Doug Millroy: Registered Nurses of Ontario wanting to protect their turf


I have no problem with the Registered Nurses of Ontario wanting to protect their turf.

But I would have a problem if they were looking to expand it at the expense of others.

Therefore the release last week by Dianne Martin, chief executive officer of the Registered Practical Nurses Association of Ontario, caught my eye.

She claimed flat out that the RNAO is working to eliminate the Registered Practical Nurse role in Ontario hospitals.

“Enough. Yet again,” Martin wrote, “RNAO is working to eliminate the Registered Practical Nurse role in Ontario hospitals and reduce RPNs in other sectors.

“RNAO’s provincial election platform document . . . calls for no new hires of RPNs in Ontario hospitals. Make no mistake about it. While it might not be readily apparent, this is a deliberate attempt to eliminate RPNs from Ontario hospitals by attrition.”

This statement naturally sent me scurrying to find out what the RNAO had actually said in its election platform, which it wants whoever wins the provincial election in June to follow. The items to which Martin took offence read:

“Require that all new nursing hires in tertiary, quaternary and cancer care hospitals be RNs,

“Require that all first home health-care visits be provided by an RN.”

Since this didn’t seem to go as far as Martin suggested, I contacted the RNAO and got the following reply from Marion Zych, Director of Communications.

“Just to clarify, we are not opposed to RPNs. They are part of our health system and we are well aware of that. In fact, in various reports we have published we talk about the role RPNs play in primary care and in long-term care.

“However, given the ever-increasing care needs of patients in acute care, we have a specific  recommendation that states that all NEW nursing hires in tertiary, quaternary and cancer-care hospitals be RNs.”

She said by and large these are teaching hospitals.

But it also includes Sault Area Hospital, where RPNs play a role in both tertiary and cancer care.

“There are currently RPN staff working in the select care areas in the Cancer Clinic,” Brandy Sharp Young, Manager Communications and Volunteer Resources at SAH, told me in an email.

“Each program has secondary and tertiary care touch points and depending on the patient’s needs we match the appropriate care provider to the patient’s needs for that visit.”

She said, “Sault Area Hospital values the role of the RPN as an effective team member in the delivery of care to hospital patients. When deciding the appropriate care provider to deliver patient care SAH considers three key factors:

“The level of knowledge of the nurse (both RN and RPN), the complexity of the patient’s condition and the clinical environment (stability, practice supports).

“We use RNs when patients are complex and have changing or unpredictable illnesses. RPN staff are employed in most inpatient-care units and outpatient clinics in the hospital.

“SAH provides primary, secondary and select tertiary services to our community; SAH does not provide quaternary services.”

I asked for an explanation of tertiary and quaternary care as the terms were new to me and I thought they might be to you. Sharp Young explained:

“Tertiary care is specialized consultative health care in a facility that has personnel and equipment for advanced investigation and treatment. Examples of tertiary care services include trauma services, cancer management, specialized surgery (cardiac or neurosurgery), treatment for severe burns or advanced care for neonates.

“SAH offers limited tertiary care in the areas of cancer treatment, hemodialysis, cardiac diagnostic interventions (angiogram) and neonatology. SAH refers patients for tertiary care to regional and provincial hospital sites for things such as trauma care, specialized surgery (neurosurgery, cardiac, urology) and advanced neonatology.

“Quaternary care is considered to be an extension of tertiary care; it is highly specialized care and often very specific to certain conditions or body systems. The types of care that might be considered to be quaternary would be experimental procedures as well as highly uncommon and specialized surgeries.”

Martin said in her release that, “What RNAO is proposing would be absolutely devastating for patient care.”

“We need every nurse: RPNs, NPs (nurse practitioners) and RNs alike. The fact that RNAO continues to engage in a sustained attack on the RPN role and against college-educated nurses is shameful.

“In its document, RNAO claims ‘RNs are being replaced by less qualified health workers’. This is an elitist attack on RPNs. RPNs are perfectly qualified to care for a portion of patients in every sector of health care.”

It is no secret there is what amounts to a class war in many of the province’s hospitals, Sault Area Hospital being no exception. Many RNs do feel they are a cut above RPNs and they are not afraid to let it show, some to the point of arrogance.

In regard to qualifications there is no doubt the RNS are a cut above, having had more schooling in the nursing profession than the RPNs.

But that is all laid out in the roles the two groups are assigned in their workplaces.

There is no doubt the RPNs, who are represented by Unifor in a bargaining unit that includes personal support workers, cleaners, kitchen staff, secretaries, etc., have taken on a larger role in the province’s hospitals and in some doctors’ offices. They now do pretty well everything RNs did at one time.

But the role of the RN has also increased in scope and the RNAO wants it to go further. It is now asking in its election platform that RNs be allowed to “order lab tests, communicate a diagnosis and prescribe medications for common ailments.” It also wants RN prescribing to be integrated into the baccalaureate nursing curriculum by 2021.

As the RNS see the RPNs as encroaching on their turf they should, with their demands, expect that the doctors will soon be complaining that the RNs are encroaching on theirs.

In their election platform the RNAO is also asking (again) for the legislating of health human-resource standards in long-term care so that there is at least one Nurse Practitioner for every 120 residents, and a staffing mix that consists of 20 per cent RNs, 25 per cent RPNs, and no more than 55 per cent personal support workers.

I don’t think you can legislate this ratio. I believe hospitals and long-term care facilities must be allowed to set the mix that is best for them.

Anyway, in regard to the issue at hand, Martin’s complaint about RNAO’s election platform, I would suggest she come out with a follow-up release admitting that she overstated what the RNAO platform actually says.

It does not ask for the elimination of the RPN role in Ontario hospitals, it only asks that all new hires in tertiary, quaternary and cancer-care hospitals be RNs.

That, of course, is still something with which the RPNAO can take issue.

But I don’t think the RPNs have to worry in any case.

Hospitals are going to employ the mix that they think is best for them and I can’t see any government interfering with that.

In regard to the turf war, I think the best way to end it is for the RNAO and the RPNAO to join forces in one organization under one banner.

After all, they are all nurses and as such surely it makes sense for them to be allied as such with their focus being on the patient..



  1. The RNAO takes issue with the RPN scope encroaching on the RN role, however, they seem to have no issue encroaching on the role of RNs in the province in the extended class who already “order lab tests, communicate a diagnosis and prescribe medications for common ailments.” We’re called Nurse Practitioners and RNAO claims to represent this group’s interests as well. Hardly in my opinion. The direction of RNAO with regards to the RN role is the reason I am no longer a member.

  2. Not surprising. In this day and age everyone is looking out for themselves, If employers…such as hospitals can hire at lower wage levels they will do so. Part time…contract work…little or no benefits…that seems to be the wave of the future.

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