Continued confusion expected over nursing roles and scope of practice
BCNU has been calling for clear guidelines and a standard approach to LPN's practice for years, yet this remains elusive.
On June 21st, the CLPNBC issued Standards, Limits and Conditions (SLCs) based on the outdated LPN Regulation which does not reflect the current reality in the workplace.
The new Scope of Practice document states there will be a gradual implementation of the SLCs. This was also the message at the CLPNBC AGM - LPNs were told to continue to carry out the work they are currently doing. Yet this work often exceeds the SLCs. We are also hearing that employers are issuing directives preventing LPNs from continuing work they have been doing for some time.
Named agency and recognition of educational qualification
While we agree with the concept of supporting provincial consistency in post-basic LPN education, we are concerned that the Scope of Practice document is unable to provide details of which "agency" is approved to provide this education. In the case of an LPN who has completed post-basic education from a bona fide institute in another province, there seems to be no mechanism for recognizing the credential.
In addition, we are concerned that the approach taken, for example in the Nursing Activity, Performing Intravenous (IV) Starts, will mean individual costs to LPNs. There is a requirement in the conditions that LPNs who start IVs must successfully complete a formal post-basic nursing course given by a school that has a CLPNBC recognized entry-level LPN program. We would prefer provincially recognized competencies and curriculum for this activity so that the education can be delivered within the health authorities as in-services.
Clinical direction
A new concept introduced in the Scope of Practice document is that of "clinical direction in the context of supervision" as explained in the outdated LPN Regulation. Clinical direction is defined as "specific written instructions given to an LPN from an RN." Clinical direction appears very close to the definition of an order, in that it is "client-specific, dated and signed by an RN who has assessed the client." CRNBC is about to issue another practice standard, Providing Clinical Direction, but this will create more confusion in the workplace.
BCNU will continue to push for the LPN Regulation to be issued as soon as possible and has already raised the issue in a meeting with the new Minister of Health, Terry Lake. We will also be advocating for resolution of the post-basic education concerns and our position that there is a provincial approach to nursing activities so that an LPN can, no matter the unit or health authority, carry out the nursing work they are educated to perform.
In the interim, contact CLPNBC and/or CRNBC for clarification on specific practice issues.