Editorial: Staff Mix Changes… are the issues clear?

ad_Nurses_Station_300_edited-1Recent changes in care delivery models in Alberta Health Services (AHS) are causing much discussion. Concerns are being voiced for loss of regulated nursing positions. The College of Licensed Practical Nurses of Alberta (CLPNA) is also concerned with the potential impact of displacing nurses in a system already strained. However, there are some points to consider.

Staffing is an employer responsibility.

Employers have the ‘right’ to define what staff mix is required. Alberta Health Services, through a project called Workforce Transformation, is implementing widespread change addressing many aspects of care delivery, including some of the historical issues with staff mix and utilization. This has resulted in some displacement of both LPNs and RNs and the process is still underway. We acknowledge that for many this change is uncomfortable and frightening.

It’s time for changes to Staff Mix.

The LPN component in staff mix varies greatly within similar populations and units throughout the provincei. Historically, staff mix was based on philosophies and culture within a nursing unit; not necessarily on factors that aligned nurse competence with client complexity. As the system evolved this trend has continued, resulting in significant underutilization of nursing resources. The literature is clear, it’s inefficient to utilize professionals below their education and competence levelii, iii,iv,v. And further, sustainability of our system must be linked to optimizing the use of all resources.

Nurses are educated differently.

Regulated nurses are educated to provide competent and safe care to Albertans. LPNs complete a two-year college based diploma program and RNs a four-year baccalaureate degree. It makes sense that nurses from a two year program and four year program are different. Each nurse is expected to work within a legislated scope of practice that defines their role, and develop their competence through education, experience, and support from others as they evolve from novice to expert. Workforce Transformation focuses on ensuring that health providers are performing at the maximum of their scope, a philosophy well supported in the literatureii,iii,iv,v.

You can’t make change while maintaining the Status Quo!

To optimize the workforce change must occur. When groups and individuals defend maintaining the status quo using terms such as “lesser skilled workers”, nursing teams are undoubtedly affected and set in opposition to each other. It’s important that resulting disruptive behavior is managed appropriately at all levelsvi,vii,viii,ix. The system needs everyone working TOGETHER to deliver quality care.

“We cannot solve our problems with the same thinking we used when we created them.” Albert Einstein

For true transformation and optimization of the system, we must try something new. Those guiding the Workforce Transformation Project are responsible to ensure a strengthened more sustainable health care system.  This will take time, commitment, and perseverance. It’s vital that health providers are ready, willing, and able to take on the challenge. Respectful commitment is necessary from all of US to achieve the preferred future in health care.

Jo-Anne MacDonald-Watson, President (CLPNA) & Linda Stanger, Executive Director (CLPNA)



[i] College of Licensed Practical Nurses of Alberta. (2012). Membership statistics. Retrieved from https://www.clpna.com/about-clpna/statistics/.

[ii] Knowledge and Education at Entry to Nursing Practice in Alberta. (2009). Retrieved from https://www.clpna.com/wp-content/uploads/2013/02/pub_KEP_Report_Feb_2010.pdf.

[iii] 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.chsrf.ca/final_research/ogc/besner_e.php.

[iv] 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/wp-content/uploads/2013/02/doc_JobRedesignStudyFinalReport2009.pdf.

[v] Canadian Nurses Association, Canadian Council of Practical Nurse Regulators, Registered Psychiatric Nurses of Canada. (2012). Staff mix decision-making framework for quality nursing care. Retrieved from http://www2.cna-aiic.ca/CNA/documents/pdf/publications/Staff_Mix_Framework_2012_e.pdf.

[vi] Health Quality Council of Alberta. (2013). Managing disruptive behaviour in the healthcare workplace. Retrieved from http://www.hqca.ca/assets/files/May%202013/Framework.pdf.

[viii] Bartholomew, K. (2006). Ending nurse-to-nurse hostility. Marblehead, MA: HealthPro.

[ix] Canadian Centre for Occupational Health & Safety. (2004). Workplace bullying harms both employees and employers. Health and Safety Report, 2(8). Retrieved from http://www.ccohs.ca/newsletters/hsreport/issues/2004/08/ezine.html.