Standardization of the Description of Competencies of Western Canadian Licensed Practical Nurse (LPN) Practitioners Project

Transcription

1 EVALUATION REPORT Standardization of the Description of Competencies of Western Canadian Licensed Practical Nurse (LPN) Practitioners Project Prepared by: Steppingstones Partnership, Inc. Edmonton, AB T6H 4P1 For: Health Canada Alberta Health and Wellness March 25, 2005

2 T Executive Summary he purpose of this project was to fast-track the development of comprehensive competency profiles for Licensed Practical Nurses (LPNs) in British Columbia, Saskatchewan and Manitoba. This was done by building on the extensive work, processes and Competency Profile developed by LPNs in Alberta with the assistance of Alberta Health and Wellness. A common set of terms and definitions for competencies will reduce obstacles to registration, employability and inter-provincial mobility of LPNs among the four western provinces. Within each province, a detailed competency profile can be used to ensure educational institutions are providing relevant and timely training for LPNs. Employers can use the profiles for job descriptions, nurse resource planning and more effective utilization of LPNs. In January and February 2005, eight two-day workshops were held in British Columbia (Vancouver, Prince George and Victoria), Saskatchewan (Regina, Saskatoon and Prince Albert) and Manitoba (Winnipeg and Brandon). A total of 134 LPNs with a wide range of experience attended these workshops where they validated the Alberta Competency Profile and made changes/additions to reflect their own set of current competencies. The workshop participants were mostly female, older (46 to 55 years of age), were LPNs for more than 20 years, tended to work in a hospital setting, worked full-time for Regional Health Authorities, received their LPN education in the province they currently worked, and came from smaller towns or rural settings. Comparison of the profile of the workshop attendees with the larger LPN population in each province suggested that the LPNs were reasonably represented. The evaluation found that workshop participants felt that all project objectives were achieved. Those best achieved were sharing the Alberta LPN Competency Profile, and preparing a Profile that reflected LPN competencies in their province that could be used for a number of purposes. The workshop participants were very satisfied with all aspects of the workshops, ranging from the quality of the facilitators, workshop structure and format to facilities and physical environment. Some would have liked more information prior to attending the workshops. The evaluation identified some of the utilization and mobility issues facing Licensed Practical Nurses in western Canada. The major ones were lack of knowledge among employers regarding LPN competencies, lack of standardization among competency requirements across jurisdictions and regulatory bodies, and role and responsibility conflicts with other nursing professions. This project was very successful in that within a three-month period, the LPNs in British Columbia, Saskatchewan and Manitoba had very detailed, comprehensive and commonly structured Competency Profiles. This would have never happened without this project. The deliverables (Profiles) were created in a very cost-effective manner. The Profiles will be used by the LPN Colleges/Associations within each province, and among the provinces, to facilitate mobility and knowledge transfer of the profession. The recommendations are that the LPN Competency Profile project be expanded to include other provinces, and that development of a national LPN competency document be undertaken. i

3 Acknowledgements This project is an excellent example of the significant results and successes that can be achieved through meaningful partnerships and collaboration in the health sector. Working together, the Government of Canada, the Government of Alberta, the College of Licensed Practical Nurses of Alberta, the College of Licensed Practical Nurses of British Columbia, the Saskatchewan Association of Licensed Practical Nurses, and the College of Licensed Practical Nurses of Manitoba, were able in three short months to develop a competency profile for the profession that could have a profound impact on the quality, cost-effectiveness and flexibility of the health care system in western Canada. Thanks to Dr. William DuPerron of Alberta Health and Wellness who conceived and initiated this project in partnership with the College of Licensed Practical Nurses of Alberta. Dr. DuPerron contributed his time and expertise to facilitate the workshops. The College of Licensed Practical Nurses of Alberta provided their Competency Profile to serve as the base document for developing a competency profile for LPNs in each of the other western provinces. CLPNA served as the overall project administrator. The Alberta LPN College also provided a resource person to attend all the workshop to assist in facilitation, recording and to provide content expertise. Thank you to Gordon McDonald, Executive Director of the College of Licensed Practical Nurses of British Columbia, and his staff for organizing and participating in the workshops in British Columbia. A similar contribution was made by Chris Bailey, Executive Director of the Saskatchewan Association of Licensed Practical Nurses. Finally, thanks to Pat MacDonald and her colleagues at the College Of Licensed Practical Nurses of Manitoba who did an excellent job of organizing and managing the Manitoba component of this project. Finally, the Colleges/Association and the project team wish to express their appreciation to the Western and Northern Health Human Resources Planning Forum and Health Canada for providing the funding for this project. Russell Sawchuk Evaluation Consultant Steppingstones Partnership, Inc March 2005 Disclaimer: The views, opinions and conclusions expressed in this report are the sole responsibility of the consultant and do not necessarily express the official positions of HR Planning Forum, Health Canada, Alberta Health and Wellness nor the four LPN Colleges/Associations participating in this project. ii

