Partnerships in Nursing A Look at the Changing Roles in Nursing

1. Partnerships in NursingA Look at the Changing Roles in Nursing HEABC AGM June 20, 2005

2. Partnership Panel Anne Sutherland Boal Chief Nurse Executive, Assistant Deputy Minister, Clinical Innovation and Integration Ministry Of Health Services Lynne Gray Director, Practice Support Services Registered Nursed Association of British Columbia Dr. Lynn Stevenson Leader, Professional Practice & Chief Nursing Officer Fraser Health Authority Karen Jewell Senior Consultant, Advocacy and Special Projects Health Employers Association of British Columbia

3. Partnerships A Ministry of Health – Nursing Directorate Perspective Goal: To support the Ministry of Health Services Service Plan in the stewardship of a quality health care system

4. 1 in 10 employed Canadians work in health care 228,000 RNs 60% of RNs work in the hospital sector 1/3 eligible to retire in 10 years In BC, 29,000 RNs 5,000 LPNs 2,000 RPNs 600 new graduates per year Providers of Care

5. Nursing Directorate • Strategies to recruit, retain and educate nurses • $63M invested since 2001 • RN Graduates in 2001 – 570; in 2005 – 800 • LPN Upgrade – 700 / OR LPN Pilot • Specialty Education – over 6000 supported

6. Future Trends for Health Care and Nursing Emphasis on: • Primary Care • Gerontology • Mental Health • Community Health • Chronic Disease Management

7. Average Age of Regulated Nursing Professionals Employed in Nursing by Province/Territory of Registration 2002

8. Number of Regulated Nursing Professionals Employed in Nursing per 10,000 Population by Province/Territory of Registration Canada 2002

9. Policy Initiatives • Amendments to the Health Professions Act • Implementation of the Nurse Practitioner • HEABC/NBA Nursing Policy Discussions • Interprofessional Rural Placement Program

10. The Future • Partnerships across professions / stakeholders / continuum of care

11. Partnerships • RNABC partnered with both the College of Psychiatric Nurses of BC and the College of Licensed Practical Nurses of BC • RNABC partnered with the College of Licensed Practical Nurses of BC to develop a pamphlet and workshop called Practice Expectations: RNs and LPNs

12. Partners at the National Level • Evaluation Framework to determine the Impact of Nursing Staff Mix Decisions

13. Key RNABC PrinciplesReflected in the Regulations • Scope of practice should reflect the reality of registered nursing practice • Clear responsibility and accountability is fundamental to safe client care

14. Delegation • Delegation must be agreed to by both Colleges • Delegation is an individual professional responsibility

15. Orders • For a named individual • Pre-printed orders are included • Can be written by the practitioners listed in the Regulations

16. Limits on Practice Regulation • CRNBC Limits and Conditions • Agency Policies • Individual RN • Competence Decision to Act

17. RNABC’s Regulatory Frameworkfor Nurse Practitioners • Competencies and Approval of Educational Programs • Initial Registration of Nurse Practitioners • Regulatory Oversight of Nurse Practitioners

18. Partnerships for the FutureThe Changing Face(s) of Nursing

20. Educational PreparationLicensure • Criteria for entrance – ‘good sturdy stock’ - high GPA • Education – ‘on the job’ – College preparation for LPNs, RPNs and University for RNs (RPNs) • Each school/employer hired based on their specifications – Regulatory Colleges (CLPNs, CRPNs, RNABC)

21. Learning Practice Partnerships - Action/Experiential Learning Model PRACTICE to consolidate learning UGN New Grads Post Grads 1-3 Years Students 4th Year RN Continuing Ed to develop post basic knowledge and skills LEARNING to develop new knowledge

22. Clinical Learning Continuum

23. Learning Practice Partnerships

24. New Partnerships • Educational Institutions (EI) – areas of focus in 4th year (RNs) • Joint appointments between EI and HAs • Innovative student placements – collaborative learning units • HAs – expanding placement options – public health, home health, OR and all areas “U”

25. Facilitators for the Future • Flexibility to utilize the newly educated • Flexibility in relation to real or perceived seniority barriers • Flexibility from HAs to experiment with innovative student experiences • Realization that learning is life-long and shared responsibility between professional and employer

26. HEABCHealth Employers Association of BC HEABC provides labour relations and human resources and related services that contribute to: • Sustainability, innovation and service excellence in health care • Consistent practices that contribute to quality care • Constructive labour-management environment • Effective employer representation at the bargaining table HEABC Mission Statement

27. HEABCHealth Employers Association of BC One of HEABC’s objectives is to assist health authorities, health employers and the Ministry of Health Services achieve their goals and objectives related to effective, sustainable health care delivery services. Among other services, HEABC provides Labour Relations Services, Human Resource Planning, and Compensation Services and conducts Collective Bargaining on behalf of its members.

28. HEABCHealth Employers Association of BC Human Resource Planning HEABC provides advice and assistance in areas such as: • Recruitment and Retention • Professional Development and Education • Supportive Work Environments, e.g. Occupational Health and Safety • Effective Management Team support through workshops: • Selection • Discipline and Performance Evaluation • Managing Grievances • Occupational Health and Safety • Claims Management and Early Safe Return to Work • Attendance Management • Managing Leaves

29. HEABCHealth Employers Association of BC Compensation Services HEABC provides advice and assistance with: • Classification issues • Job Descriptions • Compensation Determinations

30. HEABCHealth Employers Association of BC Labour Relation Services HEABC provides advice and representation on a wide variety of issues, including: • Scope of Practice • Health Professions Council submissions • Interpretation of Legislation • Work jurisdiction disputes • Collaborative practice • Practice/performance issues • Certifications

31. HEABCHealth Employers Association of BC Collective Bargaining Traditional Bargaining • Focuses on each party’s own solutions to problems • These “solutions” are found in proposals that are typically in conflict with the other’s • Often involves each party strategically adopting polarized positions and asking for more than they expect to receive so they will have something to “give away” to achieve a settlement

32. HEABCHealth Employers Association of BC Collective Bargaining cont. Interest Based Bargaining (IBB) • Emphasizes a more cooperative approach • Begins with understanding the problems and identifying mutual common interests that compliment each other • Negotiations occur over “interests” (needs, desires, fears and concerns of both parties) rather than “positions” (each parties proposed solutions)

33. HEABCHealth Employers Association of BC • 2004 Policy framework for NBA bargaining • Ongoing Policy discussions with the NBA: • Utilization and regularization of casual and overtime hours • Responsive shift scheduling • Early retirement/new graduate partnerships • Duty to accommodate • Long term care staffing

34. Panel Contact Information Anne Sutherland Boal Chief Nurse Executive, Assistant Deputy Minister, Anne.SutherlandBoal@gems8.gov.bc.ca Lynne Gray Director, Practice Support Services gray@rnabc.bc.ca Dr. Lynn Stevenson Leader, Professional Practice & Chief Nursing Officer lynn.stevenson@fraserhealth.ca Karen Jewell Senior Consultant, Advocacy and Special Projects karenj@heabc.bc.ca