The role and education of the Licensed Practical Nurse has grown and changed considerably over the years as the health care system and legislation have evolved. Here is our story.
History of the Licensed Practical Nurse in Alberta:
1947: Post-WWII nursing shortage leads to Nursing Aides
- WWII: As a result of a shortage of registered nurses during World War II, the School for Nursing Aides was established by the Department of Veterans’ Affairs and Canadian Vocational Training. Enrolment was restricted to armed forces personnel with classes held in Quonset Huts on the grounds where the Southern Alberta Institute of Technology (SAIT) is now located.
- In 1947, civilians were accepted as trainees and the “Nursing Aides Act” was passed by the provincial government, providing for the licensing of the Certified Nursing Aide. The Department of Public Health took over the training program. On successful completion of a forty week training program (20 weeks theory and 20 weeks practical), they were issued a certificate and, for one dollar, a license to practice in Alberta.
- In 1950, the graduates were given a pin and a grey cap with a white band to complement the uniforms. Enrolment in the training program was restricted to women only and uniforms consisting of a one piece grey dress, covered by a heavily starched bib apron, white nylons and white shoes. It was cause for dismissal from the program if you appeared in public in your uniform without it being covered, or had your hair touching your collar or wore jewellery. The uniforms were all measured carefully to ensure they were equal distance from the floor, 16 inches. The height of the student was irrelevant.
- In 1957, nursing aides established an organized group to meet and discuss concerns and in 1959 were given a seat on the Nursing Aide Advisory Committee.
- The Department of Health opened a second training centre in Edmonton in 1958 located in the old Garneau School near the University of Alberta. Entrance requirement was a grade nine education.
1961: Alberta Certified Nursing Aide Association (ACNAA) incorporated
- May 25, 1961 the Alberta Certified Nursing Aide Association (ACNAA) became incorporated under the Societies Act with a membership of 443 and 12 chapters.
- Beside the patient care, the role of the Certified Nursing Aide (CNA) included housekeeping duties such as dusting furniture and floors, cleaning the charting and service rooms and caring for all of the equipment. Supplies were not disposable, everything was re-used, it was washed and then sterilized. Sunday afternoons when all of the patients were put down for their nap, the time would be spent sharpening the needles. It had to be done very carefully to ensure there were no barbs and that they were sharp enough to easily penetrate the skin. At night, the flowers were all removed from the room, because it was thought they consumed too much oxygen, they were refreshed and put back in the room in the mornings.
1963: Without unions, ACNAA negotiates wages & working conditions with Alberta Hospital
- ACNAA performed many roles both social and economic as they began meeting with the Alberta Hospital Association to discuss wages and working conditions. In 1963, an agreement was reached with Alberta Hospital Association on personnel policies. Unions were not a common thing and at this time were almost unheard of in hospitals. The employees were completely at the mercy of the hospital administration and it was not uncommon for staff to start at 7:00 in the morning, work until the patients were settled for a nap after lunch, have 3 hours off and then return for the supper hour and to settle the patients for the night and finished work at 7:00pm. Ten and twelve day stretches without a day off were common. There was no such thing as overtime, you were paid by the month and worked whatever time you were scheduled.
- The entrance requirement for the Nursing Aide training program was increased to Grade 10 in 1964.
1965: Vocational Schools established in Alberta; offer Nursing Aide Program
- In 1965,the Government of Alberta approved in principle the establishment of Alberta Vocational Centres (AVCs) that would concentrate on the education of adults, including offering the Nursing Aide Program at AVC Edmonton (today known as NorQuest College) and AVC Calgary (today known as BowValley College).
- Hospitals discontinued the laundering of uniforms for nursing aides and the legislation was amended and a grey dress uniform became the call of the day. It was dull, unflattering and very unpopular.
- The Association submitted a resolution to the Advisory Council that they be allowed to wear a white uniform.
1967: Nursing Orderly program for men only established
- A training program for the male counterpart of the Nursing Aide, the Nursing Orderly, was established by the Department of Education in September 1967 in Edmonton. It was housed in the CHED radio building. The training program was the same length of time as the Nursing Aide Program, but differed in the method of delivery, lacked the Gynecology, Obstetrics and Pediatric components, but had increased the Orthopedic and Urology components. Nursing Orderlies were trained to do catheterizations, and Nursing Aides were not. Instructional staff taught classroom content and then supervised the students in clinical practice settings. A similar Nursing Orderly Program opened at the Calgary Foothills Hospital. After some years, the orderlies formed an association with voluntary registration, but were not regulated under provincial legislation.
