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1ENDOSCOPY LPN / RPN ROLE – position statementRole of the Licensed Practical Nurse (LPN) / Registered Practical Nurse (RPN) inEndoscopyDate of Approval: 29 June 2015DisclaimerThe Canadian Society of Gastroenterology Nurses and Associates (CSGNA) present this positionstatement to be used as a reference in the development of institutional policies, procedures andprotocols. The CSGNA assumes no responsibility for the practices or recommendations of anymember or other health care professional, or for the policies and procedures of any practicesetting. The registered nurse/ licensed practical nurse/ registered practical nurse functions withinthe scope of practice of the provincial licensing body and the institutional policy of the employer.PositionThe CSGNA supports the position that the licensed practical nurse/ registered practical nurse iseducated and experienced in the gastroenterology specialty, specifically endoscopy, and can begiven responsibilities that fall within their scope of practice. The LPN/RPN’s scope of practicemust align with their provincial licensing body and the policies and guidelines of the institutionwhere they are employed. The LPN/RPN works collaboratively under the supervision or clinicaldirection of an RN in endoscopy.BackgroundThe LPN/RPN increasing scope of practice has been a topic of interest to many nurses,provincial regulators, and institutions for quite some time. Data collected from the literature,Canadian hospitals, provincial licensing bodies, and front line nurses have revealedinconsistencies in practice nationally. This document may provide specific examples of how theLPN/RPN scope of practice has evolved. How LPNs/ RPNs are utilized to their full scope ofpractice is dependent on the provincial licensing body and the institution of where the LPN/RPNis employed. In those settings, the LPN/RPN must have someone to consult with in the practicesetting if the task is deemed beyond the LPN/RPN scope.The Canadian Council for Practical Nurse Regulators cites six principles on which standards ofpractice are developed. Foundational descriptors such as self-regulating, accountability, autonomy ina collaborative environment, client centered care, and working to the full scope of practice provides abroad basis to allow the LPN/ RPN to work in multiple settings and changing health careenvironments. Factors to be considered in determining the role of the LPN/RPN in a collaborative1

2ENDOSCOPY LPN / RPN ROLE – position statementpractice setting include, staffing levels and skill mix, number and acuity of patients, and unit layoutand technology.National examples of the evolution of LPN/RPN scope of practice in the endoscopy setting:In Alberta, there are few restrictions on medication administration, allowing the employerflexibility in policy development to decide what is deemed appropriate. The LPN withspecialized clinical competency can perform the task of Direct IV Push. This is considered anadditional competency education by the employer and specific only to the clinical settingwhere the competency has been achieved (College of Licensed Practical Nurses of Alberta,email communication, Findlay, L., 2015). The additional competency of direct IV push mustbe supported through policy, procedure, education, including lab, theory, and clinicalsupports to ensure safe practice (CLPNA, Bateman, T., 2008).By 2010, graduates of LPN programs in Alberta will have completed basic competency inintravenous initiation (CLPNA, Bateman, 2009).The LPN works under the direction of the registered nurse or physician, is accountable fortheir actions, is aware of licensure, legislation and legal requirements of scope of practice,demonstrates sound knowledge, provides safe competent care, and effective communication.To work in endoscopy, the LPN must have medication therapy, infusion therapy, and adultphysical assessment certifications, and can provide Direct IV push with specializedcompetency with the exception of sedative agents (Covenant Health, 2015). An LPN cannotinitiate a blood transfusion however can provide patient and blood verification as the secondsignature (AHS, 2014).In Ontario, RPNs are involved in the admission, intra-procedure and post proceduresedation care of the endoscopy patient. Some of the tasks include history taking, initiatingintravenous, and procedure room set up, snaring and biopsy, and wire cannulation, injectionof contrast dye, and saline during ERCP procedures (personal communication, DB, 2015).In another site in Ontario, RPNs assist with ERCPs, epinephrine injection to bleeding sites,Botox injections, Kenolog injections, stent insertions, bronchoscopies, variceal gluing, PEGinsertions, call back cases, admission, IV medications (no direct IV push), monitoring ofunsedated patients with RN flexible sigmoidoscopy program. Staffing mix includes 1 RN and1 RPN per procedure room, 1 RN and 1RPN in the admitting area and RNs only in recovery(personal communication, JM, 2015).In New Brunswick, the LPN works in a collaborative role with registered nurses in prep andrecovery. They will also obtain supplies, transportation of patients, bedside pre-cleaning ofscopes. At another NB site, the LPN functions in an endoscopy technician role while an RN ispresent to monitor the patient and administer sedation medication (personal communication,CC, 2015).In Newfoundland, the LPN is counted as the second health care professional. Theyparticipate in biopsy and snaring of small polyps and equipment retrieval. The LPN2

