing demands of the U.S. society to the health care services. The role awareness of the nurse graduates and a clear vision of differentiated responsibilities define the proper functioning of health care teams. A vocational nurse (VN) generates the first stage in the provision of the health care. A registered nurse (RN) acquires comprehensive skills of care management, delegation, and patient’s assessments. Both positions are analyzed in this paper in response to the broad range of essential competencies, nursing practice standards, the ability to distinguish unprofessional conduct, and appropriate use of social media, the excellence in which enables transition to the advanced practice.

Scope of the RN and VN Practices

The Texas Nursing Practice Act (NPA) serves as the primary source for identification of scope of practice of the VN and RN. The Board’s Rules and Regulations is another document distinguishing the VN’s scope of practice (Texas Board of Nursing, 2016a). The main difference between practices originates from the directed character of vocational nurse activities under the supervision. Alongside, the RN is prepared for an independent role in the health care delivery. These issues distinguish the further elements of professional preparation and range delivery. The scope of VN practice relies on advocating of patient’s needs and promoting patient’s safety while acting in response to the aforementioned regulative acts. Besides, the scope of the RN practice covers comprehensive practices dealing with judgments, complex health care needs in all the settings (Texas Board of Nursing, 2011). The delegation of rules is another distinctive feature of the RN scope of practice.

Delegation Rules of the RN

The broad range of services covered by the advanced nursing practice creates the need to delegate some tasks of the nursing plan to unlicensed personnel (UP). Texas Board of Nursing defines the delegation rules that predispose the scope of delegation to other health care professionals. The content of the tasks varies in response to the clinical conditions, setting, and the unlicensed workers’ skills.

According to Texas Administrative Code, while initiating the delegation the RN should take into account five rights (Texas Board of Nursing, 2016b). First, the RN should identify the right task that will coincide with the level of preparedness of the unlicensed worker and will not harm the patient (Texas Board of Nursing, 2016b). The next right concerns identification of the right person. In particular, the RN should be aware of personal qualities, education, and permits of the unlicensed worker. The person is not involved in the nursing decision making, except for emergency situations that distinguish the right circumstances. The RN may educate or verify the skills of the UP in response to the nursing situation while delegating the tasks or by training. Finally, the right supervision involves the responsibility of the RN for the quality of actions fulfilled by unlicensed staff and acts according to Texas Nursing Practice Act (NPA).

The delegation of tasks includes non-sterile and non-invasive procedures related to daily living. All the tasks can be delivered to the UP only if the list of regulations is followed. Further, the health care unit should follow the protocol where the RN delegation involves the described tasks, their evaluation, and reporting of the UP. Moreover, the Code prohibits delegation of tasks that require professional nursing judgment (Texas Board of Nursing, 2016b). They include all the types of assessments, generating the health care plan, administering the treatments, and client supervision in education and self-management.

The Differentiated Essential Competencies

The current educational nursing affiliations are shifting toward the patient-centered care that expands the traditional roles of profession members, providers of health care, patient’s advocates, and team workers. While fulfilling those roles a nurse should possess the knowledge, skills, and professional judgment and be able to apply them in practice. Altogether they form competencies that differentiate the VN and RNs.

According to the DECs, VNs as well as RNs, as members of the profession, should commit to the policies and procedures predefined by the hiring affiliation and clinical setting (Texas Board of Nursing, 2011). Both are responsible for delivering high-quality safe health care. Still, while RNs are directly engaged in the development of professional nursing and practice excellence, the VNs only contribute to the process.

The provision of the patient centered-care suggests the utilization of clinical reasoning and evidence-based knowledge for decision making. Still, the VN follows only the policy guidelines, while the RN preparation and evidence-based outcomes enable broader possibilities for solution options. The RN possesses the appropriate range of skills to provide comprehensive assessments of culturally and individually diverse clients, analysis to generate a health care plan and manage its implementation. The VN is able only to assist in the fulfillment of the plan and report on the evaluation results. Both constitute the members of the interdisciplinary collaboration where the VNs provide basic nursing care, whereas the RN acts to the full scope of comprehensive practice.

To advocate the patient’s safety VNS and RNs should be aware of regulative rules and procedures. They are also responsible for implementing all the principles for safe conditions (Texas Board of Nursing, 2011). The RNs take active role in formulating goals and results of the evidence-base practice for reducing risks, in which the VN assists. Both professions involve acquiring instructions, training, and assignments that coincide with the NPA within the advocate’s roles. Besides, the RN can delegate the tasks related to the safety organization.

The health care team functioning depends on the coordination, cooperation, and communication of the VNs and RNs together with other health care professionals. On the way, the RN monitors and promotes accessible quality health care, and the VN participates in the process. The decision-making in a health care team should be supported by the data from technology options. To cover all the health care needs the VNs may assign and supervise the tasks of unlicensed personnel, while the RNs may also delegate the care to senior health care staff committing to the evidence-based practice (Texas Board of Nursing, 2011). Despite the differences in the range of competencies, all the nurses should possess the minimum required level of practicing standards.

