Degree lpn online program rn

LETTERS

Staff Mix and Public Safety

Howard Searle's description of how health regions are replacing registered nurses with licensed practical nurses makes me shudder (Nursing BC, April 2004). How can we sit back and allow the provincial government to jeopardize patient care and safety? Health care is being re-engineered to place little value on the artful and knowledge-based practice of professional nursing. Licensed practical nurses are valuable members of the health care team. However, their one-year training program is no match to either a nursing diploma program or university degree program. I can speak from experience, having travelled the journey from being a licensed practical nurse to graduating from a college diploma program to completing a baccalaureate degree to now being a student in a graduate degree program in advanced nursing practice.

Unless we speak out and tell the health regions and government that this is unacceptable, more legislation will be created to put our clients at additional risk. If you have not had the opportunity to read the RNABC policy statement Nursing Staff Mix for Safe and Appropriate Care, I suggest you do. Understanding the terminology and the implications that inappropriate staff mix has on practice will help you to be prepared to articulate your concerns.

Our CNA Code of Ethics for Registered Nurses describes how we, as nurses, "value and advocate for practice environments that have the organizational structures and resources necessary to ensure safety, support and respect for all persons in the work setting." Nursing values described in the CNA Code of Ethics for Registered Nurses can become the framework we need to tell our story. We need to act fast.

Margaret Eastman, RN

Victoria, BC

RNABC frequently receives calls regarding changing staff mix. An article on this topic is published on page 11 in this issue of Nursing BC. RNABC's policy statement Nursing Staff Mix for Safe and Appropriate Care and other resources on this topic are available online at www.rnabc.bc.ca (search "staff mix") or from the RNABC Helen Randal Library at 604-736-7331 (ext. 118) or 1-800-565-6505 - ed.

As concerned registered nurses involved with licensed practical nursing educational upgrade initiatives, we feel compelled to respond to Howard Searle's comments in the April 2004 issue of Nursing BC. While we agree that client needs and care complexity must be the determining criteria for staff mix, we disagree on a number of other points.

Mr. Searle refers to a "crash skills upgrading." In our collective experience, LPN upgrades involve a comprehensive curriculum-based educational approach incorporating acquisition of knowledge and skills as well as enhancement of critical thinking and clinical judgment. Learning needs are assessed individually, then LPNs are offered learning opportunities in classroom, lab and practicum situations. In addition, transitional educational support is provided in the work area to assist the LPN and other nursing staff to effectively make changes to support LPN full scope of practice as defined by the College of Licensed Practical Nurses of British Columbia and the practice setting.

Mr. Searle states that changes to skill mix "may jeopardize patient safety." Since no references are provided, it's difficult to determine which studies he uses to support his argument. In fact, current evidence suggests that a nursing staff mix of both RNs and LPNs promotes optimal patient care delivery and positive patient outcomes.

We are disappointed with the overall tone of the column. We believe that, particularly in these times of staffing shortages and increasing workload, excellent nursing care depends on collegiality and collaboration between nursing professionals, in the patient's interest. Creating division between professional groups detracts from, rather than promotes the collaborative process so vital to optimal patient/client/resident care.

Donna Nicholson, RN, BSN

Eleanor Ravenscroft RN, MSN

Janet Ray RN, MSN(c)

Leslie Stuart, RN, MSN

I would like to agree wholeheartedly with Howard's column in the April edition of Nursing BC. Finally someone at RNABC understands what registered nurses have been saying for a long time. LPNs cannot replace RNs due to the difference in our scope of practice and the nature, breadth and depth of knowledge. There isn't any way in which an LPN can receive the same knowledge in a one-year education program while it takes an RN four years to complete a baccalaureate degree program. This is not to say that LPNs don't have a place in the health care system, but it is not to replace RNs.

When health authorities replace RNs with LPNs, the RNs don't feel like a valued part of the team. Also, the patients are denied the quality care most appropriate to their needs.

Maxine Armstrong, RN

Prince George, BC

RNABC has long held the position that the needs of clients and client outcome must be a priority in determining staff mix. This position was published in the RNABC 1995 position statement The Appropriate Utilization of Registered Nurses and revised in 2001 as the policy statement Nursing Staff Mix for Safe and Appropriate Care, which is available from the RNABC Web site www.rnabc.bc.ca (search "staff mix"). According to this RNABC policy statement, "The needs of clients and the complexity of care are foremost in determining staff mix. The category of health care provider with the most appropriate competencies to match client needs in an effective and efficient manner is selected." To assist employers to understand the expectations of registered nurse and licensed practical nurse practice, RNABC and the College of Licensed Practical Nurses of B.C. developed a document entitled Practice Expectations: Registered Nurses and Licensed Practical Nurses that highlights some of the key differences between registered nurses and licensed practical nurses. It is available online at www.rnabc.bc.ca (search "practice expectations" ) - ed.

Nurse Practitioners

Kudos to RNABC for an informative article (Nursing BC, June 2004) about the introduction of a new role for nurses within the provincial health care system. Although the nurse practitioner role is well established in the United States, only recently has the momentum for the role gained sufficient strength to affect the reintroduction in Canada.

The article reported that both the University of Victoria and the University of British Columbia offer family nurse practitioner programs, which is in fact the case. It goes on to mention that other schools are also expressing interest in providing education for the nurse practitioner role. At the British Columbia Institute of Technology (BCIT), we are currently working on a nurse practitioner program and are in the process of preparing for the RNABC program approval process. We plan to offer an online, post-master's certificate that will prepare individuals for the adult nurse practitioner role. Eventually the school plans to offer an online graduate degree to prepare nurses for the adult nurse practitioner role. We have already begun the development of two of the online certificate courses and are planning to offer them in January 2005.

A wave of change is sweeping through the health care system and nurses will be key participants in those changes over the next decades. The introduction of the nurse practitioner role is timely indeed.

Sheila Turris, RN, MSN

BCIT Adult Nurse Practitioner Program

Curriculum Development Group

As noted in the June issue of Nursing BC, the government has announced funding for the establishment of a nurse practitioner program at the University of Northern British Columbia to begin 2005. RNABC is aware that Trinity Western University is also interested in planning to establish a nurse practitioner program - ed.