CARE - Spring 2011 | College of Licensed Practical Nurses of Alberta

ISSN 1920-6348 CARE

It’s in the Stats!A National Picture

Patient Centered LeadershipThe Leader in You

Your Profession - Your College25 Years of Self-Regulation

Community Mental Health

Frameof Mind

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www.c l pnacon f e r e n ce . com

ENVISION THE FUTURE

PRACTICAL SKILLSDEVELOPMENT

NETWORK WITH LEADING MINDS

LEADERSHIP & COMMUNICATION SKILLS

EMERGINGOPPORTUNITIES

RE-ENERGIZE, RE-FOCUS, RE-ENGAGE

APRIL 7- 8 | CALGARY DEERFOOT INN & CASINO

care | SPRING 2011 3

CARE is published quarterly and is the official publication of theCollege of Licensed Practical Nurses of Alberta. Reprint/copy ofany article requires prior consent of the Editor of Care magazine.Editor - T. Bateman

Signed articles represent the views of the author and not necessarilythose of the CLPNA.

The editor has final discretion regarding the acceptance of notices,courses or articles and the right to edit any material. Publicationdoes not constitute CLPNA endorsement of, or assumption ofliability for, any claims made in advertisements.

Subscription: Complimentary for CLPNA members. $21.00 fornon-members.

spring 2011VOLUME 25 ISSUE 1

cover story

feature

Frame of MindA team approach in communitymental health in High Rivershowcases collaboration, innovation, and best practices.With a focus on patient needs,this pioneering program leadsthe way.

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Patient CenteredLeadershipLeadership is integral to everyprofessional role. This new feature will challenge and empower readers to examineLeading on the Front Linesthrough a different lens.

From the College

Know Your Healthcare TeamProfile: Midwives

Your Profession, Your CollegeCelebrating 25 years of self-regulation

The Operations RoomStay Informed with Member Information

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We often repeat the well-known phrase – “nursing is an evidence based profes-sion”. Indeed, this is a hallmark of our profession. And yet, if we give this phrasedue consideration, we must ask ourselves a series of questions. “What evidence?”“How was the evidence produced, and circulated?” “What kind of studies producedthe evidence upon which we base our decisions?”, and “How can we be certainthat the evidence being cited is indeed the outcome of rigorous study withtransferable results?“

Alberta Health and Wellness and Alberta Health Services in their business planscommit to utilization of best available evidence when making decisions. Thistypically means evidence gleaned from research. There is no shortage of researchunderway in Alberta and other parts of Canada. However, there is a shortage ofshared knowledge about the applicability of specific research studies to big picturedecision making. There is also a dire shortage of LPN related research.

Contributing to the body of knowledge of a profession is one of the key characteristics of any profession, anduniversity-based nursing research conducted by RN’s with a focus on the RN profession has been gainingmomentum for over two decades. For the Licensed Practical Nurse there has been very little research conducted.Although we know much about our profession anecdotally, there is a critical need to harness this knowledge inthe form of scientific evidence. The Council of the CLPNA sees this as so important that “Initiating and participatingin research regarding the LPN profession” has become part of our strategic direction.

Although Licensed Practical Nurses are not based in universities, and although there are few LPN’swith the academic qualifications required to lead research, it is crucial that LPN’s be engaged in theresearch process, ensuring that the research questions developed reflect the evidence required byour profession. Our deep connection with patient care and its intricacies make us vital members ofresearch teams. We must not become “subjects” of others research – we must become participantswho are engaged in the research process itself.

Further, LPN’s must develop the skills to critically review research studies and findings, and tobe able to ask questions of a qualified researcher. Unfortunately, in this field and others, researchstudies are often quoted out of context, or with only partial findings, to support a particular strategy.Used this way, even a quality study can turn into misinformation, rather than evidence.

Two lessons must be learned from this. First, Licensed Practical Nurses and the CLPNA must keepcurrent in nursing research, review it with a critical eye, and consult with research experts wherethere are questions about the applicability of findings. Second, we must be engaged in our ownresearch, and indeed, we have now made a great beginning in this domain.

CLPNA is pleased to announce the start up of a major research study that focuses on LPNs in practice settingsand evaluates LPN impact on quality of care and patient outcomes when the LPN works to scope. The study willalso look at utilization of the LPN and existing supports and barriers to full utilization. Results of the study will addto the body of evidence that can inform both policy and practice. Equally important, we hope this study will leadthe way to broader engagement of Licensed Practical Nurses in research, contribute to the body of knowledgeabout the LPN and ultimately contribute to quality care of our patients and clients. A more detailed description ofthis study will come in a subsequent issue of CARE. This study is funded by Alberta Health and Wellness andconducted by the Applied Research Department of Bow Valley College, Calgary.

CLPNA is committed to supporting your development in the area of research through regular publication in CARE,online resource development, educational opportunities, and relevant keynote presentations at conference.

Hugh Pedersen, President and Linda Stanger, Executive Director


from the college

EVIDENCE? WHAT EVIDENCE?

Our deep connection withpatient care

and its intricaciesmake us vitalmembers of

research teams…


Bow Valley College Alumni working as LPNs are eligible for a 10% discount on select BVC Continuing Education courses that qualify as continuing competency activities upon annual licence renewal.

Leadership for Licensed Practical Nurses - Online

Care of an Agitated Client *

Documentation Refresher *

Infusion Therapy – Fluid, Blood and Medication *

Intramuscular and Intradermal Injections *

Intravenous Medication Administration *

Immunization – Online or Homestudy *

Basic Foot Care *

BVC Alumni eligible for 10% discount on select courses

Your Bow Valley College tuition may be eligible for a grant from the Fredrickson-McGregor Education Foundation for LPNs. For more information visit: foundation.clpna.com

Bow Valley College’s Practical Nursing Diploma is recognized as one of Western Canada’s best. We o�er full- and part-time programs in class and online, as well as specialized programs for internationally educated nurses and those re-entering the profession. We are also active in applied research – advancing nursing practice and keeping our programs relevant and up to date.

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research

Canada’s nursing workforce grew 9%in five years, from 2005-2009, andthe growth of Licensed Practical

Nurses in the workforce grew at nearlydouble the overall rate at 18.5%. Bothgrowth rates exceed that of the Cana-dian population which grew by 5% overthe same period. These are the results ofdata produced by the Canadian Institutefor Health Information’s (CIHI) latestarticle, “Regulated Nurses: CanadianTrends, 2005 to 2009” released in De-cember 2010. In comparison, the growthrate of Alberta LPNs in the same periodwas more than double the Canadianaverage at 41% according to the Collegeof Licensed Practical Nurses of Alberta(CLPNA).

“National statistics are vital to monitor-ing growth in the profession, and we arepleased with what is happening provin-cially and nationally,” states LindaStanger, Executive Director of theCLPNA and past chair of the CanadianCouncil for Practical Nurse Regulators.

CIHI’s report examines “supply andworkforce trends for Canada’s largestgroup of health professionals at thenational, provincial and health regionlevels”. All nursing regulatory organiza-tions in Canada report their statistics toCIHI.

There were nearly 348,499 regulatednurses in Canada in 2009. 76% wereRegistered Nurses, 22% were LPNs, and1.5% were Registered PsychiatricNurses.

The growth trend of the workforce per100,000 population varied between pro-fessions. There were 228 LPNs per100,000 population in Canada for 2009showing significant growth from approx-imately 200 in 2005. Registered Nurseskept pace with the Canadian populationduring this period, but historical datashows that the current rate of 789 RNsper 100,000 population in 2009 is lowerthan in 1992 when it was 824.

“In the mid-1990s, with cuts to healthcare budgets across Canada, we saw re-ductions in the numbers of nurses andother health care professionals workingin this country, as governments imple-mented hiring freezes and early retire-ment packages,” says Michael Hunt,CIHI’s Director of Pharmaceuticals andHealth Workforce Information Services.“Despite reinvestments in health careover the past 10 years, the ratio of nursesto the Canadian population has still notreturned to what it was in the early ‘90s.In contrast, the number of physicians rel-ative to the size of the population is nowat an all-time high.”

Workplaces amongst regulated nursesvaried between professions. RNsworked most often in hospitals (62.6%)in 2009; 14.2% worked in communityhealth. The majority of LPNs alsoworked in hospitals (45.6%) with39.1% working in long term care facili-ties. Proportionally more Alberta LPNsworked in hospitals in 2009 at 56.3%,and fewer worked in long term care fa-

Canadian LPN Workforce Growing Fast!

cilities at 24.4%. Both Canadian and Al-berta LPN workplace percentages havenot changed significantly over the fiveyear period.

The average age of a nurse in Canadaduring the five year period remained sta-ble at 45. LPNs were the youngest nurseswith their average age dropping to 43.The average age of Alberta LPNs de-clined dramatically during the period to40.7 in 2009. Of any province or terri-tory, Alberta LPNs have the highest per-centage of members under age 30 inCanada at 21%. The Canadian averageis 15.7%. n

The Canadian Institute for Health Information’s complete report

“Regulated Nurses: Canadian Trends,2005 to 2009” can be found

at www.cihi.com.

Alberta LPN statistics are available fromthe College of Licensed Practical Nursesof Alberta’s 2005-2009 Annual Reports

at www.clpna.com.


>

Frameof

MindPioneering LPn MentaL HeaLtH nursing in HigH river

by Chris Fields

T here’s no signage outside the buildingadvertising its presence. There’s no overtadvertising. Too many still don’t want to

come because of a single word: Stigma.

Whether it’s generalized anxiety, schizophre-nia, bi-polar disorder, dual identity disorder,or depression, Mike Cutler would like you toknow mental illness is far more prevalent thanyou think it is. “The face of mental health isyou, me, rich, poor, all cultures, all ages, andall levels of education,” Mike says. “No oneis immune from bowling balls in our headscreated by life’s stresses or biological condi-tions. Whether we need to seek help or not isall about ability to cope.”

Mike would also like you to know that it’sOK to feel unwell, and that the closely knitmulti-disciplinary team he is a part of at theHigh River Mental Health & Addiction Serv-ices Clinic is a “safe place” that helps peopleset their life paths back on course again. “Thisis not the cliché of ‘One Flew Out of the Cuck-oos Nest’…there’s no ward lock up…it’s not

a place where you lay on the couch and talkabout touchy feely things,” Mike says. “We arejudgement-free problem solvers and enablers.”

Mike would humbly describe himself as a guywho just wants to help people. Although his pro-fessional background is licensed practical nurs-ing, his official title is: Community SupportWorker, Community Wellness Program. Otherswould call him (and two other LPNs inClaresholm) pioneers of a new community out-reach role for LPNs in mental health services.Most important to Mike, his clients might be aptto call him a confidant…a life coach…a helpinghand up…the guy who helps sort out life’s rou-tines over coffee.

