'Legitimate Objectives' May Override College's Ability to Set and Enforce Registratio

from Nursing BC ..

By Brunke, Laurel RN

You just have to read this issue of Nursing BC to know how much change is happening in health care - both in the delivery of care and in the regulation of health care providers. Four nurse practitioners - B.C.s newest health professionals - talk about the difference their practice makes everyday in the lives of British Columbians. Nurse practitioners are registered nurses who have achieved the additional competencies required for registration as a nurse practitioner with CRNBC. Their scope of practice includes providing health care services from a holistic nursing perspective combined with a focus on diagnosing and treating acute and chronic illnesses, including prescribing medications. As members of the health care team, nurse practitioners contribute to addressing service gaps and enabling clients to receive timely, high quality and cost-effective care. By this time next year, CRNBC will begin placing registered nurses with specific certified practice designations on the certified practice register. Certified practices are restricted activities that are subject to additional regulatory provisions by CRNBC. Through certified practice (see page 28), registered nurses will be able to diagnose some diseases and disorders and dispense Schedule 1 medications. Certified practice for registered nurses is unique to B.C. and will help to improve access to timely, high-quality, cost-effective care as well as address service gaps.

Initially, the list of activities that were to be certified practices was longer. The list has been shortened, however, following collaborative work between CRNBC and the health authority chief nursing officers and the commitment of government in the February speech from the throne to move some certified practices, such as management of labour, to general nursing practice [Section 6 of the Nurses (Registered) and Nurse Practitioners Regulation]. Registered nurses have the authority to carry out Section 6 activities without an order.

We have worked hard in B.C. in partnership with government and others to create a regulatory model for registered nurses and nurses practitioners to serve the public interest. Our significant challenge now is to meet the B.C. government's target date of April 1, 2009 for full implementation of the Trade, Industry and Labour Mobility Agreement (TILMA). This agreement between Alberta and B.C. is designed to remove barriers to trade, investment and labour mobility for all occupations, including registered nurses and nurse practitioners. We're very close to an agreement for registered nurses, but there is still much work ahead in relation to nurse practitioners.

As we work to meet the requirements of TILMA, we are also working to meet the requirements of an amended Chapter 7 of the Agreement on Internal Trade (AIT). The amendments are intended to reduce barriers to labour mobility between all provinces and territories and, as with TILMA, while this is easily achievable for registered nurses, the same is not true for nurse practitioners.

Across Canada there are significant differences in legislation, regulation and policies as well as in scope of practice, competencies required for safe practice, streams of nurse practitioner practice, continuing competence/quality assurance requirements, etc. For example, Quebec and B.C. are the only two jurisdictions that require both a written and clinical examination for nurse practitioners. At least one jurisdiction requires no examination. B.C. nurse practitioners are autonomous health care providers. In at least one jurisdiction, nurse practitioners must practise in a collaborative relationship with a physician. Likewise, B.C. nurse practitioners can independently diagnose and manage chronic illness such as diabetes. This is not the case in some other Canadian jurisdictions.

The College fully supports the goal of labour mobility. However, the potential impact of the AIT amendments is significant and uncertain. To date, there has been insufficient opportunity for meaningful consultation or input from regulatory bodies who will be impacted by these changes.

Our most significant concern is that health regulators, like CRNBC, will in effect lose one of their most basic functions, which is to set and enforce registration standards for the professions they regulate. Instead, government, through its ability to set "legitimate objectives" will become the final adjudicator of which standards may be required of a particular applicant for registration. In fact, it may not even be the B.C. government that becomes final adjudicator of registration standards in B.C, but rather another government in a province or territory in which registration standards are lower. Under the proposed amendments, it appears that nurse practitioners from other jurisdictions would be "automatically" entitled to registration in B.C., despite significant differences in authority and autonomy.

The question must be asked: Is granting registration to these applicants, despite the differences in the scope of practice and entry-level competencies for nurse practitioner practice in B.C., truly in the public interest?

The College will persevere in working with Alberta on the TILMA agreement and nursing regulators across Canada to meet the AIT requirements in time for the April 1, 2009 deadline. In doing so, we will endeavour to ensure that nurses coming from other jurisdictions have the required entry-level competencies so that the public in B.C. is protected. Sadly, this may be out of our control and the College may be required to register nurse practitioners from other provinces and territories who do not meet our registration standards.

Copyright Registered Nurses Association of British Columbia Dec 2008

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