PROPOSED CHANGES TO SALPN BYLAWS:
Background Information
THE ISSUE
SUN has been working on role clarity through the SRNA, Ministry of Health, and Regional Health Authorities for
some time now. In September 2013, SUN met with the Ministry of Health and presented a brief and proposed
framework to address concerns around role clarity. Our concerns focus around the foundational knowledge of the
care provider, the role they are educated to take on as a member the healthcare team, and the impact on patient
care safety.
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“Although scopes of practice evolve over time, current changes are occurring in a haphazard and arbitrary
manner without regard for evidence of medical appropriateness or patient safety by the regulatory
bodies. This is occurring in the absence of any formal framework for monitoring and evaluating their
impact on patient outcomes.
Moreover, these trends are in violation of current legislation, and are occurring in the absence of
corresponding bylaws and without any evidence of adequate educational preparation, patient needs, or
safe and appropriate care.” Source: SUN brief delivered to the Minister of Health, “Health System Risks to Patient Safety” –
September 25, 2013
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“It is inappropriate and unsafe for scopes of practice and models of care to be changed on budgetary
rather than clinical criteria. These changes must be supported by research, consideration of baseline
knowledge and educational preparation, and assessments of patient acuity and complexity. They must
be formally monitored when implemented to measure outcomes based on patient safety and patient
outcomes.
If allowed to continue, this ad hoc and budget-driven tinkering with scopes of practice and models of care
threatens to drag professional nursing back to the apprenticeship model that was abandoned in the 1970s
precisely due to concerns about the quality and safety of patient care. Allowing employers to utilize
providers as they see fit based on financial considerations without evidence and evaluation of medical
appropriateness, formal education, and patient outcomes, threatens professional nursing standards and
puts patients at risk of harm.” (p.9) Source: SUN’s “Value of Registered Nursing” Report delivered to the Minister of Health
– November 5, 2013
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“The parties [shall] work together and with other stakeholders to clarify roles and scope with reference to
existing legislation and educational credentials, professional nursing practice standards and demonstrated
evidence of need, appropriateness, and impact on patient outcomes. The parties agree to involve a panel
of agreed upon experts/external investigators in providing expertise and guidance to the process of role
clarification in support of effective collaborative approaches. […]
The parties [shall] collaborate in a transparent manner on role and scope clarification based on
legislation, formal and accredited educational qualifications, professional nursing standards, and
evidence of patient needs, appropriateness, and patient outcomes. The parties recognize that role and
scope clarity is the basis for collaborative practice to ensure the right provider for the right patient at the
right time.” Source: Discussion documents on the renewal of a Tripartite Partnership Agreement presented to representatives
from the Ministry of Health and Regional Health Authorities – June 21, 2014.
September 29, 2014
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PROPOSED CHANGES TO SALPN BYLAWS:
Background Information
THE ISSUE (cont’d)
Parallel to SUN’s work on role clarity, the Saskatchewan Association of Licensed Practical Nurses (SALPN) was
seeking official authorization through a special meeting of its members, on October 21, 2014, to amend their
bylaws in order to expand the scope of practice for Licensed Practical Nurses (LPN). SUN learned of the
development of the draft bylaws in August 2014.
Upon review of the proposed bylaws changes and draft expansion of the Foundational Knowledge and Practice
Authorization document, we understand these amendments will potentially expand LPN scope of practice to the
extent it will essentially replicate the role of the Registered Nurse (RN) in almost all practice areas including those
that are currently exclusively RN.
The main concern is that the proposed bylaws could enable LPNs to perform functions they do not possess the
education and knowledge to safely and competently perform.
We understand that many of these skills, competencies and procedures listed by SALPN are specialized care areas
for RNs who have obtained additional education and who are working in areas of high risk for patients.
