In June 2018, the Canadian Nurses Association (CNA) started a new chapter in its history with an overwhelming vote by its members to open membership beyond registered nurses and nurse practitioners to include licensed and registered practical nurses and registered psychiatric nurses. But it became clear during consultations with nurses leading up to the 2018 vote that not only were many nurses unclear about the different roles, mandates, and titles of their professional, union, and regulatory bodies, there was also confusion and sometimes suspicion and outright resentment about scopes of practice and the ways they do or do not overlap across the four regulated designations.
More recently, work done for the CNA with nurses across the country showed that although there are many examples of different types of nurses working well together, it’s undeniable that longstanding tensions and rivalry sometimes get in the way of delivering the best care. That suggested a deeper understanding of the education, roles, scopes, and regulation of the four designations of nursing could lead to strategies to improve the deployment of all types of nurses to maximize their effectiveness in delivering the best patient care possible.
This report is being published in February 2021 as Canada struggles with the second wave of the COVID-19 pandemic. The work of nurses has rarely been under such constant public discussion, as the country has rallied strongly around all our health care providers. But the pandemic has also revealed serious gaps across our health systems, which are forcing us to look at shortcomings we have papered over and patched for too long. This expansive report should be an invaluable asset as we look at those gaps and strive to determine how Canada’s 440,000 nurses, of every type, can most effectively be deployed.
Numerous issues might be traced to the traditional divisions this report illustrates in nursing education, regulation, scope of practice, and organizations. One such issue is how the best-educated generation of nurses in history is locked in roles and functions defined decades ago that underuse the intellectual capital of the entire nursing workforce. To be effective in 21st century health care, we may need to consider a more intraprofessional approach that overcomes the restrictions of our traditional hierarchy will ensure better care for patients and a better functioning health care system overall. Does the sheer number of nursing organizations (colleges, associations, and unions), with their commitment to different segments of the nursing workforce and individual interests and goals, create separation and block evolution in nursing care? Are they perpetuating outdated dynamics in the profession? Other concerns — rigidly segregated education, jealously guarded delineation of scopes of practice, a lack of understanding of each others’ roles — may all be limiting nurses’ ability to give the quality of care patients need and deserve, and adding to the strain on our health care systems.
We hope this report, as a first step toward meaningful change, contributes clarity and a deeper understanding of all regulated nurses in Canada, encourages exploration of the structures and practices that facilitate the delivery of great care, and helps in the dismantling of barriers and traditions that hinder changing for the better.