4 Table of Contents page Executive summary... i Acknowledgements... ii 1. Introduction Project description Project goal and objectives Licensed Practical Nurses Methodology Evaluation goals and objectives Process Ethical considerations Results Project management and organization Participant profiles and characteristics Achievement of project objectives Workshop environmental factors Challenges and issues Other workshop feedback Project team observations Competency profile product Applications and uses of profiles Knowledge transfer, networking and dissemination Sustainability plan Conclusions and recommendations Conclusions Recommendations Appendices Evaluation Questionnaire iii

5 List of Tables page Table 1: Nursing Professionals in Western Canada Table 2: Achievement of Project Objectives by Province Table 3: Adequacy of LPN Competency Workshops by Province...10 Table 4: LPN Challenges and Issues by Province...20 Table 5: LPN Challenges and Issues by Work Setting...22 Table 6: LPN Challenges and Issues by Age Category...23 Table 7: LPN Challenges and Issues by Years of Experience...24 Table 8: LPN Challenges and Issues by Employment Status...25 Table 9: LPN Challenges and Issues by Supervision...26 Table 10: LPN Challenges and Issues by Community Size...27 iv

6 List of Figures page Figure 1: Gender of Workshop Participants by Province...8 Figure 2: Gender of All LPNs by Province Figure 3: Age Category of Workshop Participants by Province...9 Figure 4: Age Category of All LPNs by Province Figure 5: Years of Experience of Workshop Participants by Province...10 Figure 6: Years since LPN Graduation by Province Figure 7: Work Setting of Workshop Participants by Province...11 Figure 8: Work Setting of All LPNs by Province Figure 9: Employment Status of Workshop Participants by Province...12 Figure 10: Employment Status of All LPNs by Province Figure 11: Employer Type of Workshop Participants by Province...13 Figure 12: Supervision Responsibilities of Workshop Participants by Province...13 Figure 13: Location of LPN Education of Participants by Province...14 Figure 14: Location of Education of All LPNs by Province Figure 15: Community Size of Workshop Participants by Province...15 v

7 1. Introduction 1.1 Project description In 1998, a Competency Profile was developed collaboratively between the Government of Alberta and the College of Licensed Practical Nurses of Alberta. This Profile articulated the competencies of Licensed Practical Nurses (LPN) in the province across all practice settings. This work has helped significantly in reducing the shortage of nurses and in the more effective use existing nursing personnel. LPNs utilized to their full potential are part of the solution to current and future nursing shortages. In the other three western provinces, some entry-level competencies have been defined. However, the competencies of the Licensed Practical Nurse in the other three provinces have not been commonly articulated to the depth and detail of the Alberta project. This has resulted in a significant under-utilization of many LPNs in these provinces. This project was undertaken to address this shortcoming, i.e., to develop a comprehensive and common Competency Profile for LPNs working in Manitoba, Saskatchewan, Alberta and British Columbia. A common process for describing Competency Profiles for Licensed Practical Nurses in the four western provinces will have a number of positive impacts. The benefits all contribute to the Health Human Resource Strategy Recruitment and Retention initiative objectives. These include: 1. Detailed information on the knowledge, skills and competencies of LPNs in each province will be used for recruitment and promotion of the profession among students. 2. A common set of terms or definitions for competencies will reduce obstacles to the registration, employability and inter-provincial movement of LPNs among the four western provinces. 3. Educational institutions and training agencies will have better information to graduate LPNs with the competencies necessary to provide quality health care services. 4. Employers will have the information and confidence to fully utilize Licensed Practical Nurses registered in their province, and thus address the nursing shortages in a cost-effective manner.

