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Don’t be distracted by intra-professional squabbling

by Dianne Martin

More than anyone else, patients and their families know the expertise, skill and compassion Registered Practical Nurses bring to the bedside every single day. RPNs are at the heart of any care team, working closely and collaboratively with other nurses, personal support workers, allied health professionals, and doctors. While all health professionals are invaluable to delivering excellent care, Nursing Week is a time for nurses in particular to step forward and be recognized for the vital work they do.

Whether you’re in a hospital, a long-term care facility, delivering care in a patient’s home or any other health setting, failing to cooperate with your fellow nurses is simply not an option. This should be even more so during Nursing Week, when RNs, RPNs and NPs come together to celebrate and strengthen their profession. After all, each of us shares the same goal: delivering care to people who depend on us.

That’s why it was so disappointing to so many of us when, during last month’s Nursing Week, Ontario Nurses’ Association President Vicki McKenna released a video in which she claimed “victory” for halting “inappropriate skill mix changes that put patients and all nurses at risk.” Characterizing an expanded scope of practice for skilled and knowledgeable RPNs as putting patients at risk is simply misleading fear-mongering. Claiming a halt to expanded scope would be a “victory” for one group of nurses over another is a violation of our ethical standard of maintaining commitments to colleagues and to the profession. It also, unfortunately, contributes to misperceptions of RPNs and suggests a lack of trust between nurses that we know does not, and must not, exist on the front lines of care. This risks undermining public confidence in the entire nursing profession.

Let me be clear: WeRPN supports and advocates for optimal utilization of all nurses to ensure patients get excellent care. Make no mistake, the best quality care is only possible when every health professional on a patient team works to the full extent of his or her expertise. Scope of practice should reflect a professional’s skills, training and knowledge as well as best practices. WeRPN has strongly advocated for smart, evidence-based scope changes that put patients, and patient safety, first – because we know that’s what all RPNs do every day. And we continue to work with government and the College of Nurses of Ontario to achieve these changes to do what’s best for patients and for the sustainability of our public health care system.

Let us take this opportunity to correct some inaccuracies. First, the Minister of Health and Long-Term Care did not send a letter to the College of Nurses of Ontario pertaining to skill mix changes or any other role changes organizations may be undertaking related to their current nursing practices. WeRPN believes decisions about which combination of health workers is needed to meet patient needs are best made by health service provider organizations. The Ontario government agrees, and has given no indication it intends to mandate skill mix in hospitals or anywhere else, nor has it placed any kind of moratorium on changes to RPN roles made by health service providers.

Second, while the Minister did send a letter to the College with respect only to the suggested legislated scope of practice changes for RPNs, she did not propose an indefinite halt to these changes but, instead, recognized the need for further consultation before moving forward. To be clear, this consultation is already well underway. RPNAO began consulting before recommending proposed changes to the Ministry; on the strength of this initial consultation, the Minister requested that we cooperate with government to implement a new framework for evaluating scope and practice changes. This framework, which applies to all regulated health professionals, outlines a rigorous process focused on patient need, system need and safe practice, and it includes extensive stakeholder consultation. Accordingly, WeRPN has consulted with RPNs, RNs, advanced practice nurses, other clinical experts, the Minister, the College, major RPN unions, educators from diploma and baccalaureate nursing programs, and nursing employers from all sectors of the health system. WeRPN has not, however, consulted with ONA, as we feel it does not make sense to consult with a union predominantly representing a different nursing category which has neither hegemony over, nor particular knowledge of, RPN professional practice.

It is our job as a nursing professional association to respond to present need and anticipate future needs to prepare nurses to meet them. That’s why we have brought these changes forward. It is the College’s and government’s responsibility to evaluate and approve those recommended changes.

Lastly, the scope changes we proposed are about improving patient care, not saving money. These changes are being driven by front-line RPNs, not employers, because they see patients being denied timely access to the quality care RPNs have the knowledge, skill and judgment to provide.

Fundamentally, any health professional’s scope of practice is not his or her “turf” to defend against all comers. Rather, it is a range of ways in which that person is educated to work, in cooperation with other professionals, to appropriately provide care. Our approach to scope, and to our profession overall, should be focused on how abilities can intersect to wrap around the patient: not how to build fences that keep other workers out. Because at the end of the day, when a patient is sick and desperately requires help, she cares most that the nurse assigned to her has the skill and knowledge to give her the care she needs.

Ontario’s nurses work together in our hospitals and long-term care homes and dozens of other settings day in, day out. They know there’s no winning and losing when it comes to what their colleagues are allowed to do – we only win when, together, we deliver better care. We are fortunate in Ontario to have a robust, agile and adaptive nursing workforce. Patient need, system need and patient safety are best served when we continually leverage the full knowledge and competencies of every single nurse in our system. We need every nurse and we need nursing to continually evolve to meet emerging patient needs.

Change isn’t always easy, but it is always necessary. RPNAO is dedicated to constant innovation, because we all know the needs of our patients are changing quickly; if we don’t keep up, their care will suffer. RPNAO is a champion for change that puts patients first, which is why we brought forward these common-sense recommendations informed by nursing practice at the point of care. We have a strong relationship with government, which is still committed to working with us and the College of Nurses to empower RPNs to work to the full scope of their expertise, so they can better contribute to care teams. This should be a goal for all nurses.

We can’t be – and WeRPN won’t be – distracted by intra-professional squabbling. Because patients and families are counting on nurses, on all of us. We need every nurse, in all our unique and specialized knowledge, education, and experience and it’s through collaboration that we will best serve patients.

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