- In 1971, the Nursing Aide Program rented space in the AVCs. The Nursing Aide and Nursing Orderly programs were on two separate floors and the students and staff were not allowed to communicate with one another.
1971: ACNAA becomes bargaining agent for Certified Nursing Aides
- In 1971, there were more formal processes and some unions in place for bargaining with the employers. ACNAA became officially recognized as a bargaining agent and represented the CNAs. RNOs were represented by the Alberta Union of Provincial Employees (AUPE) or by the Canadian Union of Public Employees (CUPE).
1972: Canadian Association of Practical Nurses and Nursing Assistants founded
- In 1972, together with eight other practical nurse/nursing assistant associations, the Alberta Certified Nursing Aide Association became a founding member of the Canadian Association of Practical Nurses and Nursing Assistants. Communications were established that helped to provide for commonality to increase mobility and improve education.
- Bylaws were amended for the Association in 1973 to comply with the policies of the Board of Industrial Relations and to expand the bargaining unit to include auxiliary nursing care personnel. Alberta Association of Certified Nursing Aides (AACNA) began collective bargaining with the Alberta Hospitals Association (AHA). Formal negotiations were carried out with the Alberta Hospital Association and the Association obtained collective bargaining certificates in six Alberta Hospitals and eighty-nine voluntary recognition certificates.
1976: Supreme Court of Alberta ruling brings together Nursing Aides and Nursing Orderlies
- Great inequities existed in the pay between the nursing aide and the nursing orderly with latter receiving approximately one hundred and forty dollars per month more. In 1974, briefs were submitted to the Government, the Human Rights Commission and the Board of Industrial Relations. A representative group of six Certified Nursing Aides from the Royal Alexandra Hospital, Edmonton, filed complaints with the Human Rights Commission for equal pay with the Registered Nursing Orderlies on the basis of equal pay for equal work. The first woman entered the orderly program.
- Two years after the initial complaints to the Human Rights Commission regarding discrimination on the basis of sex, the Supreme Court of Alberta ordered that CNAs and RNOs would be paid equal wages for work of equal value. This decision ruling in favour of the Nursing Aides gave direction that changed their history. The order was to cease discrimination on the basis of sex and that the Certified Nursing Aide and the Registered Nursing Orderly be paid equally. The effect of the Order went far beyond pay; the two groups were represented by different unions, trained in separate programs and under the authority of different government departments. CNAs were regulated under legislation while RNOs were voluntarily registered by the Alberta Association of Registered Nursing Orderlies. To eliminate the pay discrepancy, the Nursing Aides and the Nursing Orderlies were swept into the representative union with the largest majority (AARNA).
1978: Nursing Assistant Registration Act approved; Alberta Association of Registered Nursing Assistants succeeds ACNAA
- Legislation was drafted and approved January 1, 1978 for the Nursing Assistant Registration Act. The Act combined the nursing aide and the nursing orderly into the designation of Registered Nursing Assistant (RNA). The Alberta Association of Registered Nursing Assistants succeeded the Alberta Certified Nursing Aide Association. A Nursing Assistant Registration Board was established to oversee the registration and discipline of the RNA. For the first time, a Registered Nursing Assistant is appointed as Registrar.
- A competency analysis was done, to determine the necessary skills for the nursing assistant, and a new curriculum was designed and implemented in September 1979, under new title of The Nursing Assistant Program.
- In 1980, the Government of Alberta passed the Health Occupations Act, which allowed health occupations to become designated, and the education, registration and discipline of it’s members would be the responsibility of a multi-disciplinary committee.
- In 1982, the AARNA established a committee to do comparative analysis of the Nursing Assistants Registration Act and the Health Occupations Act (changed to the Health Disciplines Act). The committee recommended seeking designation under the Health Disciplines Act.
1981: Nursing Assistant education becomes available by distance delivery
- Beginning in 1981, the Nursing Assistant Program became available outside of Edmonton and Calgary through a distance delivery process on demand. The first program was brokered to the Alberta Vocational Centre, Grouard (now Northern Lakes College). The program ran one class a year at Grouard according to demand.
1987: Professional Council of Registered Nursing Assistants becomes self-regulated profession; new graduates required to write standard exam
- An amendment to the Health Disciplines Act in 1985 opened the doors to self-governance for designated health disciplines. RNAs sought the right to self-governance through AARNA. Since AARNA was functioning as a bargaining agent, self governing activities were seen as a conflict of interest; hence a separate professional body was established. A founding convention was held in May followed by the election of a Board of Governors.
- Entrance requirement for the program was increased to a grade 12. Government transferred all records for registration to the newly formed Professional Council of Registered Nursing Assistants in October 1986.