8 5. Clearly defined competencies for each province will enable easier assessment of internationally educated health care workers, and allow them to efficiently upgrade their competencies to meet Canadian requirements. 6. LPNs working to their full potential will be more satisfied, productive and less inclined to leave the profession. 7. The LPN Competency Profile project could easily be expanded in the future to include other Canadian provinces and territories. 1.2 Project goal and objectives T he goal of this project was to apply a common process for describing a Competency Profile for Licensed Practical Nurses working in each of the jurisdictions Alberta, British Columbia, Saskatchewan and Manitoba. This process is not involved in changing the scopes of practice, but is attempting to accurately describe, in a commonly developed terminology and framework, using the Alberta model, the current approved competencies practiced by LPNs in each jurisdiction. The objectives of the project were to: 1. Share the Alberta LPN Competency Profile with LPN regulatory bodies in the other three western Canadian provinces. 2. Review and validate the Alberta LPN competencies through a series of workshops by a representative sample of LPNs, including LPN educators and practitioners, in Manitoba, Saskatchewan and British Columbia. 3. Prepare a separate Competency Profile for LPNs in each of Manitoba, Saskatchewan and British Columbia. 4. Prepare a common LPN Competency Profile document that represents the scope of practice and utilization of Licensed Practical Nurses in western Canada. 5. Share the Competency Profiles with key stakeholders for use in health care planning, education and training, recruitment, placement and human resource management.

9 1.3 Licensed Practical Nurses L icensed Practical Nurses (LPNs) are nursing professionals who form the second largest regulated nursing group in Canada. As regulated health professionals LPNs work in partnership with other members of the health care team to provide nursing services to individuals, families, and groups of all ages. LPNs who can practice to their full scope, consistent with their educational preparation and experience and, who are not restricted from evolving to meet the changing needs of the health care system, offer a solution to Canada s current nursing crisis. (CPNA 2001). Table 1: Nursing Professionals in Western Canada Province RNs RPNs LPNs Total Manitoba 10, ,417 13,405 Saskatchewan 8, ,056 11,498 Alberta 23,964 1,128 4,766 29,858 British Columbia 27,711 2,086 4,391 34,188 Total West 70,212 5,107 13,630 88,949 Other provinces 171,130 n/a 49, ,638 Total Canada 241,342 5,107 63, ,587 Source: Canadian Institute for Health Information (CIHI) The education and scope of practice of RNs, LPNs and RPNs have expanded in the past decade to meet the changing needs of the health care system and the care needs of the public. However, it is also well documented that all nursing categories have expressed concern and frustration related to under-utilization in the practice setting. This impacts the skill mix of nurses and distorts the future nursing resource needs of the system. With respect to LPNs, this under-utilization is reflective of a poor understanding in each jurisdiction of the knowledge, skills, abilities and critical thinking that the LPN can offer to the system. Many federal and provincial reports on health reform in the past several years have addressed human resource issues. The Kirby Commission ( The Health of Canadians The Federal Role ) includes a number of principles and recommendations for reform, including the current hierarchy of health care professionals: Scopes of Practice need to change in order to improve effectiveness and efficiency. (Part 1, Page 145). Human resources have been identified as the dominant health policy issue in Canada (CHSRF), The Canadian College of Health Services Executives has commented

10 upon health human resources as a depleting asset: No amount of money, no well planned system integration can replace the need for sound human resource planning and support Unless actions are taken, Canada will experience a shortage of between 60,000 and 110,000 registered nurses by the year Detailed competency profiles of nurses are required to optimize the utilization of RNs, RPNs and LPNs in the health care system. This project was designed to contribute to better health human resource planning and more effective/efficient use of nursing resources. 2. Methodology 2.1 Evaluation goals and objectives T he overall evaluation strategy was to collect data on the process, expected outcomes and issues related to preparing and using a common Competency Profile for Licensed Practical Nurse in the four western provinces. The evaluation data collected included: Perception of achievement of project objectives Adequacy of workshop and environmental factors Assessment of the competency profile product Potential applications of the competency profile in their jurisdictions Issues and obstacles related to preparation, use and implementation of a common competency profile for LPNs Suggestions to improve the process and/or the product Participant demographics. 2.2 Process Eight 2-day LPN competency validation workshops were held in the three western provinces as follows: British Columbia Vancouver January 17-18, 2005 Prince George January 19-20, 2005 Victoria January 21-22, 2005 Saskatchewan Regina January 31 February 1, 2005

