by Jo-Anne Macdonald-Watson, CLPNA President, and Linda Stanger, CLPNA Executive Director
Managing human resources, especially nurses, in healthcare is a difficult task made more difficult by outdated legislation and the lack of full-utilization of staff.
In January, Alberta Health Services (AHS) announced a new ‘Patient Care Based Funding’ model for long term care centres. Also announced was the loss of 48 Licensed Practical Nurse (LPN) positions at CapitalCare, Edmonton with implementation of the new model. On January 24, 2013, the Edmonton Journal[i] reports that Health Care Aides (HCAs) would be hired in place of the 48 LPNs, with existing Registered Nurses (RNs) taking on the medication administration and other specific nursing duties.
After careful consideration we believe there are core issues that require system follow-up.
Managing human resources is an ongoing challenge. At the College of Licensed Practical Nurses of Alberta (CLPNA), we regularly receive calls from LPNs working in long term/continuing care facilities. These LPNs express concerns regarding the high demands in the work setting, ongoing staffing issues, and sheer volume of workload that impacts safe quality care by the nursing team. Many LPNs report working short staffed and are often mandated to do overtime just to maintain regulated nursing care on site. With these issues reported as ‘routine’ in some settings, it is difficult to understand why funding changes designed to improve a system would cause nursing layoffs in a system already seemingly stressed.
Full utilization of care providers is not yet achieved. LPNs have consistently reported that they are underutilized throughout the system, and although there is a move in Alberta to increase utilization, we aren’t there yet. IF LPNs are working in roles that can appropriately be assumed by a HCA then the roles should be filled by HCAs. Nurses should be working in roles that utilize the full extent of their nursing knowledge, skill and ability. CapitalCare CEO Iris Neuman assures CLPNA that the LPNs remaining in their system will be working to full scope. Issues around full utilization are not exclusive to the LPN. 2009 Alberta research[ii] revealed that when LPNs did not work to full scope on particular care units, neither did the RNs on these same units. Supported by this evidence the question should be, if LPNs are doing work that can be done by HCA’s, then are the RNs doing work that could be appropriately done by the LPN?
Legislation guiding decisions is dated. The Alberta Nursing Homes Act, Nursing Homes Operation Regulation[iii] 258/1985 (amended 193/2012) guides operators of nursing homes in many areas including appropriate staffing. This regulation, written in 1985, is now a barrier to effective staff utilization, as it does not account for the evolution in education, competencies and regulation for all nurses since then. Specifically for LPNs, the Nursing Homes Operation Regulation does not even consider an LPN as a ‘nurse’, but still refers to our profession as Nursing Assistants as per the 1986 Registered Nursing Assistants Regulation. A needed change to this regulation was highlighted by CLPNA in our presentation to the Ministers Advisory Committee on Health in October 2009. The 2012 amendment did not address this issue.
A funding system based on patient need is logical. Sustainability and equitable access are non- negotiable. Critical to making it all work is a current legislative framework that recognizes and promotes the unique contribution of each nursing professional and utilizes the full extent of knowledge, skills and ability of each member of the team.
[i] Edmonton Journal. (2013). $3M cut means loss of 48 nursing positions at Edmonton’s Capital Care. Retrieved from http://www.edmontonjournal.com/health/means+loss+nursing+positions+Edmonton+Capital+Care/7863115/story.html.
[ii] White, D., Jackson, K., Besner, J., Suter, E., Doran, D., McGillis, L., Parent, K. (2009). Enhancing nursing role effectiveness through job redesign. Calgary Health Region: Alberta Health Services. Retrieved from: http://www.calgaryhealthregion.ca/hswru/documents/reports/JobRedesignReportFeb2009.pdf
[iii] Government of Alberta. (2012). Nursing Homes Act, Nursing Homes Operation Regulation, Alberta Regulation 258/1985, with amendments up to and including Alberta Regulation 193/2012.