Intraprofessional collaboration in acute care: Generating evidence to inform nursing workforce retention strategies

Alyssa Indar; Sherry Espin; Alicia Jones; Sue Bookey-Bassett; Karelin Martina; Pam Hubley; Juliette Teodoro; Mark Aiello; Chantelle Browne

doi:10.1016/j.outlook.2026.102832

Intraprofessional collaboration in acute care: Generating evidence to inform nursing workforce retention strategies

Nurs Outlook. 2026 Jul-Aug;74(4):102832. doi: 10.1016/j.outlook.2026.102832. Epub 2026 Jun 11.

Authors

Alyssa Indar¹, Sherry Espin², Alicia Jones³, Sue Bookey-Bassett², Karelin Martina⁴, Pam Hubley⁴, Juliette Teodoro², Mark Aiello³, Chantelle Browne³

Affiliations

¹ University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. Electronic address: Alyssa.Indar@uhn.ca.
² Toronto Metropolitan University, Toronto, ON, Canada.
³ University Health Network, Toronto, ON, Canada.
⁴ University Health Network, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.

PMID: 42275758
DOI: 10.1016/j.outlook.2026.102832

Abstract

Background: Globally, strategies to address nursing workforce shortages include strategic changes to support all nurses to maximize their scopes of practice. In Canada, the increased utilization of Registered/Licensed Practical Nurses (RPNs/LPNs) in acute care settings has amplified challenges related to role clarity, particularly in complex clinical situations.

Purpose: This study explored: (a) the collaborative strategies used by Registered Nurse (RNs) and RPNs in complex clinical situations, (b) the unique role of RPNs in acute care settings, and (c) strategies to support RPNs to flourish in increasingly complex practice environments.

Methods: We used an interpretive description approach (Thorne, 2016). Twenty-four participants were interviewed, representing perspectives from RNs, RPNs, Personal Support Workers and nurse leaders: at a large academic hospital network in Ontario, Canada. Interviews were conducted virtually. Interview transcripts were analyzed inductively using interpretive analysis (Thorne, 2016).

Findings and discussion: Participants represented a wide range of years of experience in nursing (i.e., 1-35 years) and represented settings such as the emergency department, inpatient surgery, and critical care. We describe: (a) how RN-RPN collaboration is challenged at care decision points, (b) the need for improved role clarity, (c) the unique value of RPNs, and (d) recommendations for retention.

Conclusion: The findings can inform macro- and meso-level strategies to improve nurse retention, by supporting collaborative nursing work environments.

Keywords: Acute care; Complexity; Interpretive description; Intraprofessional collaboration; Registered Nurse; Registered Practical Nurse.