Use of Unlicensed Assistive Personnel in Canada

loriangel14, RN · Oct 13, 2009

I live in Ontario so I can only speak of my experiences with this. We originally had a designation called Health Care Aid that was later changed to Personal Support Worker. The PSW education has expanded and I think it is about 8 months long now, typically two semesters at college.They obtain a PSW certificate and they are not regulated provincially.They have long been a staple in LTC facilities and home care in the community and there has been some experimental use in acute care.The hospital I work in was thinking about going this route to save money. Our staff was not happy with this idea and we did much of our own research regarding this. We found that there were many hospitals in Canada that had tried this, replacing licensed staff with UAPs. In most cases they found it didn't work well and within a couple of years they went back to their former staffing structure. Fortunately our management has decided against this idea and have scrapped the plan. One of our big concerns about UAPs performing personal care instead of nurses is the fact that we as nurses are required to to do assessments q shift and chart on such. As it stands, we are doing our own personal care and there fore observing the pts physical condition first hand and then charting on what we observed. We were not going to be able to chart on something we hadn't personally assessed since we are responsible for assessments being accurate. Plus we are aware that many PSW programs are educating people that are on social assistance and taking the program because it is one that is paid for by welfare as a means to getting a job and getting off welfare. Usually these are young women that have no real desire to care for people and lack compassion, empathy and any real desire to provide good care. We had one lady apply that couldn't speak one word of English.Not that there aren't many really great PSWs out there as well. Many are dedicated and caring and work extremely hard in LTC facilities everywhere. I myself was a PSW for 8 years doing homecare in the community and I found it an invaluable experience. I have noticed from reading on this forum that in the US many people seem to take the CNA course as a step towards nursing. I don't think that is as prevalent here, many just go straight to nursing.

I would be interested to hear what nurses from other provinces have to add to this.

ruralgirl08 · Oct 13, 2009

I also live in Ontario, the RNs in my hospital do "total care" with patients. We have a support role a "personal assistant," they can assist a nurse with turning or transferring a pt, but that is it, when it comes to pt care. They personal assistants do help with giving out trays, making beds, getting things we may need, stocking our supplies, they are very valuable members to our team.

The reason our hopsital has chosen to have nurses for "total pt. care" is that our pts are acutely ill, and the RN has a better trained eye for physical assessment. Helping with intial ADLs are a good time to do a full head to toe assessment. Alot of times pts. are also on: multiple infusions, have boken bones, O2 therapy, missing bone flaps, or may have only certain postions they may be able to lay, or the HOB may need to be elevated to certain degrees. A trained nurse, who understand the complete health picture of her pt., is at a better advantage for helping with ADLs. That is why at our teaching hospital we have nurses doing "total care" for our pts. It might not be cost effective initially, but having less complications and a shorter hospital stay, is a huge cost saver. Improved quality of life is priceless. It would be interesting to see the research.

Pediatric Critical Care Columnist · Oct 13, 2009

In my little area of Alberta, we have a training program run through Norquest College for health care aides that is 21 weeks long and includes a 4 week practicum. They are not regulated; they work in many areas of health care, including the usual acute and continuing care settings, home care, group homes, day programs and so on. In acute care they're limited to assisting with hands-on care, providing "sitter" services for patients requiring constant observation but not necessarily by a nurse (those at risk for falls, self-harm, seizure and such), feeding patients, passing trays, stocking, running to the lab and the blood bank, portering and a few other similar tasks. I work in an ICU; our health care aides do very little actual hands-on care, restricted to helping with turns, repositioning, diaper changes and transport. The rest of their duties are setting up for admissions, gophering, stocking supply carts, emptying urine bags, garbage and linen bags, cleaning equipment and that type of thing. But I tell you, we depend on them to the nth degree! When we don't have one on the unit, we struggle for the whole shift.

Having said all that, there are a few comments that might add to your report... In Canada health care is a single-payer universal system; the federal government sets the rules and the provincial governments pay for and administer the programs. Each province has slightly different issues and priorities so each does things a little differently. In Alberta, the priority at the moment is cost-containment - or as some would say, slash and burn. Since > 70% of health care costs result from wages, that's always the first target in any cost-cutting measure. Nurses are the most numerous and highest-paid front line providers after the physicians, so they're the biggest target. Studies have shown that about 27% of what a nurse does in a shift could be done by someone else (not that it would or should, just that it could). The CEO of Alberta Health services has taken that stat and run with it. He would like nothing better than to replace RNs with LPNs and LPNs with HCAs to save a buck. (He isn't from around here and he wasn't here when this was tried TWICE before with dismally poor results and INCREASED health care costs over time!!) He's talking about layoffs down the road if his "vacancy management" (fancy words for hiring freeze) and voluntary retirement program fail to reduce the number of people employed in the system. If you want to know more about what's happening here you can read this thread: Alberta Health Services .

loriangel14, RN · Oct 13, 2009

........ Studies have shown that about 27% of what a nurse does in a shift could be done by someone else (not that it would or should, just that it could). The CEO of Alberta Health services has taken that stat and run with it. He would like nothing better than to replace RNs with LPNs and LPNs with HCAs to save a buck. (He isn't from around here and he wasn't here when this was tried TWICE before with dismally poor results and INCREASED health care costs over time!!) He's talking about layoffs down the road if his "vacancy management" (fancy words for hiring freeze) and voluntary retirement program fail to reduce the number of people employed in the system.