A few examples of the proposed LPN scope expansion bylaw changes include: cardiac monitoring of telemetry
patients, administering medications by direct IV Push/bolus, administering immunizations, mental health, and
circulating nurse role in the Operating Room. Please refer to the expanded list of proposed changes
The proposed SALPN bylaw changes could pose a huge threat to patient safety and are not supported by evidence
and research, and with certainty, we believe this will remove the RN from the bedside and/or direct patient/client
care.
The proposed bylaw changes were not made available to the public or other concerned stakeholders for review
until late in the week of September 15; to date, the draft Foundational Knowledge and Practice Authorization
documents have not been made public. Click here to view SALPN’s documents
CONCERN FOR RN PROFESSION
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The practices of abolishment, replacement and vacancy management of RN positions are steadily on the
increase – these changes will formalize and legitimize these practices with employers and government.
Enabling LPNs to perform legislated RN-only functions will erode RN practice and open the gate for rampant
and widespread replacement of RNs at the bedside.
Many employers already have policies in place that emphasize LPN utilization over RNs in instances where
vacancies have to be filled or shifts covered in a wide variety, and constantly growing number, of practice
settings.
Many employers have allowed the current practice of LPNs to expand beyond their foundational educational
and legislated abilities.
o Cardiac monitoring, IV push, immunization administration, hemodialysis care, resuscitation teams for
neonates and pediatrics, and coordination of admissions and discharge planning are already being
performed by LPNs in many settings.
September 29, 2014
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PROPOSED CHANGES TO SALPN BYLAWS:
Background Information
CONCERN FOR RN PROFESSION (cont’d)
In other jurisdictions where RN replacement with other care providers such as LPNs or SCAs is already prolific (e.g.
Alberta), RN training seats have already been reduced, while LPNs are being hired in place of RNs as a more costeffective option.
SRNA’S RESPONSE TO BYLAWS – September 19, 2014
The following are excerpts from the SRNA response to the proposed SALPN bylaw changes. Click here to view full
statement.
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The proposed bylaws would profoundly change how nursing care is provided. It is not a viable solution. The
SRNA must express its concern over both the overall premise for the creation of the new bylaws and substance
of them. We do not support the bylaws as currently proposed.
As the professional regulatory body responsible for regulating RNs in the public interest, the SRNA recognizes
the challenge to better define and distinguish the roles of the registered nurse (RN) and licensed practical nurse
(LPN). This is important. For years, our profession has struggled with this issue.
It is not surprising that there has been a blurring of RN and LPN roles given the dramatic changes in the health
system. The scope of practice of the RN and LPN is defined in legislation for both RNs and LPNs. The education
that RNs receive is based on this legislation.
Both RNs and LPNs study from the same body of foundational knowledge, however, RN education includes
more depth and breadth of nursing knowledge and clinical practice, to provide all levels of nursing care,
including patients whose needs are acute, complex and rapidly changing.
Given the nature of the concerns, the SRNA supports a broad consultation with the public, employers,
educators, unions, government, members and other stakeholders.
Any decision about assignment of care must utilize a clear framework to determine responsibility and
accountability for patient care that includes principles regarding client needs, complexity, and predictability.
Without it, there will be role confusion and research has demonstrated that this can lead to patient safety
issues.
Legitimizing the out-of-scope practices of some LPNs in some healthcare settings where patients are unstable,
have complex needs and unpredictable outcomes is a great concern to the SRNA. The RN must directly assess
and monitor complex patients. RNs have the breadth and depth of knowledge to assess, anticipate and prevent
untoward events from happening. It is too late after the event has occurred to involve an RN.
We need to step back. We need to put the patient needs in the center. Nursing is regulated because it is one of
the health professions that pose a risk of harm to the public.
We need a vision of what can be achieved with a strong framework for inter-professional practice which
supports high functioning teams with clear roles and responsibilities.
The RN has the responsibility to assess the level of care needed and then based on this, assign care. This can be
an RN manager, RN nurse in charge or an RN at the point of care. It is their accountability and responsibility.
September 29, 2014
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