It's time to tap potential of LPNs, Care Aides to help solve nursing shortage

News release

New study outlines timely, concrete solutions

The Hospital Employees’ Union says a just-completed, comprehensive research study into the roles and utilization of Licensed Practical Nurses and Care Aides provides a road map for concrete solutions to the nursing shortage facing B.C.’s health care facilities.

“There’s no quick fix to the nursing shortage,” says HEU secretary-business manager Chris Allnutt. “What’s needed is a series of significant steps and a comprehensive government plan for recruitment, retention and retraining that harnesses the expertise of all nursing professionals including LPNs, Care Aides, Home Support Workers, RNs and psychiatric nurses.

“This research report clearly supports the need for broad-based solutions, and provides comprehensive directions on how to achieve them,” he said. The result of a 15-month joint project between the Health Employers Association of B.C. and health care unions led by HEU, the study found that LPNs and Care Aides are underutilized in the delivery of nursing care in B.C. And it calls for increased government funding for LPN positions and a range of education and retraining initiatives to tap the full potential of these important nursing professionals.

Allnutt said his union has briefed Ministry of Health staff on the findings, and he’s hopeful that the report’s recommendations will be reflected in a major government announcement of a new action plan on the nursing shortage that’s expected shortly.

Cooperative efforts between HEU, Victoria and progressive employers, says Allnutt, have already resulted in a number of creative solutions to the nursing shortage, thanks to a special $10 million dollar fund established by the NDP for 1999 and 2000.

“Without much fanfare, we’ve created 218 new nursing positions in long-term care by providing the training and upgrading skills to convert Care Aides to LPNs, and added 74 new Care Aide positions at long-term care facilities across B.C.,” Allnutt said. “And within the next few weeks, we’ll finalize arrangements to create 90 new LPN positions in acute care hospitals.”

These new positions, says Allnutt, have been supported by comprehensive and creative training programs that include opportunities to harness the skills of foreign-trained nurses who currently work as Care Aides. One of these programs establishes a prototype for addressing nursing shortages in northern and rural communities by building the skills of nursing professionals who already have roots in these communities.

LPNs, whose scope of practice has a 60 per cent overlap with that of Registered Nurses, complete a 12-month post-secondary program. First created during a WW II nursing shortage, LPNs flourished in B.C. as part of a team-based nursing approach. However, in the mid-1980s, health administrators and nursing academics moved to an RN-only model of nursing care, wrenching thousands of LPNs away from the bedside.

“This study backs up what we’ve been saying for some time: that the roots of the current nursing shortage go back to these ill-advised decisions over the last two decades,” says Allnutt, whose union represents about 4,000 LPNs and 11,000 Care Aides. “That’s why we have the worst LPN to RN ratio anywhere in Canada.

“We can take some comfort that employers are finally getting it, and LPNs are increasingly part of the solution,” he said. “We can and must do more to ensure that we don’t continue to waste the skills and training of these valuable nursing team members.”

Care Aides in B.C. graduate from an intensive five-month program, which is one of the most comprehensive offered by any province.

At today’s press conference in Vancouver where the report was released, six frontline nursing professionals from HEU and BCGEU who work in facilities across B.C. gave their firsthand accounts of opportunities for innovative nursing shortage solutions in their communities.

The complete LPN/Care Aide study can be downloaded from HEU’s website by following the links from this release at .

-30- For more information, contact: Stephen Howard, director of communications (240-8524 cell)

Summary of findings, research on roles, and utilization of LPNs and Care Aides in B.C.

Recommendations: ? The Health Employers Association of B.C. and health care unions represented by Hospital Employees’ Union and the B.C. Government and Service Employees’ Union) have presented thirteen recommendations to the provincial government and health employers. Key recommendations for broad-based solutions to the nursing shortage include:

— Funding for new Licensed Practical Nurse positions; — Increased seats in the practical nursing education programs and LPN Access (bridging program for Care Aides to become LPNs); — Funding for LPN and Care Aide continuing education; — Continuation of Healthcare Labour Adjustment Agency programs and the Healthcare Scholarship Fund; — Improved coordination of in-service education for LPNs and Care Aides; — Better oversight and standards for private Care Aide education programs; and — Development of post-basic programs for LPNs in areas such as operating room and foot care.

Research Findings:

? British Columbia has fewer LPNs in proportion to Registered Nurses than any other province. In 1998, there were 4,424 LPNs employed in nursing in British Columbia. This represents a ratio of 1 LPN to 6.4 Registered Nurses. The average for other provinces is 1 LPN to 3.1 RNs; the ratio in Ontario is 1 LPN to 2.3 RNs. [See pp. 26-28.]