- Legal recognition as a professional corporate body called the Professional Council of Registered Nursing Assistants, under the Health Disciplines Act took effect on January 1, 1987 and the Nursing Assistant Regulations came into effect. Making RNAs the first designated health profession under the Health Disciplines Act. RNAs had finally become self regulating with a scope of practice outlined by government Regulations. The Professional Council assumed the registry of Nursing Assistants. It was self-regulating, responsible to the public and to the membership, to ensure the development of a better quality health care system through education, licensing, evaluation and discipline. For the first time RNA’s from Alberta were required to write the Canadian Nurses Association Testing Service Examination for Nursing Assistants.
1990: Professional Council of Licensed Practical Nurses changes title of profession
- In 1989, RNAs applied for a change of title to Licensed Practice Nurse. This was a title supported by the Canadian Association of Practical Nurses and Nursing Assistants (CAPNA). This title was widely used in the United States and was being promoted across Canada.
- In December 1990, an amendment to the Regulation received approval, by Order in Council, and the title was changed to Licensed Practical Nurse. The professional organization's name also changed to the Professional Council of Licensed Practical Nurses (PCLPN).
1995: LPN devaluation and membership decline leads to mandatory educational upgrading
- From 1986 to 1999, the number of Licensed Practical Nurses registered in Alberta steadily declined as the value and the role of the LPN was seriously questioned. Membership declined from 8646 in 1986 to 4342 in 1999 at rates from -1.3% (1991) to -10.8% (1996) per year. LPN jobs were being eliminated because:
o Their education did not prepare them to meet the changing needs of the health care system;
o The education of the current practitioners was so diverse that nurse managers could not be assured of a consistent level of competence; and,
o The LPN Regulation was a barrier to effective utilization.
- By the mid 1980’s RNAs were being relegated to long-term care and later were even removed from this setting. Nursing Managers stated the RNAs did not meet the needs of the system and, as they resigned, they were not replaced. When this information was brought to Government, it led to the formation of the LPN Education Standards Advisory Committee (ESAC) in 1990.
- The Educational Standards Advisory Committee was established to advise the Minister on program matters. This committee spent four years doing a complete review of the program, consulting with nursing managers throughout the Province. The Health Disciplines Act outlined the advisory capacity the discipline has regarding educational preparation for the profession. The Professional Council was very involved with the basic and post basic education of LPNs.
- In 1995, Health Disciplines Board forwarded the Education Standards Advisory Committee (ESAC) program recommendations to the Department of Advanced Education for the Practical Nurse Program. Recommendations are approved necessitating major changes to the curriculum. The responsibility for the Educational Standards Advisory Committee is transferred to the PCLPN.
- In 1995, the PCLPN established a mandatory upgrading requirement for all registrants. To be eligible for registration renewal in 1999, all registrants must have completed courses in Physical Assessment, Medication Administration and Infusion Therapy.
- Regulation amendments are approved in 1997 to allow LPN’s to administer narcotics and subcutaneous injections.
- In 1997, PCLPN celebrates 50 Years of the LPN profession in Alberta.
- In 1997, PCLPN starts a website at www.compusmart.ab.ca/pclpn describing the organizations key people, registration info, education updates, and special events. The organization also gets an email account.
- In 1998, the Practical Nurse Program became available in distance delivery format from Alberta Vocation College Lesser Slave Lake.
- In 1998, the first edition of the LPN Competency Profile which describes LPN scope of practice in Alberta was finalized. Later, this document was used as a template for other LPN jurisdictions in Canada as they developed their own Competency Profiles.
1998: PCLPN changes title to College of Licensed Practical Nurses of Alberta (CLPNA)
- In 1998, the PCLPN changed its title to the College of Licensed Practical Nurses of Alberta (CLPNA).
- In 1999, the Government of Alberta passed the Health Professions Act. The Act will eventually place all regulated health professions under one Act. Regulations will be profession specific. As professions complete their Regulations and the Consultation they will be proclaimed under the Health Professions Act.
- The lowest LPN registration in Alberta in recent times was experienced in 1999 with 4342 members. Registration began increasing again in 2000.
2003: CLPNA proclaimed as a regulated health profession under the Health Professions Act (HPA)
- The College of Licensed Practical Nurses of Alberta (CLPNA) was formally proclaimed on April 12, 2003 as a regulated health profession under the provisions of the Health Professions Act (HPA). CLPNA approved a new Mandate, Vision, Mission and Values as part of their strategic plan projecting 5 years in the future to 2008. The four primary areas of activity are regulation, education, advocacy, and leadership.
