The union representing registered nurses in Saskatchewan says patient safety could be at risk if the government approves proposed bylaw changes aimed at expanding the role of lesser trained Licensed Practical Nurses [LPNs].
“We have grave concerns on patient safety in the province and what this is going to mean to the citizens of this province when they go into the health care system,” said Tracy Zambory, the president of the Saskatchewan Union of Nurses [SUN].
Over the past few years LPNs have been taking on an expanded role in various parts of Saskatchewan’s health care system and now their professional body, the Saskatchewan Association of LPNs [SALPN], is writing bylaws to reflect that.
"SALPN had been given instruction by the Ministry of Health to make revision of our bylaws to ensure that current LPN practice was supported,” said Lynsay Nair, the executive director of SALPN.
But registered nurses are worried this is an attempt by LPNs to formalize what has been an ongoing “role creep,” as LPNs have been taking on a growing number of responsibilities.
“The LPN foundational knowledge is not there to allow them to take on this extreme expansion of their role,” Zambory said.
LPNs receive two years of training in technical college while RNs are required to have a bachelors degree at minimum.
Zambory said she reviewed a draft copy of the proposed SALPN bylaws and was shocked by what LPNs are proposing.
“From the registered nurses’ perspective, it is extremely troubling,” said Zambory.
“It appears to us that the LPN scope would encompass close to 99% of what a registered nurse does today.”
LPNs dismiss RN concerns as 'hysteria'
SALPN calls SUN’s concerns “hysteria” and “fear-mongering” and the organization insists that all of the proposed bylaw changes are being made with patient safety in mind.
By contrast the organization says SUN may have a different agenda.
“Our role is to protect the public and we're legally obligated to do so,” explained Lynsay Nair, the executive director of SALPN. “And the union [SUN] has a very different role - to protect the interests of their members.”
Nair said LPNs are not adding new roles for themselves but simply spelling out more clearly what they already do at various locations around the province.
“We're not changing practice. We're changing the bylaws,” said Nair.
She said despite the new bylaws there will still be plenty of room for RNs to have a leadership role in healthcare.
“The RN does have the greatest breadth and depth of nursing knowledge and that's not up for debate. They absolutely do,” said Nair.
She said LPNs will continue to care for patients that are less sick while RNs will care for those with more serious conditions.
And she points out that while RNs are able to act more independently, LPNs will continue to require supervision.
“LPNs would not be able to perform an immunization without the presence and immediate availability of another professional,” said Nair.
Bylaw vote delayed by Ministry of Health
Until recently, SALPN was planning to hold a vote of their members on the bylaws on Oct. 21.
But Nair said plans changed abruptly yesterday.
“We received the news yesterday and the membership has been informed this morning that that vote will not take place on October 21.”
When CBC’s iTeam asked who delivered the news Nair responded “the Ministry of Health.”
Nair says now there will be expanded consultations with affected groups, including SUN, though she points out consultations with SUN were always part of the plan.
As for when the vote on the bylaws will happen Nair said “actually we're not aware of the timeline at this point in time.”
SUN fears government interference
SUN says it’s worried that the provincial government is behind these proposed changes to the LPN bylaws.
Zambory said there is significant financial pressure being placed on Regional Health Authorities.
“The RHAs have been given very strict budgetary targets that they need to meet and we're very concerned that there is a correlation between expanding the scope of practice for the LPN and cost containment and these budget driven decisions,” Zambory said.
Zambory argued there is no good reason to expand the role of LPNs right now as the province has all the RNs it needs.
“We don't understand why this is even moving forward when there is a highly skilled 9,000-plus body of RNs out there (who) can already do this work plus a thousand ready to be graduated.”
Minister of Health says safety first
Health Minister Dustin Duncan said there are some good reasons for the health care system to better use the skills of LPNs.
“We have trouble attracting RNs to certain rural communities, remote communities. In some of those cases LPNs fill some of those roles,” Duncan said. “So that’s a good thing for those patients that otherwise wouldn’t have access to a health provider.”
However Duncan pointed out that ultimately the province has the final say over what’s in the SALPN bylaws.
And he says he’ll approve them on the condition that LPNs “education and their training and their experience allows them to do that function in a safe fashion. If that’s the case then I don’t as a minister have a problem with it,” Duncan said.