Two unions representing licensed practical nurses are clashing over proposed new provincial regulations.
Both the Hospital Employees' Union (HEU) and the B.C. Nurses' Union (BCNU) agree more clarity is required around what types of jobs the nurses should be doing, but they differ over how the Ministry of Health has drawn the line at this stage.
Licensed practical nurses (LPNs) are generally graduates of college programs, while registered nurses (RNs) hold university degrees. The different educational background means RNs are qualified to perform some tasks that LPN's aren't allowed to do.
The HEU, which represents more than 2,000 LPNs primarily in long-term care facilities, contends the division of labour set out in the new regulations is inefficient and would be a step back for both nurses and the health care system.
The BCNU, which was certified last year to represent more than 7,000 LPNs primarily working for regional health authorities, suggests the regulations will make things run smoother because everyone will understand their responsibilities.
Both unions say they want LPNs to become more autonomous in their workplace and that formal regulations defining which tasks they are qualified to perform is the way to do it. How those regulations are worded is a point of contention.
The proposed regulations divide LPNs tasks into two lists, some which they will be able perform automatically and others that will require an order from from a physician or an RN.
In a letter to the government filed last month and posted to their website this week, the HEU claims many LPNs are currently doing tasks like wound care and administering oxygen without orders from other medical professionals, but under the new regulations they would need to get permission first.
HEU director of research and policy Chris Kinkaid said in an interview this could force some long-term care homes to hire more physicians or RNs to provide those orders and once those people are hired they could end up doing other work LPNs are currently providing.
"Is this going lead to the hiring of more RNs? Is it going to result in more RNs doing LPN work? Because if so, it's kind of becoming counter-productive if this regulation is meant to move the LPN practice forward," Kinkaid said.
BCNU president Debra McPherson said her union generally accepts the proposed regulations and that only a few small tweaks are required. She said employers and nurses will benefit from the new rules because they will be evenly applied across the province.
"I think it provides some guidance for employers," she said. "[They] have been all over the map in the province in the absence of regulation on how they're utilizing LPNs. In some cases LPNs haven't been comfortable how they've been utilizing them - either under or over."
The current ambiguity means some LPNs are being asked to perform duties they don't feel qualified for, McPherson said.
"In some cases they were being asked to do things for which they had no preparation and they were feeling in some cases a little unsafe," she said.
Once the province sets out its regulations, it's up to the College of Licensed Practical Nurses of B.C. to determine exactly how they will be put into practice. Kinkaid said that's where his union thinks additional stipulations for tasks like wound care and oxygen dispensing should be handled rather than at the provincial regulations level.
"Given that a number of those activities are covered in the basic curriculum [for LPNs] and they are covered in what the college sets out as the basic competency of an LPN, we say 'why this extra requirement [in the regulation]?' " he said.
The government set Dec. 21 as its deadline to receive comment on the new regulations, but Kinkaid hopes what his union submitted will spark another round of consultation before the details are hammered out with the college.
Meanwhile, McPherson is looking forward to working with the college to help figure out how the new regulations will be used.
"The devil is always in the detail," she said. "We've got the broad brush stuff now and they will be putting into place all the regulatory work surrounding the changes."
The division between the two unions comes just months after many LPNs left the HEU and other unions to join the BCNU. In Northern Health, 65 per cent of LPNs working for the health authority voted to join the nurses' union.
McPherson said organizing efforts will continue to get the rest of the LPNs under her union's banner.
"We will continue to try to bring the reminder of the LPNs into BCNU," she said.