? There is considerable variation in LPN utilization - between facilities and within facilities -and LPNs are frequently not practising to their full scope of competencies. Results of our Survey of LPN Skill Utilization in B.C. indicate an underutilization in certain well-established areas such as medication administration, wound dressings, and assessments. Even the LPNs working at the six facilities in our case studies - facilities with better-than-average LPN utilization - are restricted from applying the full range of their skills in caring for patients and residents.

? Participants in the research project identified a number of factors which contribute to the divergence in LPN utilization. One issue raised throughout is that decision-makers, primarily nurse managers, are not familiar with the current education program, standards of practice, and accountability obligations of LPNs. Many managers were unaware that the skills identified in our survey are entry-level and have long been covered by the LPN education program. (Many of the skills were taught to the first practical nursing students in 1948, while others such as catheterizations and medication administration were added in the early 1980s. Certain skills such as psycho-geriatrics and subcutaneous injections were added in the early 1990s.)

Similarly, the case studies revealed that many Registered Nurses are unaware that LPNs are directly accountable for their actions, being nurses licensed with the College of LPNs. ? Other factors which influence LPN utilization, as identified by research participants, are the following: work jurisdiction conflict with Registered Nurses, lack of funding for continuing education for LPNs (many of whom have been restricted from using the full range of their skills and require refresher courses or need to renew their license), and a shortage of LPNs to fill vacant positions.

? The case studies in this report describe how three hospitals and three continuing care facilities in B.C. have confronted the challenges and fostered team nursing and better utilization of LPNs and care aides.

For example ... — In Kelowna General Hospital, the ratio of LPNs to RNs on the surgical, medical and rehabilitation units range from 1:1 to 2:1 (RN:LPN), depending on the shift. A thorough review of LPN practice in 1998 led the hospital to add new duties for LPNs - for example, maintaining tube feeds and IV pumps and removing drains and sutures; the hospital provided in-service education on these new skills. [See pp. 105-115.]

— At Terraceview Lodge in northern B.C., a team of care providers - LPNs, RPNs (Registered Psychiatric Nurses), RNs and care aides - work together to care for residents. Care aides are recognized for their vital role and are involved in family care conferences. LPNs work as “Team Leaders,” coordinating resident care and performing nursing procedures such as assessments, changing dressings, and administering medications. [See pp. 233-240.]

? Some of the ways in which the six case study sites achieved success with a new staffing mix and roles were: involvement of all members of the nursing team in the process, clear articulation of roles and responsibilities, and provision of continuing education.

? As described in the “Role Profiles” in this report, LPNs and care aides are already working in specialized roles. Opportunities for expanding these roles across the province are significant. One profile describes the job of an LPN in a fast track emergency unit at a regional acute care facility. Another presents the role of an LPN providing foot care to residents at three continuing care facilities in a northern community. The third outlines the care aide role in a rehabilitation unit for seniors with medical and cognitive impairments. Other specialized roles opening up for LPNs are in the operating room and orthopaedics. [See page 317 of the report for a fact sheet on the LPN role in operating rooms.]

? Other innovative roles for LPNs are described in the “Across Canada” review. For example:

— Royal Alexandria Hospital in Edmonton has 50-50 LPN and RN mix on a medical unit and hopes to expand team nursing across the facility. LPNs provide total patient care, including IV maintenance and medication administration. Education on skills and roles was an important factor in the success of this project. [See pp. 301-302.] — The Poseidon Centre in Winnipeg is a 218-bed continuing care facility. For each wing of 49 residents, on a day shift, there are 2 LPNs and 6 care aides working in a team with one RN who floats between wings. LPNs work as Team Leaders and provide all nursing care needs, including meds. [See pp. 311-312.] ? A comparison of B.C. and other provinces shows that while B.C. lags in terms of the relative number of LPNs and the duties they are allowed to perform, we lead the way in terms of the educational preparation and regulatory oversight for LPNs. BC is also a leader in its training programs for care aides. Part 2: BC Context describes the provincial curricula for LPNs and care aides, as well as refresher and specialized post-basic courses that are available. Background on LPN regulation is provided, with reference to anticipated changes in the nursing scope of practice (primary among them being the recognition of LPN autonomy and removal of the obligation for LPNs to practice “under the direction” of RNs or physicians. See pp. 31-32.)

? Group and individual interviews with “key informants” - employers, LPNs and care aides, educators and the College of LPNs - identified specific opportunities for improved utilization of LPNs and care aides and the training/education resources that need to be put in place.

October 25, 2000

Download LPN/Care Aide study here LPN/Care Aide frontLPN/Care Aide Section 1LPN/Care Aide Section 2LPN/Care Aide Section 3LPN/Care Aide Section 4LPN/Care Aide Section 5LPN/Care Aide Section 6LPN/Care Aide Section 7