New level of nursing essential as part of healthcare reform
It is no secret that our Canadian healthcare system requires an emergency overhaul. What is not generally known is that healthcare teams also require reformation – specifically, the role of support workers.
Personal Support Workers (PSWs) are expected to perform nursing skills and to care for clients requiring complex care beyond their unofficial/non legislated/non-regulated scope of practice. It is not uncommon for PSWs to be giving medication, injections, providing wound care or performing tracheostomy care.
This should be of concern to Canadians. The responsibility put on this level of workers does not match their education and puts client safety at risk.
Making matters worse, the PSW workforce is also in crisis. Low wages, lack of standardization, no recognition and no regulation and now the stress of COVID-19 care have made it hard to recruit and retain PSWs across the country, leading to a shortage of this level of workers. As short-term fixes, multiple organizations are working on ways to shorten PSWs programs or are trying to create new category of worker to meet the demand of supportive care.
To prevent lower levels of healthcare providers from popping up, proactive initiatives must be put in place recognizing that changes to healthcare teams are needed to meet evolving needs.
In Ontario, a precedent exists. In 2005, Registered Practical Nurses (RPNs, formerly RNAs) were required to take a college program consisting of four semesters over two years. Before that, RNA training was delivered in high schools and colleges and the length of education ranged from one to one-and-a-half years. Also in 2005, the College of Nurses of Ontario (CNO) mandated a four-year RN program as the new entry level to practice. This was the CNO’s proactive response – aligning the education of nurses to meet the changes in responsibilities.
It is a challenge that must be met again. The need to acknowledge current research, gap analyses, military reports and to provide safer care throughout the country with long-term benefits seems obvious, as does a potential solution – create a new level of nurse, the Registered Practical Nursing Assistant (RPNA).
This approach would recognize the need to once again shift the level of Nurse (adding a new level) to meet growing environmental/market changes. The RPNA would be regulated, education and scope of practice would be standardized and the delivery of care would be safer.
Frankly, this would be a promotion for existing PSWs since recognition of their expanded responsibilities would be recognized. There would still be a need for PSWs and their role would return to what the original Health Care Aide level was a decade ago. What makes this strategy feasible is that current nursing regulatory bodies already have the infrastructure to facilitate this healthcare team transformation. In addition, educational institutions offering PSW programs have faculty who can adjust existing curricula to meet the requirements of the new RPNA program.
With government support, the benefits of this strategy would be long term and seen as a positive response to the need for healthcare system (and team) reform. Current PSWs would have the option to bridge to the new nursing level and the care of Canadians will be safer and more standardized. Organizations such as unions, regulatory nursing colleges, professional PSW associations such as (the Canadian Support Worker Association) CANSWA could either gain or maintain membership. Educational institutions would benefit from increased enrolment.
Ultimately, the progression of the PSW and nursing role meets the evolution of clients’ needs with one strategy, using existing infrastructures. Time is of the essence. Our healthcare system, our healthcare teams and, most importantly, Canadians need it.