3ENDOSCOPY LPN / RPN ROLE – position statementparticipates in call back as the second nurse with urgent cases performed in the supportedenvironment of the emergency room or intensive care setting. The LPN does not participatein ERCP procedures (personal communication, MC, 2015).In Prince Edward Island, the LPN is involved in the admission process including patientteaching, assessment, and intravenous initiation. They may be called into the procedure roomfor repositioning of patient only (personal communication, PT, 2015).The Endoscopy LPN/RPN must be accountable, competent and knowledgeable in, but notlimited to:1. Anatomy, physiology and pathophysiology of the gastrointestinal tract, including both upper andlower diseases.2. Indications, contraindications, complications of all performed endoscopy procedures.3. Able to apply critical thinking skills, anticipate and manage any complications that may arise andnotify RN or physician of a change in patient health status.4. Patient preparation (teaching, health assessment skills, nursing history, establishing intravenous)during the pre procedure period.5. Familiarity and proper use of equipment intra-procedure.6. Maintenance infection prevention and control practices, proper use of PPE (personal protectiveequipment), awareness of clean and dirt separation, and sterile technique when appropriate.7. Monitoring of the patient during the post procedure period. Knowledge of airway management,recognize potential complications and can administer oxygen therapy via nasal cannula, non-rebreather, bag-mask device, and oral pharyngeal airway if needed. The LPN should also be able torecognize abnormal vital signs and post procedure issues and report them immediately to the RN orphysician.8. Knowledge of medications specific to area of practice, indications, contraindications, side effects,and reversal agents. The LPN/ RPN cannot give procedural sedation by direct IV push.9. Documents patient information according to department guidelines and institutional policies.10. Provides effective communication among the endoscopy team.11. Acts as a resource, patient advocate, and participates in quality management initiatives.12. Participates in educational activities relevant to gastroenterology and endoscopy.13. Cardio-Pulmonary Resuscitation and use of an Automated External Defibrillator.Practice limitations (Depending on licensing jurisdiction):3

4ENDOSCOPY LPN / RPN ROLE – position statementThe LPN/RPN DOES NOT participate in:1. Direct IV procedural sedation (all jurisdictions).2. Administration of blood and blood products (but can perform blood check and monitor patientduring transfusion).3. Administration of radiopaque dyes via parenteral instillation.4. Insertion of tubes beyond the nares (example naso-gastric/ oro-gastric tubes).5. Insertion or advancement of endoscope.6. Monitoring of the patient intra-procedure while under procedural sedation (but can monitor the unsedated patient).7. Applying electricity for the purpose of cauterizing tissue (exception- Automated externaldefibrillator).8. Apply lasers to cut or destroy tissue.The ability to perform to full scope of practice in a specialty is defined by:The education, experience, and competence of the health care professionalEducation module, written exam and practical assessment of skill is recommended.Continuing competency testing of skill is the responsibility of the employer or the facility inwhich the restricted activity is performed.Care needs of the clientSupport available in the clinical area of endoscopyThe ability to work within clear guidelines, and job description to eliminate role ambiguityThe Licensed Practical Nurse/ Registered Practical Nurse is accountable for the responsibilitieshe/she accepts.Staffing levels and mix are dependent on the unit layout, number and type of procedures, and patientacuity. The CSGNA supports the SGNA recommendations of:1 RN in the pre-procedure area1 RN to each procedure room for sedation and patient monitoring. An exception to this wouldbe if an anesthesiologist is monitoring the patient and providing sedation.1 RN in the post procedure areaDuring therapeutic or unstable cases, 1 RN and 1 other health care professional should beavailable during the procedure. This can be another RN or LPN/ RPN. Other members of the4