Collaborative practice is a goal and focus for change throughout health organizations. Today, work is underway provincially and nationally to integrate interprofessional collaboration strategies into health care education and practice. The new National Interprofessional Competency Framework (CIHC, 2010) provides a launch point for such direction by focusing on role clarification, team functioning, interprofessional conflict resolution, and collaborative leadership (see pg. 23 of CARE Fall 2011 for more details about this Framework). Health organizations across Alberta are recognizing the need for collaborative directives to guide and support teams and are committing to such practices. These discussions are not new; in fact, several research projects conducted in our province have clearly noted these components and their connection to collaborative practice (Besner et al., 2005; Cummings et al., 2011; White et al., 2009).
In recent months, CLPNA has expressed concern around a possible new staffing plan within Alberta’s new mega hospital in south Calgary. This potential model involves a move to registered nurse (RN)-health care aide (HCA) staffing, which could exclude the LPN role in this facility. CLPNA is very concerned about any model where LPNs are excluded particularly when current evidence and best practice, much of which comes from within AHS, demonstrates the value of the LPN on interprofessional teams.
To be clear; CLPNA strongly supports full utilization of all members of the health care team and we respect and value our working relationship with HCAs and RNs. However, in today’s health care world, literature and best practice’s demonstrate the importance of the role of professional nursing in acute care. And further, the right staff mix of professional nurses with support from HCAs ensures improved patient outcomes and nurse retention, with RNs able to work to their full potential when LPNs are utilized on teams (White et al., 2009).
As a profession committed to evidence based decision making, we look to research to provide good guidance. However, the nursing research that examines the impact of staff mix on patient outcomes is far from conclusive to date, and the evidence that does exist is often taken out of context. Missing from this research is evidence regarding the role and contribution of LPNs. This omission is particularly important given the recent changes in LPN preparation including a diploma as entry to practice (2005), mandatory post-basic education (1999), and advanced competencies (2003 onward). These preparations, combined with improved utilization, have changed our profession into the highly competent professional nurse’s who can be employed in any setting.
AHS has a golden opportunity to lead health care best practices in Canada. A new facility provides a clean slate for the creation of a health care culture that focuses on interprofessional collaboration and patient centered care. Based on current and predicted staff shortages it will clearly take all of us, strongly committed to the same goals, to meet the needs of Albertans.
Through discussion with AHS leaders, CLPNA is assured that multiple factors will be considered as staffing decisions are made for the new acute care facility, and ultimately throughout the health care system. Health reform and sustainability is dependent on high functioning health care teams that are inter-professional, fully utilized, and supported by well prepared and equipped leaders. Collaboration in health care is not an option, but a necessity.
Alberta’s Licensed Practical Nurses are well positioned as highly skilled professional nurses to assume their full role on an interprofessional collaborative care team. In a world where it will take everyone, it makes good sense to utilize each resource to the fullest, excluding no one.
We are encouraged to see fresh commitment from AHS through recent provincial directives that value, respect, facilitate, and expect collaboration among all providers toward a common goal of patient centered care.
Besner, J., Doran, D., McGillis Hall, L., Giovanetti, P., Girard, F., Hill, W., Morrison, J., & Watson, L. (2005). A systematic approach to maximizing nursing scopes of practice. Retrieved from http://www.calgaryhealthregion.ca/hswru/documents/reports/MNSOP_Final%20Report_Sept%202005.pdf
Canadian Interprofessional Health Collaborative (CIHC). (2010). A national interprofessional competency framework. Retrieved from www.cihc.ca
Cummings, G., Spiers, J., Laschinger, H., Leiter, M., Wong, C., Norton, P., Gellatly, I., & Midodzi, W. (2011). QWEST Symposium: Reporting-back to the community. Retrieved from http://www.clear.ualberta.ca/en/~/media/University%20of%20Alberta/Faculties/Faculty%20of%20Nursing/Departments/Clear%20Outcomes/Documents/QWEST_Symposium_final_report_May.pdf
White, D., Jackson, K., Besner, J., Suter, E., Doran, D., McGillis Hall, L., & Parent, K. (2009). Enhancing nursing role effectiveness through job redesign. Retrieved from https://www.clpna.com/Portals/0/Files/doc_JobRedesignStudyFinalReport2009.pdf