Mike’s work in mental health began in 2004 inClaresholm. Doctors overloaded with clientswith chronic mental health conditions were ex-pressing frustration. A new role for the LPN inmental health services was born: day to day com-munity outreach to those with chronic condi-tions that would allow doctors and therapists toaddress more acute cases. Created with the lead-


ership and guidance of Dennis Yurkiw,Manager under the supervision of an RNGerri Smith, three LPNs (Carol Hamil-ton, Ken Mckee, and Mike) gave shapeto a mental health role that focused onADL (activities of daily living): home vis-its; supports (e.g. hygiene); meal prepa-ration; house work, or just a cup ofcoffee in an effort to build all importanttrust. As the program grew and comfortwith the LPN role grew, the LPNs starteddoing medication compliance and intra-muscular medication administration.Today, Mike, Carol, and Ken have oneof the most advanced LPN roles in amental health setting in Alberta.

Mike’s work in High River began in 2009when Darcy Jessen, Area Manager ofRural Addictions and Mental HealthServices, a social worker by training, es-tablished a Claresholm-inspired Commu-nity Wellness Program (CWP) in HighRiver to be delivered by an LPN positionworking with, and supervised by, an RPN(Terri Damis). Focused on communityoutreach and clients with chronic condi-tions, the CWP complements an existing,active client-focused Brief Therapy Pro-gram delivered by therapists (RPNs, so-cial workers, psychologists).

The LPN role continued its expansionarypath in this new role in High River, ex-

panding Mike’s position to include oneon one supportive counselling, case man-agement, participation in assessments,psycho-social group facilitation, a 20

client caseload, risk assessment (anyhome environment uncertainties aroundsafety…from front door to dog), andworking with clients at a more func-tional level with things like budgeting

and decluttering to, as Mike says, “getthings out of the way of active therapy.” In broadest brush strokes, Mike says hisposition has three pillars: outreach; dailyliving support; and medications manage-ment, that his goal is to work withclients to make progress in life skills, andthat the LPN position is beneficial toclients while increasing the client capac-ity of the clinic. “My role is to preventrelapse once a level of acuity haspassed,” Mike says. “My goal is to havepeople maintain their living standard tothe best of their ability, and I use a goal-oriented process to teach living skills andcoping mechanisms to help them achievethat.”

About 80% of Mike's role requires basicLPN competencies. The remaining 20%requires specialized mental healthknowledge and further formal educa-tion, which Mike has accessed. Mike’swork requires supervision in the broad-est sense, but day to day work is largelyindependent around the routines ofhome visits and case management. Themulti-disciplinary team is always avail-able for guidance and support. Mikemeets with his clinical supervisor(Naomi Varricchio) once a month forcase updates and support around casemanagement.

The evolution of the role to full scope ofpractice has

been a process of

discovery andbest fit within

the team.


The LPN role is also proactive. For ex-ample, Mike indicates risk assessment isalways ongoing, and that he’s proactivewith the broader medical community. “Iwill go to the doctor (or the pharmacy)with the client because people get scaredsitting in the waiting room of the doc-tor’s office and leave and I’m there tohelp them through their anxiety.” Mikenotes that clients will often have otherconditions requiring care such as dia-betes, eye appointments, or surgicaldates, and the LPN role addresses thebroadest sense of holistic well-being.

>

So what is the boundary of the LPNrole? Generally it is level of acuity.Mike’s role centres around clients withchronic conditions while therapists focuson active therapy clients. That beingsaid, the team has weekly meetingswhere they discuss all cases (includingactive therapy). As a case manager, Mikeupdates care plans as the client pro-gresses and changes within their individ-ual care plan. As nurses, Mike and Terriare the only team members who can ad-minister meds.

The Clinic team consists of a consultingPsychologist, three RPN’s (RegisteredPsychiatric Nurse), one on-site psychol-ogist, four social workers, one LPN, andadmin support. Mike credits the team forsuccess of the LPN role in High River. “Ifeel like we’re 100% equals and thatideas and opinions are freely shared byeveryone. There’s no hierarchy andthere’s great team support. I can freelygo to the team to seek advice if I feel likeI’m stuck.” Mike also acknowledges thathis level of training is critical when a roleis in effect being ‘pioneered.’ In June,2010, Mike received an Adult MentalHealth Certificate of Achievement for Li-censed Practical Nurses from MountRoyal University. “It’s a great programthat was very helpful with assessmentand risk analysis skills development, andit has contributed to team trust in myskills.”

The Mount Royal program has been sus-pended due to lack of demand and Mikeconsiders that a challenge to him to shinea light on LPN opportunities in mentalhealth services, in turn driving demandfor a program he thinks is needed to fast

track an expanded LPN role and scopeof practice in mental health services else-where in the province.

“People tell me work can’t be thatgood,” Mike says, “but it is.” Mike nodshis head when it’s suggested that his pos-itive work experience might be related topioneering of an advanced LPN role inmental health services that translates tolack of pre-conceived notions about whatthe LPN does. “The evolution of the roleto full scope of practice has been aprocess of discovery and best fit withinthe team,” Mike says. Perhaps it alsohelps that longer term client relationshipsbring clarity to effort being seen throughthe prism of the patient, that the team issmall, and therapists see the LPN role asa means to ensure service to clients areintegrated rather than outsourced.

Mike has seen it all and knows workingin mental health is not for everyone. He’sseen the psychotic episode during a homevisit, requiring a 911 call. He’s workedwith clients who have attempted suicideand in a dark moment or two it causeshim to question whether he is making a


difference. He’s seen mental illnesses inmillion dollar houses, houses filled withpet feces, and everything in between.“You can’t be shocked when people tellyou they hear voices telling them to killthemselves. It’s the illness talking, not theinner soul of the person.” Because of thenature of connection required in this set-ting there are safeguards for staff; casescan become too personal, and the Clinichas established protocols for team de-briefing and case transfer.

But Mike has also been part of deeply re-warding occasions, such as the day a sui-cidal client came back for a visit, lookedMike in the eyes and said “If it wasn’t foryou Mike, I would be dead.” Mike qui-etly notes that perhaps the deep, thankfulappreciation from clients stems fromstigma itself. In a hospital treatment is ex-pected. With mental health, there’s acommon perception that “there’s no onearound to help me.” Mike says that see-ing people at a vulnerable stage of theirlife makes you keenly aware of how dif-ficult life can be, making you more appre-ciative of what you have, and more eagerto live for the moment in your own life.

Success for Mike is a client that makesany small movement forward…at theirown pace. “We’re all snowflakes. TheLPN’s challenge is to customize a planfor each client that creates a small num-ber of realistic goals that become step-ping stones to creation of more goals asthey are achieved.” As a client becomesmore comfortable with their copingmechanisms, interaction with the clientwill gradually diminish. “The LPN is thetouch point through this process, and it’srewarding to see the progress,” Mikesays.

Mike’s e-mail signature signs off with thewords of Charles Darwin: “It’s not thestrongest of the species that survive, northe most intelligent, but the one most re-sponsive to change.” Asked why hechooses those words, Mike’s response re-veals deeper meanings within the mentalhealth profession – that the raw vulnera-bility needed to shape well-being can’thelp but shape the life perspective of thepractitioner. “Life is about change andour ability to adapt,” Mike says. “Themore adaptable we are, the healthier weare.” He adds, “You come to us in a

weak moment. Our role is to have beliefin you, to help you understand, to cope,to recognize that change has to happen,but most importantly to nurture beliefthat the smallest change can make thebiggest difference in the trajectory ofyour life.”

the story ends where it began - with

perception. Mike indicates that he is

known as “Mike from Mental Health” in

the community and when he goes to

the coffee shop and asks his group

clients if they want to go, 98% say

‘yes.’ Perhaps it reveals erosion of the

shackles of perception, and a deeper

acceptance that hiding mental illness

behind doors only leaves us all a little

diminished. n

Hear more about Mike’s role as he presents at the 2011 CLPNASpring Conference in Calgary.

To register visit www.clpnaconference.com

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Help me save my life.Register now!

780-422-1350 [email protected]

TRAC sessions are available throughout Alberta.


research

PHLEBOTOMY (VENIPUNCTURE) WORKSHOP FOR HEALTH CARE PROFESSIONALS [ML500]

This newly developed course provides health professionals with enhanced skills in the performance of blood collection methods using proper techniques and universal precautions. It is also designed for health professionals who wish to add the skill of blood collection to their portfolio. It will include 6 hours of theory and 8 hours of hands on experience.

Fee: $475 Sat & Sun, 8:30 am - 4:00 pm

Apr 30 to May 1, 2011

ELECTROCARDIOGRAPHY (ECG) WORKSHOP FOR HEALTH CARE PROFESSIONALS [ML600]

This workshop is aimed at health care professionals who are performing ECGs or have performed ECGs in the past. This introductory course is designed to refresh or enhance correct technique in the performance of 12-lead electrocardiography. The workshop will include 7 hours of theory and 7 hours of hands on experience. Depending on enrolment, at least 3 electrocardiograms will be completed. Students will perform ECGs on each other and we will use digital instruments in the NAIT ECG lab.

Fee: $425 Sat & Sun, 8:00 am - 4:30 pm

May 7 to 8, 2011

AN INSTITUTE OF TECHNOLOGY COMMITTED TO STUDENT SUCCESS

TOLL FREE 1.877.333.6248

Enrol online today. www.nait.ca/ConEd

EDUCATION FOR THE REAL WORLD

BUILD YOUR SKILLS

Asurvey released by the Health Quality Council of Alberta(HQCA in December 2010 found that 62% of Albertans whoreceived health care services in the province in the past year

rated their satisfaction as 4 or 5 out of 5 on a 5-point scale. Thisis relatively unchanged from 60% in 2008 and significantly higherthan 58% in 2006 and 52% in 2004. From the public’s perspec-tive access – the ease of obtaining health care services – con-tinues to be the most important factor associated with their overallsatisfaction with health care services received. Forty-eight percent (48%) of Albertans who used the system rated access tohealth care services as easy (4 or 5 on a 5-point scale) in 2010.This is relatively unchanged from 46% in 2008 and significantlyhigher than 42% in 2003.

Additional findings include:• Satisfaction with family doctor services - 83% of respondentswho have a personal family doctor are satisfied (4 or 5 out of 5) with the services they received. This is unchanged from 83% in 2008, 84% in 2006 and 2004.

• Family doctor setting – 59% reported their family doctor was located in an office where they might see other doctors or health care professionals and medical files are shared amongpractitioners. This is up from 48% in 2008.

• Access to emergency departments – 54% of respondents who visited an emergency department rated access as easy (4 or 5 out of 5) in 2010. This is relatively unchanged from 51% in 2008 and significantly higher than 48% in 2006 and 46% in 2003.

• Leaving the emergency department before treatment – 30% of respondents considered leaving the emergency depart-ment before being seen and treated compared to 31% in 2008. 8% said they left before seeing the doctor or before care and treatment was finished.

• Access to specialist services – 62% of those that obtained specialist services rated access as easy (4 or 5 out of 5), similar to 2008 (59%) and significantly higher than 2004 (47%) and 2003 (42%).