11 Saskatoon February 2-3, 2005 Prince Albert February 4-5, 2005 Manitoba Winnipeg February 22-23, 2005 Brandon February 24-25, 2005 Each provincial LPN College/Association was responsible for recruiting the LPNs to participate in the validation workshops. The participants that were invited had a wide range of experiences and worked in a variety of practice settings. (See Section 3.2). At each of the workshops, the project team consisted of Dr. William DuPerron, facilitator from Alberta Health and Wellness, Russell Sawchuk, Consultant with Steppingstones Partnership, Inc., recorder and evaluation consultant, and a representative from the College of Licensed Practical Nurses of Alberta (CLPNA) who provided the content expertise. At each of the workshops, either the Executive Director, and/or other staff were present from the College of Licensed Practical Nurses of British Columbia (CLPNBC), Saskatchewan Association of Licensed Practical Nurses (SALPN), and the College of Licensed Practical Nurses of Manitoba (CLPNM) respectively. Each workshop began with introductions of the project team and the purpose of the validation workshops. The workshop facilitator was Dr. DuPerron from Alberta Health and Wellness who led group discussions and structured competency review exercises. This process led to the validation of the competency materials that were the deliverables for this project. All participants were requested to complete a questionnaire at the end of each two-day workshop. Representatives from each provincial LPN Association that attended were asked for their input at the completion of the workshops. The project team (facilitator, consultant and content specialist) provided input after each series of workshops and at the end of all the workshops. Data from the questionnaires was coded into an electronic format. SPSS was used to run the statistical analyses that form the basis of the tables, graphs and information presented in this report. Alberta Health and Wellness, through agreements with the LPN Colleges/Associations, retains copyright on all the Competency Profiles.

12 2.3 Ethical considerations G roups of Licensed Practical Nurse practitioners were involved in reviewing and validating a Competency Profile for their profession in their province. Therefore, no ethical or privacy issues are raised by this project. Some demographic and personal data were collected from individual LPNs in the evaluation questionnaire. However, the questionnaire was anonymous, and the individual results were only seen by the consultant and were not shared with any of the Colleges or Association involved in the project. Once the project is over, the evaluation questionnaires will be destroyed by the consultant. 3. Results 3.1 Project management and organization T his project was initiated by Alberta Health and Wellness in partnership with the College of Licensed Practical Nurses of Alberta (CLPNA). Alberta Health and Wellness contributed the services and expenses of Dr. William DuPerron as facilitator for the workshops. Because of its significant prior investment into the development of the Competency Profile for LPNs, Alberta Health and Wellness retains copyright to all the Competency Profiles. However, each provincial LPN College/Association has unrestricted use of their Profile within their own jurisdiction. CLPNA provided copies of the Alberta LPN Competency Profile document for the workshops. A representative from CLPNA was present at all the workshops to act as content expert. The Alberta LPN College also acted as primary project manager, a role that included management of the funds associated with this project. The other partners in this project were the provincial LPN associations College of Licensed Practical Nurses of British Columbia, Saskatchewan Association of Licensed Practical Nurses, and Licensed Practical Nurses of Manitoba. Each of these organizations were involved in the recruitment of LPNs for the validation workshops in their provinces. They were also responsible for booking the facilities and accommodations. Most paid participant expenses prior to being reimbursed by project funds. Russell Sawchuk, of Steppingstones Partnership, Inc., was the consultant contracted to manage the competency data. Mr. Sawchuk had been involved in the development of the competencies of over a dozen health professions in Alberta. Therefore he had the experience and systems in place to prepare and revise the Competency Profiles for each province. Mr. Sawchuk was also responsible for the evaluation phase of the project.

13 3.2 Participant profiles and characteristics E ight 2-day LPN competency validation workshops were held for this project. A total of 134 professionals participated in this initiative. The following is a breakdown of the locations and numbers of participants: British Columbia Victoria 14 Vancouver 18 Prince George 9 BC total 41 Saskatchewan Regina 14 Saskatoon 15 Prince Albert 15 Sask. total 44 Manitoba Winnipeg 29 Brandon 20 Man. Total 49 Total project 134 Demographic characteristics The evaluation questionnaire included nine demographic items designed to provide a profile of the participants. These questions can also be used for data mining to assess whether any significant differences existed among work settings, type of employers, years of experience, etc. Since the workshop participants were not selected randomly, we cannot assume that the demographic profile applies to the LPN profession in that province. However, where available, statistical data from the CIHI (Canadian Institute for Health Information) databases are provided for comparison purposes. When looking at the comparisons of the participant characteristics with all LPNs in the provinces, it appears that the workshop attendees were fairly representative of the larger population of LPNs.