Yeah this was the theory of our management as well Jan. Try to explain to a non-nurse that toileting a pt actually was an opportunity for assessment was lost on them.

Pediatric Critical Care Columnist · Oct 13, 2009

And of course that ignores the fact that if there IS nobody to do it, no matter what it is, the NURSE does it. We're not just the nurse, we're also the RT, pharmacist, dietician, PT, OT, social worker, chaplain, psychologist, unit clerk, security guard and sometimes the doctor. We can take on the essential parts of their roles, but not a one of them can take on ours. Too bad the PTB can't see that.

linzz · Oct 13, 2009

I saw Mr. Scissorhands on TV last night and thought of everything I have read on this board about him, if only the public knew!

In regards to this thread, I am against UAP's in most settings, esp. after I saw one feeding a patient lying flat down on the bed.

Pediatric Critical Care Columnist · Oct 13, 2009

linzz, are you talking about Eddie Scissorhands, or his sniper, Crocodile Duckett? Either way, you've got a good idea of what they're all about...

petgroomer · Oct 13, 2009

Hi, I'd like to give you opinion on the use of unregulated providers in retirement homes. I live in Ontario for the record :) and work as a UCP.

Here quite a few retirement homes (please note the difference with LTC/nursing homes) use both PSWs and UCPs. The function of the PSW is mostly hands-on care (bathing, escorting, giving trays), they also apply creams and stockings. The lenght of their training is somewhere between 6 months and a year. The rate for PSWs in retiremtn is low tool: 9.50 to 12 or 15.

They also have Unregulated Care Providers (UCPs) that do mostly the job of an RPN (for a lower rate and no benefits). I've met UCPs who are internationally educated nurses and doctors. Most of the UCPs I've worked with are foreign trained professionals getting ready for licensure/re-training. Many of them are pretty good. BSN students in their third or fourth year also get hired as UCPs. I've also met UCPs who are basically PSWs who went to a training at a Pharmacy or other facility. Working with some of these ones could be quite scary: an error waiting to happen. The most scary UCP I've ever worked with was an RPN graduate who failed the exam three times. Her main problem was her attitude, but this doesn't belong in this post.

UCPs do everything from meds to SCs, some IMs, non-complicated dressing changes etc, depending on the facility. They are also responsible for assessment, triage and transferring residents to the hospital. There's a lot of responsibility involved because UCPs are actually the "nurse in charge". Some places have an RPN coming once or twice a week and the rest of the time the place is run by the UCPs.

What I dislike about this practice is that many homes are saving themselves a lot of $$$ by paying UCPs a rate of 13 to 16 hourly, but at the same time they like to prospective clients with the "24 hours nursing supervision" slogan. Besides, there are no programs in place to allow UCPs to update/upgrade their skills as part of the job, unlike nurses who participate in the quality assurance program.

Wow, this is a long post :) hope it gives you an idea of another part of the big pie.

linzz · Oct 14, 2009

Wow, I have worked in two retirement homes and neither of them had UCP's doing any medications, only an RPN could that. I have heard of some using medication aides but have never heard of them doing any injections. I guess they can get around the injection aspect by saying they are part of a consistent, daily routine, however this could get sketchy if something goes wrong.

As for making assessments, I could see a nursing student doing it but not a PSW. Anyways, I guess that is how it is in certain facilities.

linzz · Oct 14, 2009

Hi janfrn: It was Mr. Stelmach on TV, by himself, without his partner in crime. All I could think of is what I have heard from here.

petgroomer · Oct 14, 2009

Wow, I have worked in two retirement homes and neither of them had UCP's doing any medications, only an RPN could that. I have heard of some using medication aides but have never heard of them doing any injections. I guess they can get around the injection aspect by saying they are part of a consistent, daily routine, however this could get sketchy if something goes wrong.
As for making assessments, I could see a nursing student doing it but not a PSW. Anyways, I guess that is how it is in certain facilities.

Well linzz, as you say, every facility is different, and obviously our experiences are different. I agree with you that assessing a patient/resident takes a lot more than a PSW education.

As a UCP I've worked side by side with RPNs who have belittled me and treated me like crap:o. I don't take it personal and don't get mad, but I pray for the day I can add an "R" to my signature.