The RN and LPN skill mix

Until a few years ago, patient care in most acute care areas at our tertiary care hospital in Alberta was delivered almost exclusively by registered nurses (RNs). Many believed their workload included tasks that did not require an RN's knowledge and skill levels. Around the same time, the hospital was faced with budget constraints. The staffing mix changed in 1991 with the introduction of another level of caregiver in the active treatment areas--licensed practical nurses (LPNs). The new mix caused problems: many RNs were unaccustomed to supervising and delegating to other workers and the primary nursing method for delivering patient care no longer worked.