14 Figure 1: Gender of Workshop Participants by Province Male Female Percent All BC SK MB Figure 2: Gender of All LPNs by Province 2003 Percent Male Female CANADA BC SK MB Source: Workforce Trends of Licensed Practical Nurses in Canada, 2003, CIHI Females tend to dominate the nursing professions in terms of numbers as shown in Figure 2. However, as Figure 1 shows, male LPNs were represented in the competency workshops in relative proportions found in each of the three provinces.

15 Figure 3: Age Category of Workshop Participants by Province Percent All BC SK MB 4 < Figure 4: Age Category of All LPNs by Province 2003 Percent Canada BC SK MB < Source: Workforce Trends of Licensed Practical Nurses in Canada, 2003, CIHI Figure 3 shows that largest age group of the workshop participants was 46 to 55 year olds in British Columbia and Saskatchewan and 36 to 45 year olds in Manitoba. The 46 to 55 age group is the largest among LPNs in all three provinces as is shown in Figure 4. Based on the data provided in Figure 4, LPNs under 35 years of age and those over 55 were under-represented in the workshops. According to CIHI statistics for 2003, the average age of LPNs in Canada was 44.4 years of age. The average LPN age in British Columbia was 45.3, in Saskatchewan 44.4 and 45.0 in Manitoba. Over the next few years, significant numbers of LPNs are expected to retire from the profession. This expected trends increases the urgency of recruiting and training new LPNs, and reducing obstacles to mobility among the provinces.

16 Figure 5: Years of Experience of Workshop Participants by Province Percent < 5 6 to to to All BC SK MB Figure 6: Years Since LPN Graduation by Province 2003 Percent Canada BC SK MB 20 0 to to to Source: Workforce Trends of Licensed Practical Nurses in Canada, 2003, CIHI As shown by Figure 5, there were many years of nursing experience represented at the various workshops. Over 60% of the LPNs in this project had 20 or more years of work experience. This knowledge base was a strong asset to this project. Figure 6 shows the years since graduation of all LPNs by province. This data is not directly comparable to years of work experience since it would not account for any years taken off to raise a family, get more education, or work at another job. Regardless, comparison of the two charts confirms the previous conclusion that the least experienced and most experienced LPNs were under-represented at the workshops. However, it is doubtful that this under-representation has any significant impact on the quality of the final competency profiles.

17 Figure 7: Work Setting of Workshop Participants by Province Percent All BC SK MB 5 Hospital LT Care Home Care Other Figure 8: Work Setting of All LPNs by Province 2003 Percent Canada BC SK MB 9 Hospital LT Care Home Care Other Source: Workforce Trends of Licensed Practical Nurses in Canada, 2003, CIHI Figure 7 shows that most of the workshop participants came from a hospital work setting. Overall, some 23% came from Continuing / Long Term Care and 10% came from a Community / Home Care setting. The Other category included LPNs working for the federal government, military and specialized private practice. Based on Figure 8, the participants were reasonable representative of the proportions found in the work place, perhaps except for British Columbia and Manitoba where LPNs from Continuing / Long Term Care facilities were slightly under-represented.

18 Figure 9: Employment Status of Workshop Participants by Province Full-time Percent Part-time Casual All BC SK MB 2 Figure 10: Employment Status of All LPNs by Province Full-time Percent Part-time Casual 0 Canada BC SK MB Source: Workforce Trends of Licensed Practical Nurses in Canada, 2003, CIHI Figure 9 indicates that most of those attending the validation workshops were full-time employees. The second largest group was part-time. Casuals were at the workshop, but when compared to Figure 10, were significantly under-represented at the workshops. It is interesting to note that over half (56%) of the LPNs working in Manitoba work parttime as compared to 21% in Saskatchewan, 13% in British Columbia and 35% nationally.

