CUPE Article on RPNs' Scope of Practice in Ontario

The article reproduced below (find the original here) gives another perspective on an issue that’s very similar to the one affecting health facilities in rural communities on PEI. What’s your take? Do you think that some of the pressures facing rural hospitals and their emergency rooms in particular could be eased by expanding LPNs’ scope of practice as this article suggests? Are we even at a stage where we can consider expanding LPNs’ scope of practice when they are limited by their scope of employment?

RPNs can ease ER crisis at Huron Perth’s Seaforth – Another rural hospital cuts services as McGuinty government turns its back

January 28, 2009 11:09 AM

LONDON, Ont. – Expanding the scope of practice for Registered Practical Nurses (RPNs) can ease the Emergency Room (ER) crisis at Seaforth Community Hospital, says Michael Hurley, President of the Ontario Council of Hospital Unions OCHU/CUPE, which represents 40 workers at Seaforth. “We have to respond to the shortage of nurses,” Hurley says. “But cutting emergency room (ER) services is not an acceptable way to respond to inadequate resources or staffing.”

Hurley encouraged hospitals to expand the scope of practice of RPNs, graduates of a two-year program, to better serve the public.

“By realigning nursing duties across the Huron Perth Healthcare Alliance and using RPNs appropriately, we can address the nursing shortage at Seaforth,” Hurley says.
As of February 7, Seaforth Community Hospital will cut its 24-hour ER down to 12 hours, and remain open only from 8:00 AM to 8:00 PM. Hospital officials say that ambulances will be diverted to other hospitals during the shut-down times.

But Hurley warned that it is the chronic underfunding of the health system underlies ER closures at Seaforth, and elsewhere, and not just the nursing shortage.

“Cutting ER services is a direct response to the financial pressures on the health care system,” Hurley says. “This is yet another example of a rural hospital losing services in a wave of underfunding and restructuring that the McGuinty government is forcing onto hospitals.”

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Contact:
Michael Hurley, President, OCHU/CUPE, cell: 416.884.0770

David Robbins, CUPE Communications, cell: 613.878.1431

Scope of Practice vs. Scope of Employment

Scope of practice, like collaborative practice, is a phrase that we often hear in the health sector. Before I started working at the PEIHSC I had never heard the phrase ‘scope of practice’, but since then it has become part of my daily vocabulary. Scope of practice is something that we will probably visit often here, so I thought I should give you a definition. It is also important to distinguish scope of practice from scope of employment. Here you go:

Scope of Practice: The procedures, actions and processes for which an individual or occupational group has received training/education.

Scope of Employment: The procedures, actions and processes which an individual is authorized to perform in their workplace.

Ideally your scope of practice and scope of employment match, and the tasks that your employer or manager authorizes you to perform are equivalent to your training.

Sounds simple, right? Not so much.

Scope of employment might be different from scope of practice for any number of reasons – regulated health occupations’ scopes of employment are dictated by legislation and job descriptions, while unregulated health occupations’ scopes of employment can be more arbitrary and dependant on the will of the employer. Ensuring that scope of employment and scope of practice match is an important human resources issue; it has a major effect on job satisfaction and certainly influences our ability to recruit and retain health personnel.

That’s it in a nutshell. Feel free to expand on these definitions. We’d also like to hear about your own experiences in the comments section.

What is ‘Collaborative Practice’ anyway?

Collaborative practice, interprofessional care, interdisciplinary care...these are phrases that get kicked around a lot in health literature, conferences and board meetings. The PEIHSC held a forum in May 2008 called the ‘Collaborative Practice forum’, so you would think that when the new Executive Director at the PEIHSC called me into his office to talk about our next year of activities and asked if I could define collaborative practice that I could give a pretty good answer, right? Well, I found myself stumbling to come up with a clear definition of how collaborative practice and interprofessional care differs from how the majority of health facilities currently operate.

I went back to an article I wrote on this subject in one of our newsletters where I quoted a definition of collaborative practice by Carol P. Herbert. She defines collaborative practice in her article “Changing the culture: interprofessional education for collaborative patient-centred practice in Canada” as “the continuous interaction of two or more professionals or disciplines, organized into a common effort, to solve or explore common issues with the best possible participation of the patient.” But what makes a practice truly collaborative, and how does that definition distinguish a collaborative practice from any other practice?

At its core, interprofessional care has to do with breaking down walls and making a shift from autonomy to interdependency. Individuals engaged in collaborative practice are mutually dependant on each other and are aware of each others’ expertise. Power is shared among team members, including the patient. Making this shift might mean the actual removal of physical walls and changing a practice into an open concept space with minimal or zero private office space. It will certainly mean instituting practices that promote collaboration and the sharing of information – multidisciplinary rounds for example, where the practitioners in a collaborative practice facility meet to discuss and recommend steps for a particular client’s care, often with the participation of that client.

James and I recently met with two individuals who were instrumental in setting up a collaborative practice facility here in Charlottetown. Something about the facility that struck both of us as a defining characteristic of interprofessional care was the adoption of a horizontal communication structure. Adopting a philosophy of horizontal communication blurs the lines between roles, removes traditional boundaries and promotes the deliberate exchange of knowledge, skills and expertise.

Getting back to Carol Herbert’s definition of collaborative practice, I think that three of the key concepts in that definition are “continuous interaction”, “organization” and “patient participation.” I’m sure that almost any health worker would agree that they interact with other health professionals to solve and explore common issues for their patients. Continuous interprofessional interaction that is organized by means of institutional policies and models of care, which includes the client as a contributing member of the team is what really distinguishes interprofessional care.Of course, that’s just my opinion. We’d like to hear yours.

Cheers,
Mark

It's a blog!

Welcome to Health Views, a blog created by the PEI Health Sector Council to discuss health human resource issues relevant to the PEI health system. This blog is designed to facilitate the sharing of information and stimulate discussion around current and emerging HHR issues in three categories:

· Recruitment and retention
· Collaborative practice
· Optimization of health human resources

These categories are intentionally broad so that we can explore a variety of topics – issues like scope of practice, interprofessional care, health worker shortages, workplace bullying, education and public awareness of health human resource issues and the changing paradigm of health care on a regional and global scale. The PEIHSC has explored many of these issues since its inception in 2006. Scope of practice and interprofessional care were discussed in two forums (the Scope of Practice Forum 2007 and Collaborative Practice Forum 2008) and a series of focus groups. Recruitment and retention of health workers was addressed by a Job Satisfaction and Retention Survey in 2008, and health career promotion was the focus of two exit strategy surveys conducted with grade 12 students in 2007 and 2008 and the directory of Health Careers on Prince Edward Island. Check out our quarterly newsletter, Health Benefits, for further discussion of these and other issues.

Stay tuned to the site for upcoming articles and commentary. We welcome your comments and also invite you to submit articles and commentary to be considered for future postings.

Cheers,
PEI Health Sector Council Staff