• Handling complaints - 61% of those that had a serious complaint about any health care services they received were dissatisfied (1 or 2 out of 5) with how the complaint was handled. This is unchanged from 2008 and similar to 2006, 2004 and 2003.

• Unexpected harm – 9% of respondents reported they or an immediate family member experienced unexpected harm, down from 10% in 2008 and 13% in 2006. If unexpected harm did occur, 34% reported they were told by their health care provider. This is the same as 2008 and down from 40% in 2006.

Satisfaction and Experience with Health Care Services: A Surveyof Albertans 2010 measured responses from more than 5,000Albertans on their actual experiences with overall quality, satis-faction and access with specific health services. It is the fifth suchsurvey the HQCA has conducted since 2003 and the first donesince Alberta Health Services was formed in May 2008.

The technical report and a summary of the findings are available at www.hqca.ca.

Satisfaction and Experience with HealthCare Services: A Survey of Albertans 2010


For more information visit the BVCAA booth at the Spring CLPNA Conference at the Deerfoot Inn and Casino in Calgary – April 7 & 8, 2011

?Are you inspiredby someone in the nursing community

Call for nominationsThrough its Rewards of Recognition and Rejuvenation, the Bow Valley College Alumni Association (BVCAA) is recognizing the exemplary e�orts of BVC Alumni who work in the helping professions.

Request a nomination package at: 403-355-4666 or [email protected]

Nomination deadline: April 11, 2011

Compassionate & caring, Amanda (left, Practical Nurse Alumna 2003) inspired Marie (Practical Nurse Alumna 2002) to nominate her for the Award

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>

there has never been a more chal-

lenging yet exciting time in healthcare,

and emerging from the uncertainty

and confusion is a new group of

nurse leaders, of which you are a part.

so you are thinking; “Me a nurse

leader - you must be joking!” it is no

joke. today, as a nurse, you are a

leader in all facets of your practice,

more so than ever before as you step

into new roles, with greater input and

increasing responsibility.

If we look at the root of the word leader-ship, it means to ‘step across the threshold’and this is exactly what is happening whenI listen to the stories from some of you onthe front lines. You are crossing newthresholds every day, as you develop curios-ity regarding care paths and decisions, asyou learn and develop new technologies, asyou grow and develop as teachers andmentors, and as you interact daily with yourprofessional colleagues, as well as your pa-tients and their families.

As an integral part of the health care envi-ronment and a critical member of the pa-tient care team, you have an inherent rightand professional responsibility to act as aleader in your practice, regardless of yourrole or practice setting.

Over the next year we will explore some as-pects of leadership that I believe are trans-formational in the context of the work wedo as nurses, and as we journey together, Ilook forward to hearing your stories andfeedback about how you applied the ideasand what shifted for you in your life andyour nursing practice.

First, take a moment to reflect upon whatleadership means to you. According to twogreat leadership thinkers, Myron Rogersand Margaret Wheatley1, “Leaders todayneed to be flexible, adaptive, self-renewing,resilient, learning, and intelligent”. These areattributes of all living systems, and since weare all living and breathing, though arguablynot always alive, they address importantcharacteristics that keep us healthy andmoving forward personally and profession-ally.

Now think about all the nurses that havecrossed your path, and which ones you ad-mire as leaders. What qualities do thesenurses bring into the world and the profes-sion? What makes them stand out as lead-ers for you?

Now consider this, “What part of you do youexperience in them”? Did that feel a littleuncomfortable, or maybe the chitter is chat-tering in your head. The truth is though, thatwe see in others what we already have inourselves, so there is no escaping the real-ity that the seeds are already planted; theyjust need nurturing to come to fruition.

Your challenge then, should you choose toaccept it, is to reflect by asking yourself“How can I grow my leadership skills overthe next year and support others to learnand grow also?”

Building The Foundation

The pyramids have stood the test of timebecause they were built on a solid founda-tion that could withstand the ravages oftime, and the same is true for great leaders.In order to lead we have to know who weare, where we came from, and where weare going. What follows is a self-assess-ment that will help you understand your rolein the context of an emerging leader on thefront line, in a new way. Take the time towork through the questions mindfully andwith curiosity as they form the foundationfor your future work as leader.

Leading on the Front Lines

a new series on Leadership with a focus on the autonomy and responsibility of the Licensed Practical nurse.

By rachel Foster

1. When, where, and with whom do i want to act more as a leader?

2. What do i need to do in order to act more as a leader?

3. How will i carry out those leadership behaviors?

4. What capabilities, skills or personal strategies do i have or need in order to carry out those behaviors?

5. What values are important to me when i am acting as a leader? What beliefs guide me as a leader?

6. Who am i as a leader?

7. Who am i serving as a leader? Who else benefits when i ambeing a leader?

8. What is my vision as a leader?

(Adapted with permission)2

Patient CenteredLeadership

together we will become

Listening Partners in Nursing,

uncover Learning Possibilities in

Nursing, Leverage your Performance

as a Nurse, and develop your

Legacy Potential as a Nurse.


Having laid the groundwork, take a mo-ment to reflect on what is showing up foryou in this moment? What have youlearned about yourself, your emerging role,or the possibilities that are ahead of you?Do you feel energized, excited, and readyfor the challenge? Perhaps you feel over-whelmed, daunted or unsure. Can you lo-cate what is going on for you inside yourbody right now? In your head, your heart, oryour gut. Know that growth is on the veryedge of discomfort, so be aware of whereit shows up for you because that becomesyour barometer as you develop and moveforward in new ways. You do feel different,don’t you?

As you reflect on your practice and the en-vironment you work in, what will you haveto do differently tomorrow when you go towork? How can you start developing yourpotential from this point forward?

If you have an answer great! If not let’sconsider one of the fundamentals of com-munication as a starting point–listening.It’s safe, it has an immediate impact, every-one can do it, and you can start straight-away! n

References:1. Wheatley, M J (2004) Finding Our Way: Leadershipfor an Uncertain Time2. NLP Partners, NLP Practitioner Training Manual.Ottawa. 2009

Rachel Fosterrachel has over thirty years diverse expe-rience in healthcare in Canada and the uK.she worked as nurse in rural and acutecare settings, continuing care and publichealth, as well as teaching at the universityof alberta. For the past ten years, she hasbeen fascinated with leadership andmentoring and in 2009 earned a graduateCertificate in executive Coaching fromroyal roads university. rachel nowcoaches leaders and executives to havecourageous conversations and discoverpossibilities.

rachel is donating her writing fee to the education Foundation to support

LPn Leadership education.


know your healthcare team

The following article has been submitted by the Alberta Association of Midwives

Profile: Registered Midwives

Midwifery has been a regulatedprofession in Alberta since1992 under the Health Disci-

plines Act. Registered midwivesare primary care providers and areconsidered the experts in normalpregnancy, birth and the postpar-tum period. Midwives work as in-dependent practitioners and caneither work alone or with groupsof other midwives in a privatepractice. Midwifery is a growingprofession currently experiencingan enormous demand in Alberta.

Midwifery care now funded by Alberta HealthOn April 1, 2009, midwifery serv-ices became a fully-funded optionfor Alberta families after manyyears of consumer and profes-sional lobbying. Alberta HealthServices now directly pays eachmidwifery practice for the coursesof care they provide and each mid-wife is allowed a maximum of 40courses of care a year (clients).Prior to the introduction of fund-ing, clients paid $3,000-3,500 formidwifery care.

Since the profession has been fullyfunded the demand for midwifery serv-ices has exploded in Alberta, and cur-rently the demand for midwifery care faroutstrips the available capacity. As a re-sult of the shortage of registered mid-wives in Alberta, the demand outstripsavailable spots for care.

What is midwifery care?The practice of midwifery is based on theunderstanding that pregnancy, labourand birth are profound experienceswhich carry significant meaning for awoman, her family and her community.Midwifery is grounded in the principlesof health and wellbeing, recognizingthat conception, pregnancy, birth andbreastfeeding are natural life processes.Midwifery care enhances these life

experiences and provides continuity ofcare through a reciprocal relationshipbetween midwives, women and theirfamilies. Midwifery is traditionally holis-tic, combining an understanding of thesocial, emotional, cultural, spiritual, psy-chological and physical aspects of awoman’s reproductive experience. Mid-wives promote wellness in women, ba-bies and families both autonomously andin collaboration with other health careprofessionals.

Midwifery actively encourages informedchoice throughout the childbearing cycleby providing relevant, objective informa-tion to facilitate decision-making. Thepractice of midwifery enables women todevelop the understanding, skills andmotivation necessary to take on the re-sponsibility for and control of their ownhealth.

The Alberta Association of MidwivesThe Alberta Association of Mid-wives (AAM) is the professionalbody representing midwives andthe practice of midwifery in theprovince of Alberta. There arecurrently 51 practicing registeredmidwives in Alberta and 27 stu-dent members in various stages oftheir education. The AAM strivesto provide continuing educationopportunities for members, sup-port midwifery-centered research,represent midwives in matters ofprofessional interest, promotepublic awareness of midwiferyand provide peer support to allmembers. In addition, the AAM iscollaborating with the MidwiferyHealth Disciplines Committee re-garding the establishment of aprovincial College of Midwiferyand is actively participating in theimplementation of a provincialmidwifery education programthrough Mount Royal Universityin Calgary.

What does midwifery care include?The midwifery scope of practice includesproviding primary care to low-riskwomen and their newborns throughpregnancy, birth and six weeks postpar-tum. Registered midwives have completeaccess to laboratories and diagnosticservices; are able to prescribe and carryselect medications, and consult or referto other specialists when needed. Accord-ingly, midwives can order prenatal labwork, ultrasounds and prescribe certainpregnancy related medications. Hospitaladmitting privileges are available in mostregions where midwives practice, or inmost cases, clients are able to choose todeliver in a birth center or at home.Clients under midwifery care do not seean OB or family physician in addition totheir midwife for pregnancy related care.

>


Midwives are able to consult with theseother providers when necessary and/ormedically indicated according to themidwifery regulations.

Midwives typically welcome clients intocare between eight to ten weeks of preg-nancy, when they have an initial ap-pointment. Appointments occur everyfour weeks until 30 weeks of pregnancy,then every two weeks until 36 weeks ofpregnancy. Patients are then offeredweekly visits until 41 weeks of preg-nancy. When labour progresses, the mid-wife goes to the woman’s home to assessprogress and remains with the womanthrough active labour and delivery, inthe woman’s home, at a birth centre orin the hospital. Typically three to fourhours after the birth, if the woman andbaby are stable, the midwife will dis-charge the woman home if at a birthcentre or the hospital. If the birth oc-curred at home, the midwife will leaveat this point.

The midwife usually does postpartumvisits at home on Days 1, 3 and 5 unlessfurther visits are required. The womanthen comes to the clinic at two, four andsix weeks postpartum when her care iscompleted and is then transferred backto her regular primary care provider. Theclient has access to her midwife 24 hoursa day, seven days a week throughout hercare by means of a pager system sharedbetween her midwife team.

