Special President’s Message on Nursing Scope of Practice

July 11, 2018

Back some months ago, former Health Minister Dr. Eric Hoskins wrote to the College of Nurses of Ontario (CNO) with proposals to expand the scope of practice of Registered Practical Nurses (RPNs) into the current practice domain of Registered Nurses (RNs). The Minister’s request was to move forward on assessing these proposed changes to expand the scope of practice for RPNs.

Subsequently, ONA had multiple conversations with the then-Minister’s office in order to  understand what was motivating this unprecedented move. The then-Minister’s office was unable to define what aspects of RPN practice could be safely undertaken in the proposed expansion, as these practice competencies are solely within the RN’s current practice domain. These proposals to insert the RPN practice into the RN scope were made without any consultation with ONA and our 65,000 members, or as we understand any other nursing stakeholder.

When we presented these safety concerns to former Health Minister Dr. Helena Jaczek, she wholeheartedly agreed. This is why she sent a follow-up communication to the CNO that was very clear about the next steps forward:

“I need to be clear that there can be no consideration for any scope of practice expansion for RPNs at this time. The proposed changes to RPN scope of practice are significant and will require thorough consultation with the goal of achieving consensus (emphasis added) among all key nursing partners, including ONA, RNAO, RPNAO and others prior to moving anything forward. Consultation needs to be comprehensive, informed by best available evidence, including peer-reviewed research and advice from clinicians and experts.”

ONA and our members are thankful for former Minister Jacek’s approach to move forward based on evidence and full consultation. The rising level of acuity and complexity of care needs in our hospitals, in long-term care and in the community, requires care from more RNs not fewer. Ontarians deserve the appropriate level of care for their conditions. The safety of patients must come first.

RNs provide care for patients with complex, unpredictable conditions with a higher risk of negative health outcomes. Only an RN has the advanced education, skill set and experience to care for these patients. The proposals put forward to expand RPNs into the domains of practice for RNs must be carefully considered by the best available evidence and experts, as former Health Minister Jaczek clearly articulated.

Let me be exceedingly clear. ONA strongly believes there is room for all nursing classifications and for personal support workers in our health-care system. That has never been our concern.

The real issue for ONA and for RNs is making sure the appropriate skilled nurse is caring for patients based on their health-care needs and considering the practice environment where their health care is delivered. This can only be assured if the scope of practice for nurses is accurate and appropriate for their patients.

What RNs know is that RNs are able to work in any setting and with any type of patients with differing health conditions. RNs can care for patients with any level of complexity of health needs in unpredictable situations – whether in intensive care units, surgical units, in emergency care, in long-term care or in home care. RNs have the education, competencies, skills and knowledge to meet all of the health-care needs of these patients.

The College of Nurses knows that RPNs more appropriately practice, and as outlined in the 3-factor framework, with patients with less complex health needs and stable and predictable outcomes. Proposals that may force RPNs to care for unstable patients with unpredictable outcomes is risky to both the patient and the nurse.

There are some organizations that want to depict these statements as nothing but a “turf war.” Nothing can be further from the truth. ONA is interested only in ensuring that patients receive the level of skilled nursing care necessary for a safe and healthy outcome.

The appropriate roles played by all nurses in our health-care system must be recognized, safeguarded and preserved for the sake of our patients. When this happens, it is Ontarians who will have achieved a victory worth celebrating.

In Solidarity,

Vicki McKenna, RN