​Why Health Care Services Will Never Improve: Labor and Employment Board LPN decision

On Friday, January 8, 2021 the New Brunswick Labor and Employment Board handed down its decision on the fate of LPNs working largely in the Health Care System in New Brunswick.  There are 4000 LPNs in the province with 2500 working in the hospital sector.  That the decision came as a shock and disappointment to the eighty five percent of Licensed Practical Nurses who launched the action would be an understatement.

For many years, as the LPN profession has matured, there has been a strong and growing unease with this professional care delivery group being represented by CUPE and 85% of the LPNs initiated an action to be moved from CUPE to another union.  This involves a long and expensive process of application and hearings with the New Brunswick Labor and Employment Board.
This decision represents, as well, a set-back to the vision, expressed by many, to introduce reforms to the health care system.   

As discussed in previous commentaries, the entire culture of care needs major overhaul.  While there are many moving parts in creating a true culture of Patient-Centred Care, one major element is the creation of a clinical workforce that truly works together in complementary, not competitive, roles. The roles of PSW’s, LPNs, and RNs need to be clearly identified so that they function in true complementary fashion with all functioning at full scope of practice and collaboratively with all health care professionals.  The workplace in which those dynamics come together under informed leadership is a true delight!

Many years ago, one could become the equivalent of an LPN (RNA in those days) by working on the job and  continuing education followed by challenge exams on specific topics.  Training went from six months to one year then eighteen months.  That, of course, has been replaced in recent years by a rigorous two-year training program at Community Colleges, the curriculum of which is articulated with the University RN program so as to allow a continual progression in professional knowledge and certification.

The LPN Profession has progressed to the status of being a valued and recognized health care professional playing indispensable roles in many acute and long-term care settings. It is not about competition with the Registered Nursing personnel but realizing that both have essential skills and knowledge which, when they come together, represent the essential qualities of great clinical care.

LPNs have been members of the CUPE union for decades long before modern professional standards and regulations were established.  I have worked with CUPE for many years and throughout those years have enjoyed a good working relationship with various representatives as we have worked through sometimes challenging people and labor relations issues.  Each union has its own culture and way of doing business and CUPE’s style has had a feisty flavor that causes some employees to wince more than a bit.  While in the end, workers covered by the certification order and regulations are required to follow the lead of the union, some fall into line with misgivings.

Licensed Practical Nurses believe that CUPE has not represented them well, that they are not recognized for their scope of practice, and they know they are the lowest paid of all LPNs in the country!

Such has been the case with the LPNs.  As their professional status and image has expanded over the years, many prefer to be considered and treated as professionals.  Many see some of the public expressions of the union as a bit extreme for their liking.  More importantly they seriously want to take all steps possible to continue the growth and development of their profession which includes, amongst other things, improving the dialogue with the RN leadership, physicians and other clinicians.

The LPNs, who are not primarily seasoned labor people, simply want to continue to develop their skills and guide the profession so that it serves to attract young people seeking employment in the caring professions.  The goals are noble.

The issues for the unions are, simply stated, the retention or acquisition of new revenue streams.  Twenty five hundred LPNs at $504 per year would translate into one million two hundred sixty thousand dollars in revenue.  So CUPE could lose or the Carpenters and Millwrights could gain.  As with much else in society, just follow the money.  The LPN sector, given that their professional activity is governed by a government-sanctioned regulatory authority, to which they also pay dues at $350 per annum, is a fairly easy group for a union to manage.  Unlike other CUPE employees, LPNs pay $854 per annum in total.  The work of the regulatory authority actually makes it easy for CUPE to service this sector of the membership. 

The hearing involved a lawyer for the union to which the LPNs proposed to transfer, the representative from the CUPE union whose goal is to retain membership, and the representative from the Department of Justice and Public Safety ostensibly representing “the employer”.

In reading the transcript of the hearing as published, one is left with the major concern of “who is seriously interested in the best interests of the LPNs?”  Who is seriously concerned about the quality of care for patients?  My experience has been, when I was a CEO, I worried about the quality and culture issues with unions and government officials fairly detached.  That is not to question their motivation but to simply point out that following contracts and regulations are the mandate of union and governmental officers.  The quality of the service is with the employees and institutional management.
​
Legally it is true that the Department of Justice representative represented “the employer” in the hearing; that is only a legal technicality.  But the LPNs function a long way away from a government office, normally in a hospital or other health facility having no contact with “the employer”.  At the end of the day, quality of care is driven by great people, highly motivated, led by good supervisors at the service level.
Ken McGeorge,BS,DHA,CHE is a retired hospital and long term care CEO, author of Health Care Reform in New Brunswick, and free-lance consultant, and columnist with Brunswick News.  He can be reached at kenmc1@bellaliant.net