In nursing homes, the urgency to advance our measurement of nursing practice grows because nursing homes are increasingly regarded as an essential component of the care continuum needed to achieve national care quality goals. Prior qualitative case study research identified two key characteristics of nursing practice that differentiated how licensed nurses in nursing homes enacted their scope of practice: the degree to which registered nurses (RNs) and licensed practical nurses (LPNs) function interchangeably in providing nursing care and the quality of the connections between RNs and LPNs. RN-to-LPN staffing ratio was a critical, contextual factor shaping these characteristics. The purpose of this pilot study was to develop and validate an instrument of interchangeability and connections between RNs and LPNs regarding how they assess, plan care, supervise, and delegate in nursing homes. One hundred and one RN directors of nursing completed the self-administered, pencil-and-paper, pilot survey instrument. Both classical test theory and item response theory indicated adequate psychometric properties of the 8-item RN-LPN Differentiation scale (α =.78) and the 12-item RN-LPN Collaboration scale (α =.79). The RN-LPN Differentiation score differed by state (p <.001), congruent with between-state differences in RN and LPN scope of practice. RN-LPN Collaboration related to an established measure of interaction behaviors among nursing home staff (p <.001). The scales will advance research measuring the relationships between enacted scope of licensed nurse practice and quality of nursing home care.
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© 2013 National Council of State Boards of Nursing, Inc.