19 Figure 11: Employer Type of Workshop Participants by Province Percent RHA Public Private Non-profit Other All BC SK MB 6 Most of the workshop participants worked for Regional Health Authorities (Figure 11). Only a small portion worked for other types of employers. Figure 12: Supervision Responsibilities of Workshop Participants by Province Yes Percent Sometimes No 0 All BC SK MB Many of the LPNs in this initiative had regular supervisory responsibilities (Figure 12). Manitoba workshop participants were most likely to be supervisory, while Saskatchewan participants were least likely. Between 23 to 35% in each province occasionally acted in a supervisory capacity. This range of experience provides several different perspectives to the validation of LPN competencies. It is highly unlikely that this proportion of supervisory responsibilities exist among the general LPN population in each province. Supervisors were over-represented in the workshops, but they also bring a broader perspective and more experience to the roles, scope of practice and competencies of LPNs.

20 Figure 13: Location of LPN Education of Participants by Province Percent All BC SK MB 2 Same West Other Figure 14: Location of Education of All LPNs by Province 2003 Percent AB BC SK MB Same Other Foreign Source: Workforce Trends of Licensed Practical Nurses in Canada, 2003, CIHI One demographic question asked was where the participant received their LPN / nursing education (Figure 13). Some 78% of the participants overall received their training in the same province in which they were currently working. However, there were some significant differences between the provinces. Manitoba has the greatest number of stayin-the-province LPNs at 96% followed by Saskatchewan at 83%. However, British Columbia had greater diversity as only 50% of their workshop participants were trained in the province. This pattern is consistent with the data shown in Figure 14. Manitoba graduates are most likely to remain in the province to work, followed by Saskatchewan and Alberta. British Columbia benefits most from graduates from other Canadian provinces ( Other ) and from foreign trained workers.

21 Figure 15: Community Size of Workshop Participants by Province Percent All BC SK MB 47 City Town Rural Finally Figure 15 shows that there was good representation from LPNs working in large cities, towns and smaller rural centres. Manitoba had the largest group from rural facilities.

22 3.3 Achievement of project objectives T he LPN competency validation workshop participants were asked 12 questions about how well they thought this project achieved its objectives. The results are shown by total and province in Table 2. Table 2: Achievement of Project Objectives by Province Objective 1. Share the Alberta Licensed Practical Nurse Competency Profile with LPN representatives in the other three provinces. 2. Review and validate the Alberta LPN Competency Profile in your province. 3. Prepare a Competency Profile that accurately reflects the knowledge, skills, attitudes and judgments required by LPNs in your province. 6. Provide better information to institutions and agencies that are responsible for educating and training LPNs. 10. Use a common LPN Competency Profile to assist in recruitment and promotion of the profession. 5. Have a common set of terms and definitions for LPN competencies in western Canada. 8. Establish common competency language to assist in reducing obstacles to registration, employability and movement of LPNs among the four western provinces. 9. Use a common Competency Profile for more effective assessment and upgrading of internationally educated health care workers wishing to practice as LPNs. 11. Enable LPNs to work to their full potential, thus being more satisfied, productive and less inclined to leave the profession. 4. Prepare a common LPN Competency Profile that fairly represents the full scope of practice and utilization of LPNs in western Canada. 7. Provide information and confidence to employers to fully utilize LPNs registered in their province. 12. Assist in reducing anticipated nursing care shortages through the standardization of LPN competencies in western Canada. % Achievement = Very Well BC SK MB All N=41 N=44 N=49 N=

23 For the evaluation questionnaire in general, the workshop participants tended to rate most items as very positive. This reflects the positive tone of the workshops and the comments made to the project team members. However, from a research perspective this rating pattern limits the data variability and the options for analyses. For this reason, the consultant chose to report the results in Table 2 the percent of workshop participants that said this objective was achieved very well. There were too few not at all or little ratings to be useful. The table is sorted by all respondents from the highest degree of achievement to the lowest. The project objective that was best achieved was to share the Alberta LPN Competency Profile with LPN representatives in the other three provinces. There were little significant differences in the ratings among the participants in British Columbia, Saskatchewan and Manitoba. The next two highest objectives that were achieved were to review and validate the Alberta Competency Profile in your province and to prepare a competency profile for LPNs in your province. The objectives to provide better information to educational institutions, and to use a common Competency Profile to assist in recruitment and promotion of the profession, were said to be achieved very well by 92% of the participants. The project objective that was (or would be) least achieved was to reduce anticipated nursing shortages through the standardization of LPN competencies in western Canada. There were also some differences on this objective among the three provinces Manitoba LPNs (65%), Saskatchewan LPNs (74%) and British Columbia LPNs (81%). One possible explanation for these differences may be related to Figure 14. BC benefits most from in-migration of nurses and Manitoba the least. Therefore, standardization would enable British Columbia to more easily attract LPNs to avoid nursing shortages. One somewhat surprising finding was the lower ranking of Item # 7 Using the Competency Profile to encourage employers to make greater use of LPN s in their province. In Alberta, this has been a major benefit of the development of the LPN Competency Profile. Copies of this document can be found at virtually every work site in Alberta. As well, the CLPNA devoted considerable time, energy and resources to inform and education employers about the capabilities of LPNs. This effort has paid dividends with most Alberta LPNs now working to full scope. Participants from Manitoba were most confident that this objective could be achieved (94%), while those in Saskatchewan were less so (81%).