- In 2004, the “1st Annual LPN Appreciation Dinners” were held across Alberta to celebrate Nurses’ Week in mid-May. Over 400 LPNs attended the dinners held in Edmonton, Grande Prairie, Calgary, Red Deer, Lethbridge, Medicine Hat, Fort McMurray, and Bonnyville.
- 2004: CLPNA Practice Statements released for the first time. Practice Statements provide LPNs, employers and the public with information and clarity regarding the scope of practice of an Alberta LPN; and to assist employers with utilizing LPNs more effectively in the health care system. The first Practice Statements issued are:
- Practice Statement 1: Professional Responsibility and Accountability
- Practice Statement 2: Temporary Registration
- Practice Statement 3: Accepting, Transcribing and Processing Physicians’ Orders
- Practice Statement 4: Actively Engaged in Practice
- Practice Statement 5: Fitness to Practice
- Practice Statement 6: Therapeutic Nurse-Client Relationship
- Practice Statement 7: Specialized Practice
- Practice Statement 8: Self-Reporting of Criminal Offences
- 2004: A new Intradermal (ID) Medication Module for self-study was released.
2004: LPNs in Specialized Practice recognized by the Health Professions Act
- 2004: LPNs in Specialized Practice (Operating Room, Dialysis, Advanced Orthopedics or Immunization) required by the Health Professions Act to submit proof of specialized education to CLPNA in order to be granted specialization on their Practice Permit.
- 2004: Canadian Council of Practical Nurse Regulators (CCPNR) was formed in October 2004 with representatives from every nursing jurisdiction in Canada except the Northwest Territories.
- 2004: The 2nd Edition of the Competency Profile for LPNs was released. The Profile describes the scope of practice of LPNs in Alberta.
- 2005: New Practice Statements released:
- Practice Statement 9: Confidentiality
- Practice Statement 10: Documentation
- Practice Statement 11: Foot Care
- Practice Statement 12: LPN Preceptor Role
- 2005: The CLPNA released a document, “New Times – Bright Future: Primary Health Care: Emerging Roles for LPNs” to clearly articulate the role of the LPN in primary health settings.
- 2005: First classes begin in Fall 2005 for students who will graduate with a Diploma in Practical Nursing. The work towards a Diploma program began in 2002, and will be gradually implemented among the colleges providing the practical nurse program in Alberta.
- On December 14, 2005, CLPNA Executive Director/Registrar Pat Fredrickson was awarded the Alberta Centennial Medal recognizing her leadership in the nursing community in Alberta. The medal was presented by the Honorable Iris Evans, Minister of Health and Wellness.
2006: Retirement after 20 years for CLPNA Executive Director
- 2006: Lifetime Achievement Awards given to retiring CLPNA Executive Director/Registrar Pat Fredrickson (1986-2006) and Director of Practice and Policy Rita McGregor (1987-2006). Fredrickson and McGregor’s terms ended July 1, 2006. As per the succession plan, Linda Stanger became the new Executive Director/Registrar. Stanger sat as a Public Member to the CLPNA Council from 2001-2004 and brings a background in senior health-care administration along with a Bachelors of Nursing and a Master of Science degree in Administration.
- 2006: Post-basic LPN certificates from Bow Valley College go online for accessibility throughout the province. Certificates include: Leadership for Practical Nurses; Chronic Disease Certificate for Practical Nurses; Gerontology Certificate Program for Practical Nurses; and Post-PN Mental Health Certificate.
- 2006: The Immunization Certificate Course, previously available solely through the CLPNA, became available through Bow Valley College on September 1, 2006, with an online version planned for 2007. CLPNA also suspended the employer brokering of the Intramuscular and Intradermal Medication Course on the same date.
2006: CLPNA receives $3.3 million grant to support LPN continuing education
- 2006: The CLPNA received a $3.3 million dollar grant from Alberta Health and Wellness to support continuing education needs of LPNs in Alberta. In a one-time endowment, the Alberta Government established parameters for spending that ensure an ongoing fund to support LPN continuing education into the future. The grant funds are administered and distributed by the Selections Committee of the Fredrickson-McGregor Education Foundation for LPNs.
2006: Alberta Health and Wellness approves LPN Diploma
- 2006: In 2006, Alberta Health and Wellness approved the Diploma as the entry to practice credential for newly graduating Licensed Practical Nurses in Alberta. Graduates of the new diploma program began entering the workforce in the spring of 2007. Working closely with the CLPNA, the colleges that deliver practical nurse education developed a new curriculum enhancing the depth and breadth of nursing content, and increasing liberal arts courses to broaden student’s knowledge base. The program was lengthened from a 52 week to a 68 week program to increase time for students to consolidate their learning. Admission requirements also changed. The Diploma program was a goal of the CLPNA for many years and is consistent with a national trend in practical nurse education.