Educational and registration requirementsTo apply for registration in Alberta, mid-wives must submit a portfolio detailingtheir education and experience to theMidwifery Health Disciplines Commit-

know your healthcare team

tee, which is funded andgoverned by AlbertaHealth and Wellness.Appropriate universityeducation is a prerequi-site for registration. Asuccessful registrant willhave attended at least 60births in the past fiveyears. Of these, 40 mustbe as a primary caregiver, 30 with continuityof care, and at least 10births in hospital and 10out of hospital. Yearlycertification is requiredin CPR, neonatal resusci-

tation, and emergency skills. Midwivesalso attend a variety of other workshops.

At present, there are no educational pro-grams to train midwives in Alberta, andso students must receive their educationsin other provinces or outside of Canada.Mount Royal University, however, is cur-rently in the process of the final regula-tory steps with the Alberta Governmentfor approval and funding of a proposedBachelor of Midwifery program. Thefour-year program is proposed as a di-rect-entry program, meaning applicantsdo not need another degree to enter theprogram and could be admitted directlyfrom completion of Grade 12. The uni-versity is optimistic to admit the first stu-dents in the Fall of 2011. Once in place,the proposed program will eventuallyhelp alleviate the critical shortage of reg-istered midwives in Alberta.

In the meantime, experienced midwivesfrom other provinces may apply for re-ciprocal registration in Alberta. All othermidwives are required to pass a priorlearning assessment program organizedby the Midwifery Health DisciplinesCommittee. The prior learning assess-ment program consists of an applicationfor registration, submission of a detailedportfolio followed by written, oral andpractical exams and a supervisory periodonce registration has been granted.

Working with other providersMidwives have excellent collaborativerelationships with other specialist mater-nity care providers and clear guidelineswithin the regulations on when it is ap-propriate to consult or transfer care.Many times, a specialist consult is all thatis needed and primary care remains with

the midwife. In situations where thewoman or her baby’s condition falls out-side of the scope of low risk midwiferycare, mutually respectful relationshipsbetween midwives and other careproviders ensure a smooth and safe tran-sition of care for everyone. If a transferof care becomes necessary in labour, themidwife remains with the woman in asupportive role, provides care to the babyat birth and then resumes care of themother once she is stable.

How do RM’s differ from other maternity healthcare providers? Registered midwives are the only mater-nity care providers that can offer a choiceof birthplace to their clients. Midwivescarry with them at all times the necessaryequipment to conduct deliveries out ofhospital, the equivalent of a level 1 hos-pital in the trunks of their cars. They canalso deliver in any hospital in the regionthat they have admitting privileges in, asopposed to family doctors or obstetri-cians who are usually affiliated with aparticular hospital.

Midwives work in small groups of nomore than four, which allows them to de-velop a personal relationship with theirclients before birth. Once active labor be-gins midwives provide continuous pri-mary care and support to their clients andremain with them for several hours afterthe birth. Once birth is imminent, a sec-ond midwife attends to provide care to thebaby. Essentially they provide the equiva-lent of the nursing and physician care thattakes place in the hospital setting.

The large call groups and even largerclient loads of family doctors and obste-tricians do not typically allow for thesame kind of one on one continuous carethat midwives consider an integral partof their practice. The emotional, physicaland informational support provided bydoulas is an asset to the birth team but itis important to note that unlike mid-wives, doulas are not trained to provideprimary care or conduct deliveries. n

For more information about or to find a registered midwife, contact the Alberta Association of Midwives at

www.alberta-midwives.com, [email protected]

or 403-214-1882.


From the very beginning, the leadership ofthe Professional Council of Registered Nurs-ing Assistants (PCRNA, now the College ofLicensed Practical Nurses of Alberta) knewthere was a problem. In the very first AnnualReport of the organization in 1986, the“continuous and increased erosion” of RNAjobs is discussed.

From 1986 to 1999, the leadership base ofthe organization was very small with few staffand few resources. Executive Director/Registrar Pat Fredrickson and Director ofProfessional Practice Rita McGregor wereinstrumental in gathering the necessarypeople and resources to start to solve theproblem.

It was determined that RNA jobs were beingeliminated because: 1. Basic nursing education did not

prepare RNAs to meet the changing needs of the health care system;

2. The background of current practitioners was so diverse that a consistent level of competence amongthe profession was unclear; and,

3. The RNA Regulation was a barrier to effective utilization.

Work began immediately on these issues. In1988, the PCRNA gave the following rec-

ommendations to a provincial governmentCommission developed to “determine thedirection of future health care”:1. The need for up-grading of the basic

training program2. The lack of availability and need for

clinical experience for the nursing assistant students in all health care settings

3. That there be increased opportunity to allow RNA to play a greater part in health care delivery

4. That there be opportunities for post-basic training programs for RNAs.

(Annual Report, April 1989, The Professional Council of Registered Nursing Assistants, p7)

During this same time, a change in title wasunderway in Alberta and across Canada,transforming the RNA from a nursing assis-tant to a Licensed Practical Nurse (LPN). In1990, the PCRNA became the ProfessionalCouncil of Licensed Practical Nurses(PCLPN).

Responding quickly to LPN and employer re-quests, a plethora of comprehensive post-basic courses were developed by thePCLPN. LPNs were eager for the learningopportunities in education and in practice. In1991 alone, nearly 600 LPNs completedcourses in Administration of Oral Medication,

Intravenous Therapy, Working with the Aged,Advanced Training in Orthopedics, HealthAssessment of the Elderly, and NursingProcess Documentation.

But leadership knew that these programsweren’t enough. Executive Director PatFredrickson boldly declared, “The currenteducation is out-dated and dead-ended,” atthe 1990 PCRNA Spring Conference. Thebasic education of new LPNs needed anupgrade. But this took time.

Basic education changes had to wait for theadvice of the newly established PracticalNurse Education Standards Advisory Com-mittee (ESAC). This group began in 1990 byMinisterial Order and consisted of represen-tatives from the PCLPN, Alberta VocationalColleges, Alberta Association of RegisteredNurses, College of Physicians and Surgeons,and Alberta Healthcare Association. Itsagenda was to “advise the Health DisciplinesBoard with respect to the standards of com-petency and approval of basic, refresher,specialist and advanced training programs”(1991 PCLPN Annual Report). They imme-diately began studying LPN utilization andevaluating practical nurse programs. Prior tothis point, the practical nurse programs inAlberta had been overseen by governmentand did not have education standards or anevaluation process.

Over the next few years, ESAC identifiednecessary competencies to meet the Scopeof Practice outlined in LPN regulation. A re-view of current practical nurse curriculumwas completed in 1993 and recommenda-tions delivered to the Health DisciplinesBoard. The goal was not only to meet currenthealth care needs, but to create a nurse whocan “function competently in a changinghealth care environment”. ESAC’s final re-

this feature will host a variety of historical topics over the next year in celebration of 25 Years of self-regulation for the Licensed Practical nurse profession.

Your Profession, Your College

THE 1990s - MEMBERSHIP DECLINE OVERCOME The transformation of a crisis into a victory through leadershipmarked the first half of the history of the Licensed Practical Nurse(LPN) profession. After Registered Nursing Assistants (RNAs)became self-governing in 1986 under the Health Disciplines Act,membership began to nosedive at a rate of 2% to a frightening11% per year. From an initial membership of 8643, fully half ofthe association’s membership had left the occupation by 1999, only13 years later.


port was approved by the Health DisciplineBoard in 1994 and forwarded to Alberta Ad-vanced Education for implementation in thepractical nurse colleges.

In the Fall of 1995, Alberta Vocational Col-leges (now Bow Valley College, NorQuestCollege, and Northern Lakes College)launched revised Practical Nursing pro-grams. Not only did the programs include ad-ditional weeks of study, but the field of studywas also broadly expanded. A completelynew curriculum had to wait for the PCLPNto develop revised LPN Regulations, Stan-dards of Practice and a Competency Profilefor the profession.

Simultaneously, a realization was dawningthat the only way to truly ensure a workforcewith a consistent level of knowledge andskills was to conduct a massive educationalupgrade. In a “bold and unprecedentedmove”, the Board of Governors made adecision. January 1, 1996 began a count-down to the new educational standard.Members were notified that mandatorycompletion of educational programs in AdultPhysical Assessment, Infusion Therapy,and Medication Therapy were required toachieve eligibility to practice as an LPN forthe 1999 registration year.

This was a massive undertaking. 5000 LPNsneeded this education over a three year

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period, and PCLPN only had a handful ofpeople on staff to facilitate this. In 1996,PCLPN hired 18 nursing educators to teachthe courses, and two years later this in-creased to 29 educators. Employers werecontacted to support the endeavour andRegional Health Authorities brokered theprograms to deliver to their employees.

During this time, the PCLPN was re-namedthe College of Licensed Practical Nurses ofAlberta (CLPNA) in preparation for procla-mation under the Health Professions Act.

Membership declines continued through1999 to about half of the 1986 numbers(8643 to 4342). Many environmental factorswere at play during this time, with regionalrestructuring affecting many areas includingstaffing and philosophies within the healthsystem. However, demand for LPNs was ris-ing. Employers began advertising for LPNsfor the first time in local newspapers andacross Canada. The Licensed PracticalNurses of Alberta had wholeheartedly takenon the challenge of advancing competencies,and by the end of the mandatory educationupgrade deadline 98% of the profession hadmet the new standard.

This was a time for celebration, as the pro-fession had literally been transformed. Enroll-ment in basic education programs hadincreased and there was a new energy in the

profession. With strong strategic direction,tenacious hard work, and die hard commit-ment from the LPN profession, the hemor-rhaging of members stopped. “For the firsttime in fourteen years, since 1986, the num-ber of registrants in the College at the end ofthe year 2000 exceeded the number of reg-istrants from the previous year,” declared the2000 CLPNA Annual Report.

The positive effects from the professionalfoundations laid by the LPNs committed tolearning and the leadership of CLPNA,ESAC, and other committees continuestoday. As we move into the future, these areexciting times. The number of LPNs regis-tered in Alberta has more than doubled since1999 to a new all-time high of 9015 at theend of 2010; today’s education programsteach to a scope of practice that is highly ad-vanced from the past; and opportunities forstudents and graduates in practice arediverse. Building on the historical foundationsare new leaders and new practitioners whocontinue to assure that the LPN professionwill evolve well into the future. n


Introduction

Several reports released at the beginningof this decade highlighted the need to ad-dress underutilization of the nursingworkforce (Advisory Committee onHealth Human Resources, 2002) andimprove overall management of healthhuman resources to make health caremore effective and sustainable (Fyke,2001; Commission on the Future ofHealth Care in Canada, 2002). Theserecommendations led to the developmentof a program of research that has focusedon generating scientific evidence to in-form the effective and efficient utilizationof health human resources. That researchhas led us to conclude that a collabora-tive practice model incorporating Regis-tered Nurses (RNs), Licensed PracticalNurses (LPNs) and Health Care Aides(HCAs) is likely the most effective modelfor optimizing nurses’ role enactmentand improving health outcomes, at leaston general medical acute care unitswhich have been the focus of much ofour research. The premises leading to thisconclusion are discussed in this paper.

