How did we get here? “Nursing education has been a key factor in the quality of health care throughout Canada’s history, and the quality of education for nurses has been a major focus for the CASN throughout its considerably shorter history. The progress in educational standards has clearly been substantial since Dr. Mack first established his training school in 1875.” The Tie that Binds report, produced by the Canadian Association of Schools of Nursing in 2012, is a fascinating history of how we got here!
In any superb health system, there are a few key ingredients, factors that are essential for quality and public satisfaction. Nursing is one of the big ones! It has always been thus since Florence Nightingale.
In New Brunswick, government and the profession and universities have some issues to resolve if the profession is to grow and develop in a manner that will meet public need and the need of employing organizations. In recent years the public has been exposed to much publicity about violence in the workplace, overworked, stressed nurses, large numbers of impending retirements with insufficient persons being trained to fill the positions, nurses without full-time jobs, unemployed Nurse Practitioners……and more.
What is the public to believe?
The issues are complex and given the nature of health care, inherently politically charged. The public loves nurses so anything that is interpreted by anyone as an affront to the profession looks bad on government. Yet this is 2021 and a long way from the time at which existing structures and systems were put in place. Society has changed, values have changed, requirement for work/life balance has taken on new priority, the relationships between professional groups within healthcare have changed dramatically. It is critical that all the parties interested in the profession take a deep breath, a time out, place the issues factually on the table and engage in intelligent discussion.
Many who are currently engaged, be it in the profession or in a regulatory or employing role, probably are not aware of the history, the milestones, the decisions that go back to the Hall Report of 1964 or the Flexner Report of 1910. These were hallmark documents, of the equivalency to the Canadian Constitution, in terms of their thoroughness and prescription for creating excellence in health care.
The Hall Commission foresaw, as did reports before it, a two-level approach to nursing, one being a level of basic care requiring 2 (or 3) years of training while the degree program, administered by University Schools of Nursing, would educate nurses whose prime roles would be teaching, research, supervision, monitoring. This was, as well, supported by the American Nurses Association in 1965.
Multiple levels or progression?
The two levels recognized what has been known since Florence Nightingale; all of nursing does not involve highly-complex interventions requiring university degrees. There is a continuum in the care process in which much basic and essential care can be taught to skilled practitioners in a fairly short time. That is why hospitals used to have “care aides” and “nursing orderlies” that did much of the work that often is missed by patients. As an informal caregiver, with or without training, the bathing, dressing change, mobility assistance, administering meds are all legitimate nursing functions but just not taking place in a structured hospital or clinic environment.
In 1982, the prestigious Canadian Nurses Association board passed a motion to the effect that the baccalaureate degree be adopted as required for entry to practice nursing by the year 2000. Then one by one, the provinces adopted that requirement in which LPNs, Orderlies and Care Aides were eliminated from hospitals. This came less than 20 years after the US Nurses Association advocated for two levels of nursing.
In the last two decades, the issues of supply of nurses, job satisfaction, pride of performance do not seem to have improved, if you can believe the press reports. Worse still, as pointed out by former Dean Ericson a few years ago, often the missing link in care is not the knowledge of disease, the technology, the superior knowledge of drugs and interactions; on the contrary, when people have complaints, it is most often due to the difficulty they experience in the basics of care such as toileting, bathing, nutrition, pain management.
This initiative of the Baccalaureate degree as entry to practice has been an interesting experiment but it is time to simply recognize that all nursing functions do not require university level education. Or perhaps it is time to integrate training so that, as the American Nurses Association suggested 40 years ago, there be an Associates degree for level 1 and a full Baccalaureate for level 2 then move to masters and PhD after that.
In the meantime, the LPN profession has grown and emerged with a robust two-year curriculum but not exactly welcomed with open arms in hospital practice settings. As recently seen in a failed Labor Relations Board Hearing, this important group of nurses has the feeling of being rebuffed. Yet in many practice settings their performance and contribution are exemplary.
Nurses, whether PhD, Masters, BN, NP, LPN, or PSW, deserve our respect and certainly deserve to work in an environment in which they can sense pride of performance. The controversy, the competition, the squabbles over workplace safety, absenteeism, stress on the job…….no plan yet created by government has led to resolution. There have been how many Nursing Resource Strategy documents published in recent years? This is not the time for one more high-sounding political speech.
Time for Action:
No, it is time for all concerned, starting with government, to acknowledge that this is not the time for more glossy documents. There are public policy issues at stake that keep the profession from shining as it should in this province. These issues represent more elephants in the room and if we are going to get to the level that most nurses want the profession to be.
Reforms of the magnitude required are not for the faint of heart but we have a choice: do we just go on talking, never doing? Or will we have a moment of truth and get in the same canoe to paddle to shore? Do we want the issue more than the solution?
Public Policy Issues for Resolution:
These are complex issues and highly politically-charged, as is most of health care! Yet if we all mean what we say about our desire for high standards, best interests of the patient, quality health and long-term care, then all those with interest in this complex agenda need to lay aside conventional positions and thinking and come to a table to support progressive strategies that will take New Brunswick from constant bickering to the active pursuit of excellence:
Ken McGeorge,BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at firstname.lastname@example.org; there is more on this topic at: www.kenmcgeorge.com
Ken McGeorge, BS,DHA,CHE is a career health care executive based in Fredericton, NB, Canada.