I'd like to thank the committee for the opportunity to comment and provide input on behalf of the Canadian Association of Practical Nurse Educators this morning.
The Canadian Association of Practical Nurse Educators, or CAPNE, was formed in 2000, with the initial meeting held in Manitoba. At that meeting there were practical nursing educators and licensed practical nursing regulatory bodies from each province and territory, with the exception of Quebec.
CAPNE is the national voice for practical nursing education in Canada, with representation on the board from all provinces and territories. CAPNE's objectives include supporting and enhancing the quality, effectiveness, and consistency of practical nursing education across Canada.
In support of our strategic goals, a national educators conference is organized annually and takes place in a different province each year. These conferences have been very successful, with an average of about 120 participants from across Canada in attendance and much great feedback from attendees. The venue provides the opportunity for practical nursing educators to get together, to collaborate, to share best practice stories, and to gain a clearer understanding of the big picture of practical nursing education across the country, as well as learn and understand more clearly the role of the licensed practical nurse, or registered practical nurse, as it is called in some provinces.
Over the years, some common themes have been identified as issues, or barriers, perhaps, by practical nurse educators across Canada. I will speak to some of those now.
The first is the difficulty in obtaining appropriate clinical education sites in which LPNs, the licensed practical nurses, or RPNs, registered practical nurses, work to full scope of practice, especially in mental health and maternal child nursing areas in some jurisdictions.
Second, with increased competition for clinical sites, simulation has been seen as a way to augment clinical experience, but not everyone has access to good simulation labs or good equipment, because of the cost of set-up and maintenance. Simulation in more remote areas of the country may not be readily available, and this is seen as a barrier in some instances.
The third is difficulty in obtaining clinical instructors. These positions are on a part-time casual basis, and it's difficult to attract qualified nurses for short-term casual work.
Then we raise the issue of the role of clarity. The role of the practical nurse may vary from setting to setting and from province to province in terms of the ability to work to their full scope of practice. Often, fellow health care staff do not fully understand the role of the LPN or RPN, because the role can vary a great deal depending upon the setting in which the individual is working.
In Ontario, for example, the Nursing Act identifies scope of practice for an RN and an RPN in the same statement, noting that nursing is one profession with two categories. From this, some argue, the scope of practice statement for nursing in Ontario is the same, which technically it is. Confusion can arise when “scope of practice” is being defined and used in two different ways. We feel it would be helpful to have more clarity in terminology, and on a national scale.
While role clarity is sometimes fuzzy for the LPN or RPN, there are many provincial differences and there is possibly more confusion in respect to the role of the unregulated health care worker. This can cause much confusion at the national level whenever we talk about the LPN and RPN role in terms of delegation to the unregulated worker.
Some areas identified as important in the future of practical nursing education as we move forward include: first, providing opportunities for inter-collaborative education, for example, forming teams of students from different disciplines to work collaboratively within their respective roles and scopes of practice in a clinical experience so as to bring about positive outcomes in meeting their learning goals; second, exploring the possibility for students and/or faculty to exchange between provinces and other regions of Canada in order to gain a broader national perspective; third, having continuing opportunities for international placements for practical nursing students in order for them to work inter-collaboratively and develop cultural competence and learn first-hand about health care standards, the role of the health care team, and health care issues that affect populations outside of Canada.
Continuing to support the transition of internationally educated nurses into the Canadian nursing system is identified as very important and has been a standing agenda item for our board for some time. This offers many benefits. I believe we all see that the nursing shortage will likely happen. It hasn't to the extent we anticipated some time ago, but it's inevitable that it is about to happen, given the age of the nursing population at this point.
For example, data for Nova Scotia from the Canadian Institute for Health Information's “Regulated Nurses, 2012” report shows a decrease in the overall number of licensed practical nurses of 1.5% from 2011 to 2012, with the average age of the LPN in the province being 45 years. On par with the RN population age, many LPNs can retire in the next few years. In addition to filling the gap in much-needed nursing positions, well-educated and experienced IENs, internationally educated nurses, help make our health care system more culturally diverse. As our population ages, these individuals, IENs in other words, will play an important role in sustaining Canada's health care system.
An issue brought forward in Quebec is that all nurses there who are internationally educated must have English proficiency, of course, as they do in every other province, but they must also have French proficiency. Under current legislation, graduates of nursing programs have to obtain a licence in the province from which they graduated before they can move on to become licensed in another province. Without passing the French exam, they cannot be licensed; therefore, they cannot move on to another province or become licensed in another province. This extra layer can certainly limit the internationally educated nurse's success.
In conclusion, on the topic of internationally educated nurses, I'd like to share with you a best practice story from my province, Nova Scotia. Over the past four years the College of Licensed Practical Nurses of Nova Scotia, CLPNNS, in partnership with the Nova Scotia Community College, NSCC, and with funding from the Nova Scotia Office of Immigration, has developed and implemented a program for internationally educated nurses. This program is called the pathway to success. The program builds on the internationally educated nurse's education and experience, leading to a credential as a licensed practical nurse and employment in Nova Scotia.
Since 2010 CLPNNS has licensed 113 IENs as LPNs in Nova Scotia, and today approximately 90% are currently employed in Nova Scotia. In March the pathway project received the 2014 International Qualifications Network, IQN, innovation award at the awards ceremony held in Ottawa. We currently have funding for this project until the end of June, and we're looking forward to meeting the educational requirements of possibly up to 20 more internationally educated nurses in that timeframe.
Thank you very much for your time this morning.