Something’s Gotta Give

We all know our Alberta Health Care system is broken. It is chronically ill and shows every sign of being fatal. If something drastic doesn’t happen, it will collapse, possibly without chance of recovery. I don’t want that to happen, but I also feel powerless to stop it from happening. I’m not a politician. I’m not a decision maker or policy crafter. What am I supposed to do? Health care workers matter to me, so as a writer I try to shine a light from the perspective of my personal experiences. Does it make a difference? Who knows? I DO know that doing nothing results in exactly that – nothing. So, what’s a spectator to this spectacular train wreck to do? My friend and neighbor Ginny Wong, a Licensed Practical Nurse, has an idea.

But first, we must understand the differences between RN (Registered Nurse), LPN (Licensed Practical Nurse), and HCA (Health Care Aide). Here’s a basic breakdown:

• LPNs complete a 2-year college diploma, RNs complete a 4-year degree, Health Care Aides complete an 8-month certificate. LPNs learn the same things RNs learn, minus some specific knowledge like charge nurse training.
• LPNs learn most of the same things RNs learn, minus some specific knowledge like charge nurse training and some more in-depth knowledge about treatments and such.
• LPNs and RNs take on the same patient load on hospital units. They work together as a team. If they didn’t tell you their titles, you would never know the difference between your RN and your LPN. When you ring for a nurse from your hospital bed, they both answer.
• LPNs are not Health Care Aides. HCAs are a critical part of your care team when you are in hospital. They are deeply valued and respected by RNs and LPNs. To state it simply, nurses can do HCA work, but HCAs cannot do most nursing work.

Let me be very clear – I am not suggesting HCAs are not as important and RNs or LPNs.

They are incredibly important to effective patient care. Sooner or later, we are all going to need HCAs to help us manage personal care, whether for post-surgery recovery or long-term home care. When I was in hospital the HCAs treated me with kindness and compassion, helping me with showers, sorting out correct meals, and even spending a few minutes chatting with me to ward off loneliness and anxiety.  But they have very specific job descriptions and limitations. They are aides, not nurses.

Nursing Classification matters, and here’s why:

Right now, LPNs are classified as Auxiliary Nurses, sharing this designation with HCAs. But LPNs are doing the same things as RNs. Their responsibilities have increased drastically along with the increase of their scope of practice. Let’s not forget that increased responsibility = increased risk. I mean, we are talking about people’s health and lives, and the risks are high. By reclassifying LPNs to the “Direct Nursing” category, it recognizes LPNs as nurses, thereby acknowledging and respecting the LPN profession. When LPNs are not recognized as nurses but are asked to do nursing duties, why would they stay in Alberta, when they can work in BC under a Direct Nursing classification? If Alberta reclassifies LPNs as Direct Nursing, LPNs are more likely to practice to their full scope. Job satisfaction will increase, as will nursing staff retention.

Why should we care about nursing classification?

Our healthcare system is falling apart in front of our eyes. Nurses are leaving in droves to other provinces and other countries or drawn to travel nursing. LPNs in Alberta have the biggest scope of practice in the entire country (comparable only to Ontario). They deserve to be recognized accordingly, as is the case in other provinces.   

In Ontario, RPNs (Our LPN equivalent) are also considered nurses, regulated by the College of NURSES of Ontario, along with RNs and other nurses. They have a very comparable scope of practice there compared to the one in Alberta. Did you know that Ontario is publicly recruiting nurses from Alberta? Check this out: Ottawa hospital calls to Alberta health workers | CityNews Calgary

Here’s why I care:

I know some nurses. You probably do too. They are burning out, and I’m not ok with that.

When I was most recently in the emergency room I sat in the hallway for 55 hours, and I paid attention. I haven’t written a full blog post about it yet because it was pretty traumatizing, but I can tell you that nursing shortages had very real consequences to patient care. For instance, patients had to wait longer than normal for pain meds. Not just me – everyone in that hallway was suffering and there weren’t enough nurses to go around. So, we waited. We waited for pain meds, anti-nauseants, and IV bag changes. I fasted for nearly 2 days waiting to hear whether I was surgical. I developed the worst migraine of my life, and that’s saying something because I am familiar with migraines. While I was collapsing on the floor and the nurse was injecting heavy pain meds in my IV while I was puking my guts out, the cancer patient in the back of the hallway who was also experiencing excruciating pain had to wait for the nurse to finish helping me before he could get some relief. Why? Because there weren’t enough nurses.

Believe me, the nurses were even more frustrated than the patients by the degrading standard of care. They did a great job looking after us all, within their human limitations. They desperately want things to change, and they need our help to make that happen. But it’s frustrating to want to help, while feeling like there’s nothing I can do for nurses besides buying them a coffee and expressing my gratitude. Let’s circle back to my friend and neighbor Ginny Wong, and her idea. Here’s what she posted recently on social media. It got my attention.

Hello everyone! I’d really appreciate it if you could help make licensed Practical Nurses (LPNs) nurses officially. LPNs are classified as “auxiliary nursing” – it means one’s job is to help nurses take care of people. We’re doing nurses’ jobs, but we’re not classified as such by Alberta legislation.

Please take a moment to send an email to your MLA and the Labour Minister thank you so much for your support!

Our MLA: Matt Jones, Calgary.SouthEast@assembly.ab.ca

Labour Minister: Minister Kaycee Madu, Labour.Minister@gov.ab.ca

Title: LPNs are nurses, please help make it official

Dear Honourable Jones,

The topic of LPN’s being grouped under “auxiliary nursing” along with HCAs has been coming up a lot, especially after AUPE recently signed a new contract with AHS representing LPNs and HCAs. Since the term “auxiliary nursing” means someone whose job is to help nurses to take care of people, it implies that LPNs aren’t nurses (Cambridge, University 2022). At a conference held by the Alberta Labour Relations Board back in 1997 stated that RNs and LPNS would soon have “not enough functional differences… between the groups (RNs and LPNs) to maintain the separate bargaining units in view of their daily co-operation and joint responsibility for direct patient care” (ALRB, 1997).

The scope of practice for LPNs in Alberta has been increasing drastically over the past decade. Many of us are now performing the exact same duties as our fellow RNs on the same unit, side by side, with similar education. However, LPNs are still categorized under the bargaining unit of “Auxiliary Nursing Care,” while RNs and RPNs are categorized under “Direct Nursing Care” (http://www.alrb.gov.ab.ca/bulletins/10bulletin.pdf). LPNs have proven over and over again that we are versatile and willing to improve our skills through additional education via CLPNA or extra certificates (e.g.: via MacEwan and foot care courses). I would argue that we have reached a point where there are “not enough functional differences… between the groups (RNs and LPNs) to maintain the separate bargaining unit in view of [our] daily co-operation and joint responsibility for direct patient care” (ALRB, 1997).

I humbly ask you for your assistance in helping Alberta LPNs challenge the Alberta legislation that assigns LPNs to Auxiliary Nursing, and to have LPNs take their rightful place as providers of Direct Nursing Care with the RNs.

Thank you very much for your attention. I look forward to hearing from you soon.

Sincerely,

Now this is something I can do! Ginny did all the hard work. It’s a simple copy and paste to an email, and click send. My fellow Albertans, you can do this too. I’m asking you to take 60 seconds out of your day and join me in sending the email. (If you don’t live in Southeast Calgary you’ll have to take an extra 60 seconds to google the MLA for your area.) It makes a difference, and it’s better than a coffee and a handshake.

On second thought, buy the coffee too. A nurse you know deserves it.