1. Nurses are currently underutilized

A study examining nurses’ (RN, Regis-tered Psychiatric Nurses and LPN) per-ceptions of the extent to which they wereable to fully apply their knowledge andskills in day-to-day practice revealed sub-stantial underutilization of all categoriesof nurses (Besner et al, 2005). Althoughthere were differences among nurses intheir interpretation of what it meant towork to full scope, 50 percent of RN par-ticipants and almost 80 percent of LPNssaid they were frequently unable to fullyapply their knowledge and skill in prac-tice. RNs noted that excessive workloadscaused them to focus on medically re-lated tasks to the exclusion of psycho-so-cial-cultural-spiritual needs assessment.

So, you’re focusing more on the physical aspects of things and you’re not really… you don’t often have time to focus on psychosocial. (RN)

Many LPNs reported having to upgradetheir skills to meet licensing require-ments, only to find they were prohibited

from using these skills in many settings.Being unable to give medications was themost common restriction reported.

All the LPNs had to upgrade to a certain level. We had to take a med course. So as I’m working on this unit, I have not used all the stuff I learned… I’m not giving meds… I’m not changing dressings. (LPN)

Patient care managers almost unani-mously felt that the majority of RNswere not working to full scope on theirunits, representing a gross underutiliza-tion of knowledge and skill.

The expectation is not there from the organization… The staff on the unit, they are still doing the task-oriented things, trying to look at the big picture, but they don’t have the time. I think the unit manager works to herfull scope of practice. I don’t think any of the other RNs do. (Patient Care Manager)

Although a majority of Patient CareManagers and registered nurses in spe-cialized roles felt that LPNs were under-utilized, it appeared that resistance orstereotyping on their part were majorfactors in limiting full implementation ofLPN skills.

Honestly, I just don’t think they have the education to do the job. (PCM)

2. Underutilization of nurses negatively impacts patient and system outcomes

The focus on tasks caused many nursesto worry that patient outcomes were per-haps not as good as they could be andconcern about their inability to meet pa-tient care needs contributed to job dissat-isfaction in some cases.

Patient load and whatever else will prevent you from doing things as thoroughly as you would like to or really feeling like you have com-pletely grasped the whole situation with your six or 12 patients. (RN)

It’s very rushed and sometimes you

research

ABSTRACT

The Canadian Nursing AdvisoryCommittee report released at the be-ginning of this decade highlightedthe need to address underutilizationof the nursing workforce. Given thecritical role of nurses in delivery ofsafe, quality care, every effort mustbe made to ensure that they are sup-ported in fully enacting their roles inthe health care system. Our programof research has focused on generat-ing scientific evidence to inform theeffective and efficient utilization ofhealth human resources, includingRegistered Nurses, Licensed Practi-cal Nurses, and unregulated workerssuch as Health Care Aides. Thisresearch has led us to conclude thata collaborative nursing practicemodel should be considered as ameans of improving the effectivenessof the nursing model of care, at leaston medical patient care units, wheremuch of our research has beenconducted.

Improvingthe Quality ofNursing Care:The Case forCollaborativePracticeBy Jeanne Besner, RN, PhD


may miss things … your daily assess-ments might not be as good as they were if you had more time to spend with that patient. (LPN)

Subsequent research (White et al., 2009)confirmed nurses’ perceptions that cur-rent practice is largely focused on theperformance of tasks and activities re-lated to meeting patient’s bio-medicalneeds. Of concern, findings from thisstudy revealed that underutilization ofnursing knowledge and skill potentiallycompromised patient outcomes and mayhave contributed to excess utilization(e.g., preventable 90 day readmission).Observation data on this medical unit re-vealed that RNs spent limited time onpatient / family psycho-social assessmentand support (~ 4.6%), while consider-able time was devoted to activities ofdaily living and personal care (13%),bio-medical assessment (8%), medica-tion and treatments (13.2%), many ofwhich clearly fall within the scope ofpractice of LPNs and HCAs.

The “population profile” for the unit re-vealed that a majority (~ 65%) of pa-tients discharged from the unit wereelderly (i.e. 70+ years) and had one ormore chronic diseases. About 34% re-turned to the emergency department and25% were readmitted to in-patient unitswithin 90 days of discharge. Analysis ofpost-admission co-morbidities associatedwith increased lengths of stay revealed anumber of conditions (e.g., fluid andelectrolyte imbalance, fluid overload,acute renal failure) that were potentiallypreventable with increased monitoringand surveillance. This realization height-ened staff awareness of gaps in practice.

After I looked at the data, I thought, boy… there is a lot of room to do a lot of things for the better or to start getting things where you could focus more on what we’re supposed to be doing a lot of the time. (RN)

This study was conducted on a unit pre-dominantly staffed by RNs who were ac-countable for the provision of allregulated activities, supported by a smallnumber of HCAs. RNs were over-whelmed with the performance of regu-lated activities (e.g., medication

administration, dressings, etc.) and feltunable to attend to the comprehensiveneeds of patients while maintaining ex-isting workloads. Since staff generallyagreed that outcomes were not as goodas they ought to be, one of two solutionsseemed obvious – recruit more RNs orincorporate LPNs into the staff mix toallow RNs sufficient time to attend to“value added” activities that were other-wise being neglected. A critical shortageof RNs made the first option unrealisticand published evidence about the poten-tial negative impact of introducing LPNsraised concerns about the second. Al-though it is often implied that only dif-ferences in “nursing knowledge andcritical thinking ability” account for theobservation that better outcomes are re-alized with higher proportions of RNs,findings from earlier research led us topropose an alternative explanation.Could ineffective relationships and poorcommunication between RNs and LPNs“explain” the poorer outcomes that areoften documented as the ratio of LPNsto RNs increases in the staff mix?

3. Relationships among nursingproviders influence patient outcomes

The influence of collaborative nurse-physician relationships on patient,provider and system outcomes is welldocumented (O’Brien Pallas, Hiroz,Cook, & Mildon, 2005). Role confusion,power differentials (Corser, 2000), re-spect and autonomy (cited in Larson,Hamilton, Mitchell, & Eisenberg, 1998)all act as barriers to effective nurse-physician collaboration, which in turninfluences patient care and outcomessuch as medication errors (cited inO’Brien Pallas et al., 2005). There is littlereason to believe that the same factorsthat contribute to effective collaborationbetween nurses and physicians wouldnot apply to relationships among nursingproviders.

Research on nursing scope of practice re-vealed substantial role confusion withinnursing. Nurses reported feeling disre-spected by other team members and ten-sion and “power struggles” betweenRNs and LPNs were apparent. A subse-

quent study underscored the importanceof enhancing knowledge and compe-tence for collaborative practice amongnursing providers (White et al., 2009).

Insufficient attention has been paid toclarifying roles and promoting collabo-ration among RNs and LPNs as increas-ing numbers of LPNs were added to thenursing staff mix in recent years. In mostcases, the predominant model of servicedelivery (i.e., modified primary nursingor total patient care) has been main-tained and care has been assigned toLPNs on the basis of predictability orstability in the patient population. Fur-thermore, it is perceived by some thatLPNs are hired to replace RNs as a costreduction measure, contributing to un-necessary conflict and tension among thetwo groups of nursing providers. Underthese conditions, it is not surprising thatincreases in the proportion of LPNs toRNs in the staffing mix have led topoorer patient outcomes (Needleman,Buerhaus, Stewart, Zelevinsky, & Mat-tke, 2006), but the contributing factormight not be knowledge and skill per se,but rather the quality of the relationshipsbetween RNs and LPNs. It is thereforeplausible to suggest that LPNs andHCAs can safely be introduced into thestaffing mix in tertiary care environ-ments without any negative impact onpatient outcomes, providing attention ispaid to creating an organizational con-text that supports effective collaboration(Arford, 2005).

4. The “right” model of care is an important determinant of outcomes

There is no question that knowledge andskill play a critical role in preventing se-rious complications such as pneumonia,shock and cardiac arrest (Needleman etal, 2006). In view of increasing patientacuity in most contemporary hospitals,few would argue that every patient de-serves to be cared for by a competentand well qualified nurse. At the sametime, there is growing recognition thatnew approaches to care delivery areneeded to address the challenges of im-proving access, quality, and sustainabil-ity in the face of shrinking human andfinancial resources (Campbell & Briley,

>


2008). Our research (White et al., 2009)indicated inefficiencies with the modifiedprimary nursing model (a version of totalpatient care), in that many of the ob-served activities that were being per-formed by RNs were clearly within thescope of practice of LPNs, HCAs, house-keeping, clerical, and other personnel.There was also evidence that RNs wereineffective in meeting the comprehensivehealth needs of patients, due to the focuson “task oriented” activities needing tobe performed. Hiring more RNs wouldbe one solution to increasing effective-ness in delivery of care, but would donothing to overcome the inefficiency in-herent in having RNs perform work thatin many cases could be assigned to othermembers of the team.

The evidence thus suggested the need toimplement a collaborative practicemodel that would align provider knowl-edge and competencies with the needs ofthe patient population. The goal is to im-prove patient, provider, and system out-comes by deploying all human resourcesin the most effective and efficient man-

ner. We defined collaborative nursingpractice as shared-decision makingamong a specified team of nursingproviders who together plan, implement,and evaluate the care of a group of pa-tients for whom they are collectively ac-countable. Unlike the former teamnursing model that predominated duringthe 1950s and 1960s, our approach tocollaborative nursing practice is not in-tended to be hierarchical, with commu-nication primarily shared from chargenurse to team leader to team members(Shirey, 2008). Rather, in a tertiary caresetting, the RN will most likely functionas coordinator, who engages other teammembers in discussion about the careneeds of all patients assigned to the teamand ensures that care plans are under-stood and implemented by the most ap-propriate member of the team, includingthe RN who still maintains contact withevery patient assigned to the group, as doall team members.

Since we are still in the early stages of im-plementing collaborative nursing prac-tice, it is too early to state with any

assurance that it will reduce inefficiencyin service delivery while improving pa-tient outcomes. Early experience with themodel has highlighted the need to help allmembers of the team improve their skillfor collaborative practice. It has becomeclear that the model will not achieve in-tended outcomes without the establish-ment of continuing education programsto enable providers to better enact theirrespective roles and develop competencyfor effective collaborative practice.

Early findings from ongoing evaluationof the implementation of collaborativenursing practice on one medical unitnonetheless leads us to believe that thisapproach has the potential to contributeto improved patient satisfaction withcare, enhanced job satisfaction and po-tential cost savings, once roles are fullyoptimized. It also appears that the modelallows more flexibility in meeting fluctu-ating patient care needs over the courseof a shift, helps reduce variability inworkload among nursing staff, and pro-vides greater opportunity for mentoringand peer learning.

