Historic changes at the Canadian Nurses Association

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By Mike Villeneuve

Canadian Nurses Association (CNA) members reached a landmark decision on June 18, 2018, at their annual general meeting in Ottawa when they voted overwhelmingly to open membership to all regulated nurses in Canada. Since its founding in 1908, CNA has been the national professional home and voice of registered nurses (RNs) and more recently, nurse practitioners (NPs), who are all RNs. Currently, CNA represents some 139,000 RNs and NPs across all 13 Canadian provinces and territories, including nurses living in hundreds of Indigenous communities. The June 18 vote opened the door to welcome licensed and registered practical nurses (LPNs/RPNs) as well as registered psychiatric nurses (RPNs) — courageously setting the stage for a new future for CNA and professional nursing in Canada.

Nurses are being called on to optimize their scopes of practice. They’re expected to deliver new kinds of care in new delivery models that respond to the need for managing chronic diseases, supporting Canada’s aging population, and dealing respectfully with palliative and end-of-life care. As an association, CNA represents nurses in the face of ongoing regulatory and legislative changes across the country. The vote was a game-changing decision for nursing and, ultimately, for the people of Canada. It answers the call for real collaboration within and among nursing categories as the profession is confronted with this complex menu of challenges.

Employers, governments and the public can be confused by the number of nursing categories. What do the titles mean? Who can do what care safely? The public needs nurses to explain their practice and the value different categories of nurses bring to different care settings. And they expect nurses to speak forcefully and with unity in their public advocacy work for better health, better care, and better value for Canadian tax dollars. With their vote, members chose to increase CNA’s national leadership and political force to speak on behalf of the whole family of nursing.

The vote means that any of the more than 400,000 nursing professionals in Canada will be able to join CNA. Like RNs and NPs, practical nurses are employed in all Canadian jurisdictions. These professionals are regulated as LPNs everywhere except Ontario, where they are titled as RPNs. They are educated at the community college level and have similar scopes of practice as RNs, but typically deliver care that is more predictable, less complex and less urgent than would be provided by an RN.

Registered psychiatric nurses are regulated only in British Columbia, Alberta, Saskatchewan, Manitoba and Yukon. They are educated in a mix of college and university programs and deliver a broad scope of practice not unlike RNs but with deeper training in mental health, as implied in the title.

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CNA now must review its governance and membership models to evaluate the structures that need to be put in place to reflect the unique and collective needs of these different regulated nursing groups. There is a lot at stake here. The CNA board and operational team must move forward prudently, consulting with all the categories of nurses about their needs and the best ways to support each of them. Careful and ongoing planning is required if the association is to tailor specific programs and services for each category while marshalling the power of unity when a strong collective political voice is needed. CNA must continue to translate evidence into practical solutions and provide sound advice to governments, employers and Canadians, particularly on ways to deploy the right number and mix of nurses — and in what circumstances a specific category of nurse is warranted.

In a 2010 commentary, Steven Lewis famously said, “Nursing’s combination of numbers, reputation and reach should translate into power and influence over how health care is financed, organized and delivered. Yet politically, the profession punches below its weight. The country is the worse for it.” He was right. CNA and the nurses of Canada have responded. To achieve the triple aim of better health, better care and better value, Canadians must have access to the right provider delivering the right care in the right place and at the right time. By working together more strategically as an inclusive, united, national professional association, a new CNA holds the promise to deliver a more powerful advocacy punch as we work together to deliver on those formidable goals.

Mike Villeneuve is the Chief Executive Officer, Canadian Nurses Association.