Thank you for your Nov. 30 article on registered nurses. Meagan Gillmore captured a lot of what I said in our interview, but in the third-last paragraph she switched from using the title nurse practitioner to registered practical nurse. They are very different roles.
Registered practical nurses, sometimes referred to as licensed practical nurses (depending on the province), are diploma-educated nurses. It is an entry-level nursing role with a limited scope in medication administration and stability of patients that they care for. They usually work in long-term care, or in teams with registered nurses in acute-care settings, like on the medical ward at Whitehorse General Hospital.
Registered nurses are nurses educated at the degree level – usually a four-year degree. RNs make up the majority of nurses (150,000 in Canada) doing the majority of roles that the public usually sees. Locally, RNs work at the hospital, public health, communicable disease, medevac, home care, and in the communities at the rural health centres (formerly referred to as nursing stations). In this latter setting, RNs have an expanded scope, with the ability to diagnose and treat a limited number of conditions with a limited number of medications based on protocols.
Nurse practitioners are masters-prepared nurses. They were RNs who gained significant experience in these roles (often in expanded scope roles), and then returned to university for a master’s program. The role has been in existence for almost 40 years and was gaining momentum in the ‘80s in Canada, but was cut back (along with the number of physicians) because of a perceived over-abundance of doctors at that time.
It continued on in the U.S. since then, but only started to be better used in Canada since about 2005. All provinces have adopted new legislation to allow for nurse practitioner practice, with the Yukon being the last to do so on Nov. 23.
The changes had to start with the Nurses Professions Act as a self-regulated profession. Further changes will follow to many other acts (including the pharmacy act, to allow prescriptions to be written by NPs, and the Highways Act, Workers Compensation Act and other such acts, to allow for NPs to conduct and sign off on physical exams, and other laws that only refer to physicians at this point).
NPs practice according to guidelines and to their own level of expertise, but are not limited by protocols which are often outdated and are not dynamic enough to meet the public’s needs adequately.
Along with physicians, social workers, physical therapists, occupational therapists, dietitians, pharmacists, etc., the various nursing roles are all significant contributors to the team approach to health care. We all bring strong and varied perspectives to one’s health, the combination of which makes for the ideal health-care team.
Sean Secord, president
Yukon Registered Nurses