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Conclusion

The underutilization of nurses is unacceptable at any time, but isparticularly troublesome in the face of current nursing shortagesand increasing cost pressures. Given the critical role that nursesplay in promoting patient safety and quality of care, every effortmust be made to ensure that they are supported in fully enactingtheir respective roles in the health care system. Although researchto date has consistently demonstrated a relationship between thelevel of RN staffing and patient outcomes, there has been no spe-cific attention given to the model of care that has been linked tothose outcomes. Based on our research to date, we would predictnegative outcomes if LPNs or HCAs are introduced into a newstaffing model without due attention to the importance of con-tinuing education to enhance skill in collaborative practice for allteam members. As we implement new models of collaborativepractice, particular attention must be given to overcoming the re-lationship issues that may well account for the poorer outcomesobserved in research that has examined the impact of reducingthe proportion of RNs in the staffing mix. While it is much toosoon to state with confidence that collaborative nursing practiceis the “right” model of care in all settings of practice, we wouldargue that it is also inappropriate to reject this model outright.Unless more conclusive evidence can be provided that patient out-comes are positively or negatively impacted by introducing LPNsand HCAs into the staffing mix, collaborative nursing practicewould appear to be a fiscally responsible approach to managingscarce nursing resources. n

ReferencesAdvisory Committee on Health Human Resources. (2002). Our health, our future.Creating quality workplaces for Canadian nurses. Ottawa: Author.

Arford, P. H. (2005). Nurse-physician communication: An organizational account-ability. Nursing Economics, 23(2), 72-77.

Besner, J., Doran, D., McGillis Hall, L., Giovannetti, P., Girard, F., Hill. W., Morrison,J., & Watson, L. (2005). A systematic approach to maximizing nursing scopes ofpractice. Research report submitted to the Canadian Health Services ResearchFoundation and Alberta Heritage Foundation for Medical Research.

Campbell, G. M. & Briley, T. (2008). Bundled redesign: Transformational reorgani-zation of acute care delivery. Critical Care Nursing Clinics of North America, 20,489-498.

Commission on the Future of Health Care in Canada. (2002). Building on values:The future of health care in Canada. (R. J. Romanow, Commissioner). Ottawa,ON: National Library of Canada.

Corser, W. D. (2000). The contemporary nurse-physician relationship: Insightsfrom scholars outside the two professions. Nursing Outlook, 48, 263-268.

Fyke, K. (2001). Caring for medicare: Sustaining a quality system. SaskatchewanCommission on Medicare. Regina, SK: Government of Saskatchewan.

Larson, E., Hamilton, H. E., Mitchell, K., & Eisenberg, J. (1998). Hospitals: An ex-ploratory study to assess what is said and what is heard between physicians andnurses. Clinical Performance and Quality Care, 6(4), 183-189.

Needleman, J., Buerhaus, P. I., Stewart, M., Zelevinsky, K., & Mattke, S. (2006).Nurse staffing in hospitals: Is there a business case for quality? Health Affairs,25(1), 204-211.

Shirey, M. R. (2008). Nursing practice models for acute and critical care:Overview of care delivery models. Critical Care Nursing Clinics of North America,20, 365-373.

O’Brien Pallas, L., Hiroz, J., Cook, A., & Mildon, B. (2005). Nurse-physician rela-tionships. Solutions and recommendations for change. Comprehensive Report forthe Nursing Secretariat and Ministry of Health and Long-Term Care ResearchUnit. Revised December 2005.

White, D., Jackson, K., Besner, J., Suter, E., Doran, D., McGillis Hall, L., & Parent, K.(2009). Enhancing nursing role effectiveness through job redesign. ResearchReport submitted to the Alberta Heritage Foundation for Medical Research.

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A nurse relates: “I was visiting an acquaintance in hospitalwith lung cancer. Her condition had beendeclining and prognosis was now a mat-ter of a few weeks. When I arrived shewas breathing 36/min, was distressed,anxious, and unable to settle.”

“I asked her nurse for her breakthroughdose of opioids to help settle her discom-fort. The nurse responded, “I don’t wantto give her medications as it may slow herbreathing down and decrease the oxygenlevel in her blood.”

“When I returned to my acquaintance’sbedside, she was gasping and in obviousdistress. I rang for a nurse to come. Noone came. Leaving the woman alone I hur-ried into the hall and called to the nurse. Idiscussed with her the rationale for givingthe medication. She prepared the medica-tion and we returned to the room. Thewoman had died.”

Dyspnea is the sensation of difficulty inbreathing and the person’s reaction tothat sensation (Roberts, Thorne andPearson, 1993). One study suggests that50-70% of patients with terminal cancerwill experience some degree of dyspnea,especially in the last six weeks of life(Dudgeon, 2006). We can anticipate thatdying persons and those with chroniclung or heart disease are likely to experi-ence dyspnea.

Assessment Dyspnea cannot be determined solely onthe basis of physiological change, e.g.,low oxygen levels in the blood. A personmay have an adequate level of oxygen intheir blood, they may not have rapid res-

pirations and their breathing sounds maybe normal, but the person may still feelbreathless. Just as in exercise, your bodyhad adequate oxygenation yet you stillfelt breathless due to the restricted air-flow. Like pain, dyspnea is a subjectivesensation that has many potential con-tributing factors. Like pain, people mayuse different terms to describe their strug-gle to breathe such as: “I am tired,” “Ifeel weak,” “I have to sleep with myhead up,” “I can’t get a deep breath.”The Fraser Health Symptom AssessmentAcronym can provide structure to theassessment (see CARE Magazine, Winter2010, p25).

Observe• Respiratory rate, pattern, depth,

sounds• Needs to pause when talking • Chest movement /Muscles utilized• Presence of cough, sputum • Fever • Respiratory congestion, chest pain,

diaphoresis (perspiration), confusion • Presence of anxiety/fear

Possible CausesThe health care team works together todetermine the causes of dyspnea, to con-sider treatments, and to consider comfortmeasures. Any treatment should be tai-lored to the patient in consultation withthe health care team. As with othersymptoms, knowing the cause will helpto develop appropriate treatment andcomfort measures. For example, a personwith restricted air movement cannot takedeep slow breaths; therefore it would befrustrating for the patient if they were di-rected to do so.

This is the third in a series ofarticles about caring for thedying. Kath Murray, RN, is ahospice palliative care nursewith a passion for developingand delivering education.

Contact her at [email protected].

Dyspnea:The

Feeling ofBreathlessness

By Katherine Murray, BSN, MA, CHPCN(C)

life & death matters

Palliation with OpioidsMedications are important interventions in providing relieffrom severe dyspnea. For this article, I will focus on the use ofOpioids to manage dyspnea.

Opioids are valuable medications for relieving dyspnea in pal-liative care when disease modifying therapies are already max-imized or inappropriate. Opioids may help to decrease thesensation of dyspnea through sedation, vasodilation, and/or bydecreasing the sensitivity of CO2 receptors in the brain(Roberts, Thorne and Pearson, 1993).

Principles for managing dyspnea with opioids are the sameprinciples used in managing pain with opioids, i.e. give med-ication regularly, round the clock, provide breakthrough doseswhen needed, provide alternative route when unable to swal-low, continue medication through to death.

Starting opioids early in the disease process can increase theperson’s quality of life. Twycross suggests “early use of opioids,rather than hastening death in dyspneic patients, might actuallyprolong survival by reducing physical and psychologicaldistress and exhaustion” (Twycross and Wilcock, 2001).

Oxygen Historically we have relied on oxygen as the first line comfortmeasure when someone is short of breath. However, it is sig-nificant to remember that a low level of oxygen in the blood isonly one cause of dyspnea. People can be very distressed withtheir breathing and yet have sufficient oxygen in their blood.Wearing an oxygen mask might even increase a feeling of claus-trophobia and shortness of breath. It cannot be assumed thatoxygen is “the answer” for all dyspneic individuals. Researchindicates that oxygen is not usually helpful unless a person istruly suffering from lack of oxygen.

Comfort Strategies As with other symptoms, comfort measures for dyspnea needto be adapted to individual preferences and needs as well asconsidering the underlying contributing causes. There are sev-eral preventative measures that can be useful in decreasing thefrequency of dyspneic episodes. • Identify factors that trigger a dyspneic episode. • Ensure a good supply of fresh air, ban perfumes and

powders.• Limit visitors if necessary. • Provide/suggest loose non-restrictive clothing around neck

and chest. • Maintain mobility as appropriate - a consult with physio

therapy early in the illness may help a person maintain their activity level and muscle strength. This becomes less appropriate or important as death becomes imminent.

• Position the patient to increase lung capacity—elevate head, use a recliner and position pillows.

• Pace activities—take time as needed to allow the patient time to breathe, don’t rush through an activity, rest between activities.

• Provide breathing stations—e.g., provide a chair to rest on halfway down the hall.

• Try progressive relaxation, guided imagery, or focused breathing to help patient learn to slow their own breathing.

Strategies To Use During An Acute Dyspneic EpisodeIn addition to the points outlined above, the followingstrategies may help during an episode of dyspnea:• Stay calm and be present. • Use unhurried actions.• Reassure patient, “Your breathing will ease.” • Offer companionship, “I will stay with you.” • Provide a focus message, “Look in my eyes…breathe with

me…your breath is getting slower...” as you match your breathing to the patient’s breath and then slow it down.

• Show pursed lip breathing which may help to slow the respiratory rate.

• Administer medications as prescribed. • Use oxygen for patients with hypoxia (low levels of oxygen

in blood).

Develop a Plan The first episodes of dyspnea might well cause a crisis for boththe patient and for caregivers and may result in hospital trans-fers and/or additional practitioners on the care team. Regard-less of whether the episode occurs in the home, residential carefacility, or hospital, it is important for the patient and care-givers to address the question: “What do I do if this happensagain?” It is inappropriate to leave a person or their caregiverswithout an action plan.

An action plan for dealing with dyspnea must identify med-ications to be taken, comfort measures to initiate and numbersto contact a health professional 24/7. When dyspnea is notadequately managed, a consultation from a palliative careconsultant/ team may be useful. n

REFLECTION ACTIVITY

Persons with respiratory or heart problems shouldnot do this exercise. This experiential exercise willhelp you understand the sensation of dyspnea.

Exercise

Take three drinking straws. Insert one straw intothe next, and so on until you have all three strawsforming a single extra-long straw. Take the longstraw and put one end in your mouth. Plug yournose. While breathing only through the straw walkfor 2 minutes.

Review

What you have just experienced may give you asense of what some patients experience on adaily basis—dyspnea.

What did that feel like? What if that sensationhappened unexpectedly? What would you thinkwas happening?

Take a moment to breathe deeply (without thestraws!) and enjoy the deep easier breaths.



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the operations roomclpna.com

Member Information - College Activity - Best Practices

NEW COUNCIL MEMBERS JOIN CLPNA

NATIONAL NURSING WEEKMay 9-15, 2011

“And what nursing has to do… is to put the patient in the best condition for nature to act upon him”

Florence Nightingale

NATIONAL NURSING WEEK celebrations occur throughout thecountry the week of Florence Nightingale’s birthday (May 12). This timegives opportunity to recognize and appreciate nurses and the professionof nursing for contributing to the well-being of society.