The Minimum Acceptable Standards

The rule 217.11. of TAC describes the general and specific standards of the VN and RN positions. First of all, the nurses should follow the Nurse Practice Act, the health care related laws, and the board’s regulations. Other essential standards manifest in maintaining safe clinical environment; knowing the rationale for the treatment outcomes; precisely reporting and documenting care constraints; data and patients’ responses; committing to the patient’s privacy; participating in counseling, education, and supervision; following professional boundaries; provision of quality services to all the patients (Texas Board of Nursing, 2016b). Additionally, the VNs fulfill all the standards under the direction and supervision of advanced practice professionals and assist them in caregiving. The minimum standards for the RN also include the utilization of systematic approach and delegation skills.  The mentioned competencies and standards constitute the basis for the test plans.

Test Plans for VNs and RNs

To meet all the earlier identified requirements, National Council of State Boards of Nursing (NCSBN) has prepared a plan for the licensure of practice. The test plan involves a comprehensive summary of the scope competencies required for an entry-level nurse to provide monitoring, promotion, and rehabilitation of health. The content of the VN and RN test plans consists of the client’s needs in all the clinical settings and conditions. Four major categories for all the nurses are safe and effective care environment, health promotion and maintenance, psychosocial and psychological integrity (NCSBN, 2016).

The issues included in the categories differ for VNs and RNs. In particular, while establishing an effective health care environment, the RN should be able to manage the care. The VNs should possess the knowledge about coordinated care (NCSBN, 2014). The coordinate care and the management of care subcatogories differ in the range of competencies. The related content of the RN test plan concerns advanced directive, as in the case with the VN self-determination, life planning, skills of assignment, delegation, and management of the provided care (NCSBN, 2016). Moreover, more content is directed in the case of the RN to the pharmacological and parental therapies. In the health promotion category, the RN should demonstrate the skills of health screening and physical assessment that are not included in the VN examination plan. The licensure plan also suggests eliminating unprofessional conduct that may bring harm to a patient’s status.

Unprofessional Conduct

Rule 271.12 of TAC considers unprofessional conduct to be dishonorable behavior that may endanger the health care delivery. The first unprofessional activity concerns unsafe practice that manifests in careless and frequent failures or inabilities to conduct nursing practice, manage and delegate, and supervise according to the minimum required level (Texas Board of Nursing, 2016b). Unsafe practices may also be caused by mood-altering substances, physical and mental disorders of a nurse and misuse of drugs. Others concern failures of chief administrative nurse to follow administrating requirements, misconduct or criminal conduct, and failures in the payment of student loans and child support. Finally, the dismissal from the approved program and nursing assignment is also considered to be unprofessional conduct. To diminish unprofessional conduct, the nurses should develop professionalism and their quality. Communication and teaching are the most visible ones.

The RN as a Communicator and a Teacher

The skills of communication and teaching determine the higher level of nursing excellence in comparison to the VN. Effective communication requires the non-verbal skills of active listening, timely silence, paralanguage, body gestures, and eye contact (Harrington & Terry, 2013). The verbal communication signifies the nurse’s commitment to simplicity, general leads, open-ended questions, clarification, and summarization of the interview process. Therapeutic communication based on trust and empathy leads professional competency as well as contributes to team building.

Education constitutes the essential component of communication in the nursing profession. Similarly to communication, the teacher’s role means trust, partnership, and motivation of the learner to improve the health status. Effective teaching relies on a combination of learning styles and the variety of modern teaching materials that fit the individual needs of the clients (Harrington & Terry, 2013). Social media is one of those teaching environments that are convenient to patients.

The Nurse and Social Media

Social media tends to play a significant role in communication and teaching aspects of nursing practice. American Nursing Association and NCBSN recognize the importance of utilization of social networks in public education, discussion of nurse-related issues, networking, and professional knowledge exchange (Texas Board of Nursing, 2016). Alongside, the policymakers of the field predict numerous risks of media utilization. They concern patients’ privacy and its misinterpretation. Such issues may undermine the nurse’s career. As a response to frequent complaints that lead to disciplinary penalties, the boards identify the principles of safe use of social media in nursing practice (Texas Board of Nursing, 2016). They consider following ethical and legal requirements of patient’s private information management. The postings may not include any private facts, names, photos and cannot be uploaded without the permission of the organization. A similar principle concerns the discussion of the team. Being aware of those restrictions, a nurse will benefit from the appropriate application of social media in the patient-centered practice.

Conclusion

The generation of the nursing continuum involves the preparation of basic professional skills and their transition to advance nursing practice that reflects the needs of time and patient’s expectations. The scope of practice of VN concerns the directed and supervised services manifested in the minimum standards of licensed nursing. The scope of practice of RN reflects the advances in the nursing hierarchy that enable management of comprehensive care and delegation of skills. Altogether, the differentiation of skills, competencies, professional conduct, and roles between the VNs and RNs enable the efficient functioning of patient-centered health care system.

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