On May 9, the Registered Nurses Association of Ontario (RNAO) published a position paper called ‘Mind the Safety Gap: Reclaiming the Role of the RN’. This document and the ensuing campaign to promote it has been viewed by many in health care as an unapologetic attack on Ontario’s registered practical nurses (RPNs) and, in particular, their work in the acute care sector, where they have provided excellent care for many years.

Our association avoids engaging in intra-professional conflicts in the press. Given the contents and recommendations of this document, however, there is no other alternative but to respond on behalf of the province’s 39,000 RPNs.

This document contains inconsistencies, contradictions and misleading statements. It is based on questionable assumptions and uses partial statistics to support its premise. And while purporting to put patients first, in reality, this document questions the decision-making abilities of Ontario’s nursing leaders, prioritizes turfism at the expense of collaboration and seeks to elevate RNs by tearing down their RPN colleagues (who are regulated by the same college as RNs, the College of Nurses of Ontario, and required to practice to the same standards).

RNAO uses the term ‘RN Replacement’ to imply a systematic campaign aimed at replacing RNs with RPNs. And while ‘RN Replacement’ makes for tantalizing headlines, this is an incredibly oversimplified label for the complex changes taking place in healthcare.

The document compares the growth rates of RN and RPN positions but refers to them as ‘shares’ of nursing, with no definition of what a ‘share’ is. If a ‘share’ refers to a nursing position, the comparison would be inaccurate, since RPNs have a much lower full-time employment rate than RNs. Comparing positions in this manner would be ‘apples to oranges’.

The document also promotes the idea of PSWs, RNs and NPs working to full scope of practice. Yet, when hospitals work to allow RPNs to work to their full scope of practice, they are accused of engaging in ‘RN replacement’. Ontario needs more of all categories of nurses working to their full scope of practice to service its healthcare needs.

Among its recommendations, RNAO proposes that the MOHLTC develop a Health Human Resources (HHR) plan to align health care needs with the various types of care providers. They propose their document should be the building block for that process. While we agree that it’s time to develop such a plan, it needs to be built from the ground up with input from all nursing groups as equal and respected partners.

The document proposes that the Ministry issue a moratorium on nursing skill mix changes until the completion of the HHR plan. Yet, on the following page, it proposes sweeping and immediate skill mix changes.

The document calls for the elimination of RPNs from Ontario hospitals. It is true that the majority of hospital patients require care by an RN. However, there are many patients in acute care (e.g. well moms, well babies and patients in continuing care, rehabilitation and less complex medical and surgical patients) for whom RPNs provide excellent care. In addition, 14 per cent of hospital patients today are classified as alternate level of care (ALC), or no longer requiring acute care, a patient population well within the appropriate practice of an RPN. RPNs absolutely have roles to play in acute care hospitals. For an outside group to suggest otherwise is offensive.

The document uses the term ‘diploma-prepared’ to refer to RPNs. RNAO also refers to RPNs as ‘less qualified personnel’. Their document fails to mention that both categories of nurse have a wide range educational backgrounds within their designations and there are fabulous nurses from both categories who are diploma-prepared. That is not to say that RPNs and RNs are the same – they are not. The point is that using RPNs’ education to attempt to diminish their effectiveness as care providers is wrong. An Ontario RPN’s education is comprehensive, grueling and, as is the case with many other health providers, has evolved immensely over time, providing these nurses with the expertise to do their jobs in all sectors of healthcare.

Ontario is facing significant healthcare transformation. All of us need to be invested in addressing this challenge. However, holding back one group from practicing in the manner that they’ve been educated in order to advance another group is completely counter to that goal.

Building up one group by tearing down another is never the right answer. We’re stronger together.


Dianne Martin

Executive Director

The Registered Practical Nurses Association of Ontario (RPNAO)