This year the LPN profession celebrates 25 years of self-regulation.Growth, change, and advancement define our history over those 25years as we have forged our future together. However, the progressionin our profession could not have been achieved without the support ofmany other professionals. Celebrate with your team this Nursing Weekrecognizing and appreciating everything we can accomplish when wework together-collaboratively, for it really is the best way for us to servethe people of Alberta!

We encourage you to continue to Walk theTalk - Inside this magazine is a new LPNposter and a magnetic LPN banner. Hangthe poster at work and post the magnet onyour vehicle or in a prominent place in yourhome or workplace. Together we can

educate, enlighten, and empower others about ourprofession! Join our social media sites today and watch for someexciting opportunities to share your LPN voice. Be proud of your chosenprofession. Wear your LPN pin; drive around with your magnet; andshare information with others about who you are!

District 5 (former Aspen Health Region)On December 9, CLPNA Council appointed Lorraine Strelezki, LPN, as the District 5 representative. Since hergraduation from Portage College in 2005, Lorraine has worked in Bonnyville in acute care. Her public involve-ment has led her to volunteer for the Provincial Health Ethics Network and her local town council.

2 New Public MembersThe Health Professions Act requires the provincial government to appoint public representatives to sit on Counciland represent the views of the people of Alberta. On November 24, 2010, a Government of Alberta Order ofCouncil appointed Allan Buck and Ralph Edward Westwood as public members to the Council of the Collegeof Licensed Practical Nurses of Alberta (CLPNA). Westwood and Buck have extensive board experience andbackgrounds in education, and attended their first Council meeting on December 9-10, 2010.

CLPNA Council and staff welcome Lorraine, Allan, and Ralph to our team.


the operations room

INSTANT ACCESS FOR MEMBER UPDATES

Thanks to the new Members/Applicants website, Alberta’sLPNs have 24/7 access to update their CLPNA profile online.It’s quick and easy to update contact information, employer,employment status, education, and, by popular demand,Continuing Competency Program (CCP) Learning Objectives.Members will now more easily be able to comply with theHealth Professions Act’s requirement that members ensureCLPNA has their current contact information at all times.

For the first time, the online profile allows members to notifyCLPNA about changes during the year to their ContinuingCompetency Program (CCP) Learning Objectives. Current datais only from the 2011 Registration Renewal form, but in futureyears this information will be available for CCP Validation andgeneral record keeping.

The secure password-protected website may be accessed atwww.clpna.com by selecting “Members/Applicants Login” in thetop right corner. After logging in, members can select “ViewProfile” to review and edit personal information. Login informa-tion was sent to members with their 2011 Registration Renewalpackage, or may be requested from CLPNA.

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Members reported theyfound the online registra-tion process quicker,easier, and clearer thancompleting it on paper.Also appreciated was theimmediate confirmation ofregistration status, insteadof waiting for paperworkprocessing.

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For the CLPNA, the quantity of incompletepaper Registration Renewalforms returned to the member decreased by90%. This greatly reducedpostage and processingtime. Additionally, member-ship data is more up todate, with hundreds ofhours of data-entry timeeliminated and data-entryerrors reduced.

Improved member serviceand significant resourcesavings for the CLPNAwere realized due to thenewly introduced onlineRegistration Renewalprocess in Fall 2010.


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7

65

3

21

4

CLPNA District Map

Join the Council – Help Forge our Future!A re you interested in seeing a more global view of nursing?

Do you believe you can make a difference? Are you willingto use your LPN voice to impact change?

Then we have an opportunity for you!

The College of Licensed Practical Nurses of Alberta(CLPNA) seeks LPNs interested in becoming involved in Col-lege affairs. Members residing in four election Districts areinvited to let their name stand for election to the CLPNACouncil by submitting a Nomination Package before May 31,2011. In June, LPNs in the election Districts will select theirrepresentative by mail-in ballot.

2011 ELECTION DISTRICTS:

The Council is responsible for the overall general direction ofthe College operating on a broad policy, planning, and finan-cial level. The Council does not manage day to day operationsof the College, which is handled by the Executive Director.This opportunity allows direct participation in the College’sMission: “To regulate and lead the profession in a manner thatprotects and serves the public through excellence in PracticalNursing.”

Council members attend two-day meetings every threemonths to review reports of College business and planupcoming goals.

SUBMITTING A NOMINATION

Job Descriptions and Nomination Forms are available fromwww.clpna.com under “About CLPNA”, “Council”. Or contactthe CLPNA office at [email protected], or 780-484-8886 or1-800-661-5877 (toll free in Alberta).

Your Profession - Your College

DISTRICT 2: CALGARY ZONE

DISTRICT 4: EDMONTON ZONE

DISTRICT 6: PART OF NORTH ZONE(former PEACE COUNTRY HEALTH)

DISTRICT 7: PART OF NORTH ZONE(former NORTHERN LIGHTS HEALTH)

T he Continuing Competency Program Validation(CCPV) launched spring of 2009 and willcontinue annually. In June 2011, 20% of

membership will be randomly selected to participatein this process.

The objective of CCPV is to review your partici-pation in the Continuing Competency Program(CCP) over the previous two years. CCPV quali-fies the validity of your CCP documents and as-sesses the transfer of learning within your nursingpractice. Through self-assessment and reflection,you measure how learning changed your nursingknowledge and what effect this knowledge hashad on your professional practice.

Everyone will have the opportunity to participatein the CCPV as outlined in the Health ProfessionsAct, at least once within a five year span. To beprepared, CLPNA recommends that you trackyour learning with a certificate, attendance letter,or by filling out a concise Record of ProfessionalActivities. The CCPV process is much easier ifyou file your education records in an organizedmanner, so when it’s your turn to participate inCCPV, you are ready.

Don’t delay! Start today. Be prepared.

20%of Membership involved

CONTINUING COMPETENCYPROGRAM

2011 vaLiDation


THE CLPNA COUNCIL APPROVED A NEW STRATEGIC VISIONat the December 2010 meeting enhancing goals toward regulatoryexcellence and including new emphasis on research and publicawareness.

Freshly introduced in the new Vision is increased public understand-ing of the role and contributions of Licensed Practical Nurses. Thisgoal formalizes recent opportunities for promotion of the profession,such as 2009’s “Says a Lot About You” recruitment campaign and2010’s foray into social media through the “Walk the Talk” initiative.

A second new goal of initiating and supporting research relevant tothe Licensed Practical Nurse profession and the health care systemis already underway. There is very little LPN research available. Whatresearch exists is difficult to apply to Alberta LPN practice, due tothe highly varied scope of practice across North America. Pursuingevidence-based practice is key to providing quality rational for chang-ing current practice.

The research goal is very timely considering the September 2010launch of the Government of Alberta’s “Patient Safety Framework forAlbertans” with the goal to “guide, direct, and support continuous andmeasurable improvement to patient safety”.

A final significant change is that the membership number goal wasreworded into a broader goal “to increase demand for LicensedPractical Nurses generating continuous growth in the profession”.This Vision better describes the actions for the CLPNA to pursue inthe next few years rather than merely a quantity of members.

Read the new Mission/Vision Statement on page 38.

Canadian LPN discussioncrosses the 49th ParallelRepresentatives from the Canadian Council for Practical Nurse Regu-lators (CCPNR) attended the December NCSBN Board Meeting inChicago on December 8, 2010 by invitation from Myra Broadway, Pres-ident of the National Council of State Boards of Nursing (NCSBN).Discussion centered on the competencies and the role and scope ofthe Canadian Licensed Practical Nurse to increase understanding asa first step in facilitating ease of mobility for LPNs between Canadaand the US. In addition, common issues facing the nursing regulatoryenvironment were part of a general discussion. CCPNR Chair LindaStanger stated, “Opportunity for meaningful conversation betweenCanadian and US nursing groups is important for future growth ofthe LPN profession. We intend to build on this and other relation-ships with our American Nursing colleagues.”

FresH goaLs in 2015

strategiCPLan

Pictured left to right: Linda Stanger, Chair CCPNR(2008-2010); Myrna Broadway, President NCSBN;and Teresa Bateman, past Chair National Practice

Consultants Group (2009-2010)


the operations room

LPNs provide basic and advancedfoot care in a variety of settings in-cluding: hospitals, long term carecentres, community agencies, clin-ics, and clients’ homes. LPNs pro-viding foot care may be employedby a facility / agency or may be inself-employed practice.

LPNs are responsible to maintain education and competenceto meet the health needs of their clients. When providing acomprehensive foot care treatment, LPNs require additionaleducation in advanced foot care procedures.

In Alberta, there are two authorizations for LPNs performingfoot care.

Basic Foot CareBasic foot care is taught in the entry-level practical nurse pro-gram and includes anatomy and physiology of the feet andlower extremities, common micro-organisms, infection preven-tion, common complications, and documentation includingclient referrals. Basic foot care is similar to that providedthrough a routine pedicure.

Advanced Foot CareAdvanced Foot Care is considered a restricted activity andmay involve the removal of tissue below the dermis. The re-stricted activity listed in the Health Professions Act, LPN Reg-ulation 2003 (5[a]) authorizing advanced foot care states:Only regulated members on the specialized practice registerand who are specifically authorized by the Registrar may per-form the restricted activity of cutting a body tissue, adminis-tering anything by invasive procedure on body tissue orperforming surgical or other invasive procedures on body tis-sue below the dermis for the purposes of… Removing a cornor a callus as part of the provision of footcare…

AuthorizationFor authorization in advanced foot care, the LPN must com-plete an education program containing theory and supervisedlab practice beyond that in the basic practical nurse program.To achieve authorization in advanced foot care, LPNs mustsubmit a copy of their advanced foot care program certificateor a foot care checklist must be completed, which includesverification of competence.

If you have not yet verified your advanced foot careeducation / competencies or if you are in self-employedpractice, please contact the CLPNA immediately [email protected] for more information.

attention:Foot Carenurses

http://blog.CLPNA.com | www.twitter.com/CLPNA

www.youtube.com/CLPNA | www.facebook.com/CLPNA

L I C E N S E D P R A C T I C A L N U R S E S

OBSERVE

T A L K the WA L K

Can a Licensed Practical Nurse (LPN) administer the medication Methotrexate?

Yes, LPNs can administer the medication Methotrexate. Safe administra-tion of this medication will require knowledge of pertinent information in-cluding action, duration, frequency, purpose, side effects, and all nursingimplications. LPNs are expected to follow medication protocol regardingproper preparation, administration, and storage or disposal proceduresas supported within agency policy. Competence must be achieved beforeadministration of this medication or any other medication applicable totheir role.

Is accepting, transcribing and initiating orderswithin scope of practice of Licensed PracticalNurses?

