Good morning.
Mr. Chair and members of the committee, I'm very pleased to have the opportunity to appear before you today as chair of the Canadian Council for Practical Nurse Regulators to provide an overview of the profession of practical nursing from the regulatory lens and respond to your questions pertaining to scope of practice for licensed practical nurses.
I have been a licensed practical nurse for 31 years in the province of Newfoundland and Labrador. My clinical experience has included mental health, medicine, surgery, emergency care, and community discharge planning. For the past 15 years I have been employed as the executive director and registrar of the College of Licensed Practical Nurses of Newfoundland and Labrador.
The Canadian Council for Practical Nurse Regulators is a federation of provincial and territorial members identified in legislation as responsible for the safety of the public through the regulation of licensed practical nurses. The mandate of the Canadian Council for Practical Nurse Regulators is to support the regulation of licensed practical nurses through collaboration, collectively, internally, and externally, with other provincial and territorial regulatory organizations to maintain and enhance professional relationships; to support provincial-territorial organizations with regard to decision-making, resource allocation, management issues, and individual provincial-territorial regulatory laws and resources; additionally, to support processes that allow for accountability and responsibility for decisions and which recognize the individuality of the jurisdiction; and to promote excellence in practical nursing regulation by demonstrating leadership, best practice, innovation, and professional development.
Canadians expect their health care system to provide them with safe care and to support them in becoming as healthy as possible. Meeting this expectation requires that licensed practical nurses be educated and capable of providing safe, competent, and ethical nursing care. Licensed practical nurses must demonstrate the capacity to meet jurisdictional entry-to-practice competencies and be able to practice within the context of relevant legislation and regulations while adhering to professional standards of practice and codes of ethics for the profession. Through legislation, the practical nursing profession is also granted the authority to recognize and set standards of education and standards of practice for the profession, with an obligation to protect and serve the public interest.
The practice of licensed practical nurses spans a continuum from novice to expert and may encompass clinical practice, administration, education, research, consultation, management, regulation, policy, and system development. Through their entry-level education program, licensed practical nurse experience, and continuing education activities, licensed practical nurses gain the theoretical and practical foundation to provide safe, competent, and ethical nursing care. Licensed practical nurses care for people of all ages regardless of gender, ethnicity, or social situation, and in a variety of practice settings, such as hospitals, communities, homes, clinics, schools, and residential facilities. Their practice requires knowledge about health and illness, human biological sciences, the pathophysiology of diseases, health promotion and prevention, teaching and learning, and health care systems.
Licensed practical nurses have a duty to practice safe and appropriate nursing care and to practise collaboratively with other members of the health care team. They practise autonomously within their own level of competence and seek guidance from other health care professionals when aspects of the care required are beyond their individual competence. The psychosocial components of care, including interpersonal, communication and teamwork skills, are fundamental to safe and effective practice.
Licensed practical nurses are required to practise in accordance with the standards of practice for their profession. The standards of practice are authoritative statements that define the legal and professional expectations of licensed practical nursing practice. In conjunction with the Code of Ethics for Licensed Practical Nurses, they describe the elements of quality LPN practice and facilitate mobility through interjurisdictional mutual understanding and agreement on expectations and requirements for their practice.
As members of a self-regulating profession, LPNs are personally responsible for meeting the standards of practice. The legislative responsibility for setting, monitoring, and enforcing the standards of practice lies with the provincial and territorial regulatory authorities.
The policies and practices of employing organizations do not relieve LPNs of accountability to meet these standards of practice. Where the legislation and this standards of practice document conflict, legislation will apply.
Traditionally, nurses have worked together to provide quality care, and have actively sought the responsibility for self-regulation of that care through legislative authority. As mentioned earlier, there are three groups of professional nurses in Canada: licensed practical nurses, or registered practical nurses as they're called in Ontario, registered psychiatric nurses, and registered nurses. They are responsible to their respective professional nursing regulatory bodies.
Scopes of practice continue to evolve over time due to changes in the health care environment and the health care delivery system. It is essential that there be cooperation and collaboration between and among professional nurses, the nursing regulatory bodies, government, employers, and educational institutions in order to provide guidance to nurses and ensure public safety. Regulatory bodies, in collaboration with other members, will advocate for the development of public policy that fosters health promotion and wellness.
According to the Canadian Institute for Health Information, the supply of licensed practical nurses eligible to practise in Canada grew by 23.2% between 2008 and 2012, reaching a total of 99,935. During the same period, the LPN workforce increased by more than 18%, from 74,380 to 88,211. The rate of LPNs per 100,000 population increased from 223 in 2008 to 253 in 2012.
Underutilization of the LPN scope of practice has been a long-standing issue for the profession in Canada. It is imperative that these issues be addressed. I believe the federal, provincial, and territorial governments need to change the way health human resource planning is conceptualized in Canada. It is not acceptable to regulate a profession and then permit others to arbitrarily restrict the practice of that same regulated health professional. Limiting the practice of nursing professionals to roles that are less than those enabled by educational preparation and regulatory authority wastes precious nursing human resources at a time when the health care system can ill afford it.
Ensuring that the right mix of providers is available to meet the needs of Canadians is everybody's business. Federal, provincial, and territorial governments need to ensure that licensed practical nurses are included in local, provincial, and national policy-making decisions and committees that affect nursing practice.
Licensed practical nurses have an important contribution to make in the delivery of appropriate, effective nursing services in Canada. A concerted effort is required on the part of the federal, provincial, and territorial governments to eliminate barriers that limit practical nursing student access to clinical placement practice experience and that prevent LPNs from practising to their full scope of practice within health care settings across Canada.
In closing, like many other health professionals, practical nurse regulators are very committed to having their members provide the right care to the right person by the right caregiver to optimize care and resource utilization while ensuring public safety for the provision of nursing services in Canada.
The Canadian Council for Practical Nurse Regulators is keenly interested in engaging with national and provincial professional authorities and organizations to contribute to the dialogue and to keep abreast of new initiatives that may benefit the Canadian health care system.
Thank you once again for the opportunity to be here with you today.