- 2006: 2005 National Survey of the Work and Health of Nurses (NSWHN), the first nationally representative survey to focus on the working conditions and health of Canada’s nurses is released. 18,676 RNs, LPN, and RPNs participate.
- 2006: CLPNA releases one of the first LPN-focused applied research projects. Funded by Health Canada and led by Bow Valley College in partnership with CLPNA, the result of the research project is an online Toolkit to assist managers in successfully transitioning LPNs to full scope of practice within continuing care facilities.
2007: 60th Anniversary of practical nursing in Alberta
- 2007: CLPNA celebrates 60th Anniversary of practical nursing in Alberta at the 2007 Spring Conference.
- 2007: Columbia College in Calgary becomes the first private college in Alberta to be approved as a provider of the practical nurse education.
- 2007: The 2007 CLPNA Member Survey was completed and results tabulated by the Population Research Lab at the University of Alberta. Survey results are used for planning and to inform stakeholders and decision-makers in areas of LPN utilization, career satisfaction, retirement plans, and relations within health care teams.
2007: Practical Nursing for Internationally Educated Nurses program begins at NorQuest College
- 2007: Practical Nursing for Internationally Educated Nurses program at NorQuest College trains nurses trained outside Canada with the knowledge, clinical judgement, and communication skills required for Canada.
- 2007: New CLPNA Standards of Practice and Code of Ethics approved by Council December 7, 2007.
- 2007: As directed by the Health Professions Act, CLPNA began the Continuing Competency Program (CCP) Validation program verifying membership learning completed in the last two years.
2008: CLPNA launches new brand and magazine
- 2008: CLPNA launches its new brand at the 2008 Spring Conference with a redesigned logo and website, www.clpna.com. The new logo features a modernization of nurse Florence Nightingale’s lamp, and a focus on the term “Licensed Practical Nurse”. A tagline, “Competent – Committed – Care” was also revealed along with the statement “LPNs – Professional Nurses”.
- 2008: CARE magazine replaces former CLPNA newsletter “News & Views”. CARE magazine is redesigned as a glossy, colour magazine with feature stories and a member’s section.
- 2008: The CLPNA office moved to a new store-front location at 13163-145 Street, Edmonton, AB.
- 2008: A partnership between CLPNA, NorQuest College and Capital Health developed a process to recruit, assess and register nearly 1000 internationally educated nurses (IENs) from the Philippines to work in Alberta.
- 2009: LPN scope of Practice was updated in Spring 2009 allowing LPNs in appropriate environments to administer medications via peripheral intravenous (IV) push. Effective 2010, all graduates of Practical Nurse programs will have achieve competence in IV initiation.
- 2009: Practice Statement 13: Abandonment of Care was approved by CLPNA Council on September 26, 2008.
- 2009: An Occupational Profile Video featuring LPNs was created for the Alberta Learning Information Service (ALIS) website. ALIS is a Government of Alberta website and the provincial gateway to help Albertans plan and achieve educational and career success! It provides information for career planning, post-secondary education and training, educational funding, job search, labour market trends, and workplace issues.
2009: $1.2M received from Alberta Health and Wellness for Refresher Bursaries
- 2009: Alberta Health and Wellness provided CLPNA with $1.2 million for bursaries to offset tuition costs for students enrolled in LPN refresher/re-entry educational programs. Refresher programs are offered at Bow Valley College and NorQuest College.
- 2009: Due to the grave concern with the H1N1 Pandemic, CLPNA releases Practice Statement 14: Pandemic Preparedness.
2009: Number of Alberta LPNs doubles in 10 years from 1999 to 2009.
- 2009: The number of LPNs registered (8531) is double the number registered only 10 years previously from 4342 in 1999 to 8531 in 2009.
- 2010: The Knowledge and Education Project (KEP) report released in early 2010 is the culmination of three years of research looking at the academic knowledge held by students in all three categories of nurse just prior to graduation.
- 2010: CLPNA commissioned a survey of Albertans and LPNs regarding 15 key values around professional nursing care.
- 2010: A Registration Fee increase was announced by CLPNA Council. The last membership fee increase was for the 2004 registration year. Registration Fees for an Active/Limited/Conditional/Temporary Practice Permit for the 2010 registration year is $250, and will increase to $300 for 2011, and $350 for 2012.
- 2010: First CLPNA Position Statement regarding “The LPN Role in Triage – Specific Settings” was released.
Content adapted by Carolyn Black (December 2010), Pat Fredrickson (April 2007), and Kathy Glover (July 2001).
The Practical Solution
The Practical Solution