Yes, LPNs can accept, transcribe, and initiate various medical orders froman authorized health professional. LPNs are expected to ensure accuracyof transcription, communicate with other health professionals as neces-sary, implement the appropriate action, and adhere to agency policy andprocedures. Any LPNs who require updated competencies in this areacan access post basic or employer education.

I am working on a medical floor of a hospital aspart of a nursing team. My question is: As I workin partnership with other nurses on my team, amI accountable for my nursing practice or wouldthis responsibility transfer to the charge nursethat I report to?

Under the Health Professions Act, LPNs are autonomous health careproviders. As professional nurses LPNs are accountable for their ownnursing practice, and as any professional are expected to seek assis-tance when the needs in practice go beyond their competence level.There are several areas of accountability involved in professionalpractice. LPNs are accountable to; the client by representing them andacting in their best interest; their employer through following policiesand procedures; their regulatory College to adhere to the standardsand guidelines established through scope of practice, code of ethics,standards of practice, and applicable legislation.

When care is assigned there are several accountabilities that comeinto play; the charge nurse must assign appropriately, and the accept-ing nurse must have the competencies necessary for the care needsof the client. For example, when you perform an initial assessment onyour client and you identify complex care needs that are outside ofyour competence level, you must communicate with the charge nurseimmediately. At this time you may be reassigned or someone collab-orates with you to support quality care delivery.

Contact our Practice Consultants at [email protected] or 780.484.8886


the operations room

The following are frequently asked questions toCLPNA’s Practice Consultantsby our members, managers,

educators, or the general publicthat could provide valuable information for you in your practice environment.

Q.

Q.

Q.


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A ctive Practice Permits expire onDecember 31 of each year; howeversome members still don’t understand

what this means. In 2010/2011, CLPNAfound 50 LPNs guilty of unprofessionalconduct due to practicing without a validPractice Permit and $25,000 in fineswere levied.

CLPNA Complaints Director SharleneStanding does not believe members in-tentionally fail to renew their registrationon time, “However, it is the responsibil-ity of the LPN to ensure they have a validPractice Permit prior to practicing onJanuary 1 of each year. Stating you faxedor mailed the Registration Renewal formdoes not guarantee it was received. LPNsare responsible to take steps to ensurethat their Practice Permit has been ap-proved prior to practicing in the newyear”.

CLPNA provides access to online regis-tration to provide a fast, efficient andconvenient method of Registration Re-newal. As well, the CLPNA Public Reg-istry provides up-to-date registrationinformation to allow for registrationverification by members and employers.

In fact, employers are also accountableto verify Practice Permit’s. Under HealthProfessions Act Section 47 and 48 it isconsidered an offence to employ an LPNwho does not have a valid Practice Per-mit. Penalties levied against an employercould range from a fine to imprisonment.

The public expects professionals to com-ply with their professional obligations.Part of this obligation includes only prac-ticing with a valid Practice Permit. With-out a valid Practice Permit liability(malpractice) insurance may be affectedplacing undue risk on the LPN and theemploying agency.

According to the Health Professions Act(HPA), Mandatory Registration meansall health professionals must be regis-tered with their regulatory college to pro-vide professional services to the public.

Professional services for the LicensedPractical Nurse profession includesapplying the knowledge, skills, attitudes,judgments, and behaviors of the profes-sion as defined by the CompetencyProfile for LPNs, 2nd Edition, 2005.

Practicing without a valid Practice Permitis serious and considered to be unprofes-sional conduct. Unprofessional conductas defined by the HPA includes:

• contravention of the Health Professions Act, LPN code of ethics or LPN Standards of Practice

• displaying a lack of knowledge of or lack of skill or judgment in the provision of professional services

• conduct that harms the integrity of the LPN profession

This conduct issue can be easily miti-gated by simply renewing registration ontime and by checking to ensure a PracticePermit was issued. For member conven-ience, the CLPNA initiated OnlineRegistration – approximately 60 % ofLPNs renewing took advantage of thisaccurate, easy and efficient method.

After December 31, 2010, members whodid not yet submit an application torenew their Practice Permit for 2011 andwant an Active Practice Permit mustcontact the CLPNA for a “Reinstate-ment Package” at [email protected] or780-484-8886.

An excellent resource for Employers isthe Health Professions Act Employer’sHandbook – a guide for employers ofregulated health professionals located athttp://www.health.alberta.ca/docu-ments/HPA-Employers-Handbook-2004.pdf

MATTE

RS

the operations room

CO

ND

UC

T $25,000 iN FiNeS For PrACTiCiNg

WiTHouT A PrACTiCe PerMiT

this feature is intended

to educate CLPna

members regarding

unprofessional

conduct-related issues

administered by

CLPna’s Conduct

Department under the

authority of the Health

Professions act.


2010 CLPNA Registration Data

statisticsmembership

Registrations

2009 2010Alberta Initial Graduates 661 721

Re-Entry LPNs 5 4

Other Canadian LPNs 277 264

Non Canadian LPNs 136 34

Renewals 7452 7992

TOTAL 8531 9015

94% 6%

LPN GenderDistribution

26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65+

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Y

R9

R8

R7

R6R5

R4

R3 R2

R1

Distribution of LPNs by Region (former)

2009 2010

R1 Chinook Regional Health Authority 476 513

R2 Palliser Health Region 293 320

R3 Calgary Health Region 1995 2146

R4 David Thompson Regional Health Authority 863 882

R5 East Central Health 407 427

R6 Capital Health 2987 3094

R7 Aspen Regional Health Authority 455 478

R8 Peace Country Health 383 401

R9 Northern Lights Health Region 133 148

Other Canadian 539 606

TOTAL 8531 9015 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65+

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

YEAR

53 34 41 74 90 80 81124

205247

601

413

298

Out of Province & InternationalRegistrations

BC|

102

SK|6

MN|5

ON|

121

QC|1

NB|3

NS|

15

PEI|1

NL|

10

NT|0

YK|0

NU|0

USA|

31

OTHER*|3

In Migration Breakdown

TOTAL - 298*Philippines

26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65+

2010

Y

2010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986

9015853178597264686365336037557551724848443143424606472349635562619663786545665167366956722578948643

5.7%8.6%8.1%5.8%5.0%8.2%8.3%7.8%6.7%9.4%2.0%-5.7%-2.5%-4.8%-10.8%-10.0%-2.9%-2.6%-1.6%-1.3%-3.2%-3.7%-8.5%-8.7%

Number of LPNs

Percentage ofLoss/Increase

LPN Registration Trends

Age of Active LPNs

19-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65+

AGE GROUPS

8.7%788

18.3%1646

13.0%1171

11.8%1063 9.7%

870

10.5%946

10.6%952 8.7%

782

8.8%797

2010

Y

Average Age: 2008 - 41.2

2009 - 40.7

2010 - 41.4


CLPNA CouncilPresident

Hugh Pedersen

Executive Director/RegistrarLinda Stanger

[email protected]

District 1 (South Zone)Carla Koyata

District 2 (Calgary Zone)Donna Adams - Vice President

District 3 (Central Zone)Jo-Anne Macdonald-Watson

District 4 (Edmonton Zone)Sheana Mahlitz

District 5 (Part of North Zone)Lorraine Strelezki

District 6 (Part of North Zone)Roberta Beaulieu

District 7 (Part of North Zone)Alona Fortier

Public MembersRobert Mitchell / Allan Buck

Ralph WestwoodTo contact Council members please call the CLPNA office and your

message will be forwarded to them.

CLPNA StaffTamara Richter

Director of [email protected]

Teresa BatemanDirector of Professional Practice

[email protected]

Sharlene Standing Director of Regulatory [email protected]

Linda Findlay Practice Consultant/[email protected]

CLPNA Office Hours

Regular Office Hours

Monday to Friday 8:30am to 4:30pm

Closed forStatutory Holidays

Log On to clpna.com • CLPNA Publications

• Learning Modules• Competency Profile• Job Listings

and more…

OUR MISSION

To lead and regulate the profession in a manner that protects and serves the public through

excellence in Practical Nursing.

OUR VISION

Licensed Practical Nurses are a nurse of choice, trusted partner and a valued professional in the healthcare system.

The CLPNA embraces change that serves the best interestsof the public, the profession and a quality healthcare system.

By 2015, the CLPNA expects to see:

• Increased demand for Licensed Practical Nursesgenerating continuous growth in the profession.

• Full utilization of Licensed Practical Nurses throughout the health care system.

• All Licensed Practical Nurses embrace and fully enact their professional scope of practice.

• Increased public understanding of the role and contributions of Licensed Practical Nurses.

• The College initiate and support research relevant to the Licensed Practical Nurse profession and the health care

• Enhanced collaborative opportunities provincially, nationallyand internationally.

• The College and Licensed Practical Nurses fully engaged in all decisions affecting the profession.

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA

Passed by Council on December 9, 2010

the operations room


Licensed Practical Nurses can move ahead with NorQuest College!

We offer a wide range of continuing education programs designed specifically for LPNs to equip

them with the advanced education needed for their positions. Most importantly, these programs

provide LPNs with the skills for providing a higher standard of care for patients.

Advanced Education in Orthopedics

Expand your scope of practice by specializing in orthopedics. This program

prepares you to work in a cast room, emergency department or orthopedic

unit. You will learn vital assessment skills and client care practices.

Continuing Education for LPNs

▶ Infusion Therapy

▶ Wound Care

▶ Medication Administration – Intramuscular and Intradermal Injections

▶ Mental Health Nursing

▶ Urinary Catheterization and Bladder Irrigation

▶ Pharmacology Therapeutics and Medication Administration

▶ Health Assessment

▶ Dementia Studies

▶ Insertion of Nasogastric Tube

▶ Math Refresher

▶ Integrating Research into Practice – starting 2011

Register Today!

For more information about

Advanced Education in Orthopedics,

email: [email protected]

For more information about

Continuing Education, email:

[email protected]

To register, call: 780-644-6000

www.norquest.ca

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St. Albert Trail Place, 13163 - 146 Street Edmonton, Alberta T5L 4S8Telephone (780) 484-8886 Toll Free 1-800-661-5877 Fax (780) 484-9069

ISSN 1920-633X CARE

Publications Mail Agreement Number 40050295

Return Undeliverable Canadian Addresses To:St. Albert Trail Place, 13163 - 146 Street

Edmonton, Alberta T5L 4S8email: [email protected]

www.clpna.com

APRIL 7- 8 2011 | DEERFOOT INN & CASINO, CALGARY DON’TMISS OUT!

REGISTER TODAY

ANNUAL GENERAL MEETINGApril 6, 2011 from 6:00 - 7:30 pmCalgary Deerfoot Inn and Casino

Join us for an exciting two-days as speakers challenge, engage, and motivate. Hear from LPNs,RNs, RPNs and others who are eager for the futureand what we can do together to make a difference.

REGISTER ONLINE atwww.clpnaconference.comYour Profession, Your College

CARE - Spring 2011 | College of Licensed Practical Nurses of Alberta

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Transcript of CARE - Spring 2011 | College of Licensed Practical Nurses of Alberta