24 3.4 Workshop environmental factors N ext, 20 questions were asked regarding various components of the workshops themselves. Again, since the ratings tended to be so overwhelming positive, the results are reported by the percentage of participants that rated each item as more than adequate. The results are presented in descending order in Table 3. Table 3: Adequacy of LPN Competency Workshops by Province Component % Reporting More than Adequate BC SK MB All N=41 N=44 N=49 N= Knowledge of the facilitator(s) Preparation by the workshop organizers Overall facilitator(s) effectiveness Answering questions Hand-outs and materials Structure and format of the workshop Diversity of experiences of participants Time allocated to the workshop Knowledge of workshop participants Group exercises and interactions Proposed changes and additions to the LPN competency profiles Refreshments, breaks and meals Physical setting and facilities layout and comfort Honoraria and payment of expenses Location (city/hotel) of workshop Pace of the workshop Physical setting temperature and lighting Number of workshop participants Appropriate use of audio-visual resources Pre-workshop information and planning

25 Knowledge of the facilitators, preparation by the workshop organizers, and overall facilitator effectiveness, were the three components rated highest by the workshop participants. The next highest rated components were answering questions, hand-outs and materials, and the structure and format of the workshop. Aspects of the workshops that were rated lowest were pre-workshop information and planning. The likely reason for this is the very short timelines by which this project had to be completed (March 31, 2005). More time would have enabled the LPN Colleges and Association to do better planning and provide more information to potential participants. The second lowest rated component was audio-visual resources. This is understandable as none were used.

26 3.5 Challenges and issues T his project was designed to address some of the utilization and mobility issues facing Licensed Practical Nurses in western Canada. Therefore, a question was included in the evaluation questionnaire that asked, How significant are each of the following to obstructing use and/or mobility of LPNs? Table 4 shows the percentage of issues that were rated as very significant by participants in the competency validation workshops. Table 4: LPN Challenges and Issues by Province Challenge/Issue 39. Lack of knowledge among employers regarding LPN competencies and capabilities 37. Lack of standardized competency requirements across jurisdictions 38. Lack of standardization among provincial LPN regulatory bodies 40. Role and responsibility conflicts with other nursing professions % Reporting Very Significant BC SK MB All N=41 N=44 N=49 N= Provincial legislation and regulations Different educational and training programs Lack of credential and qualifications transferability across provinces 43. Clear and reasonable career mobility paths among nursing professions 36. Overlap of qualifications with other nursing professions 42. Validating credentials and upgrading of foreign trained health care workers The issue that was perceived as most significant by the LPNs attending the workshops was lack of knowledge among employers regarding LPN competencies and capabilities. This issue was seen as more significant in BC and Saskatchewan than in Manitoba.

27 The second most significant issue was the lack of standardized competency requirements across jurisdictions. There was very little difference among respondents from the three provinces on this issue. The third issue was the lack of standardization among provincial LPN regulatory bodies. There were considerable differences on this issue among the three provinces. Lack of standardizations was a bigger issue in BC and much lower in Saskatchewan. Again, this may have to do with BC have greater in-migration of LPNs than the other two provinces. Role and responsibility conflicts with other nursing professions were a bigger issue in Saskatchewan, followed by BC and less of a challenge in Manitoba. Provincial legislation and regulations was the second highest issue for British Columbia LPNs. This is because their legislation is currently under review, and the College is trying to bring about changes to enable LPNs to work to their full capabilities. Saskatchewan seems least concerned about this issue. Different educational and training programs were a lesser issue with Saskatchewan workshop participants, than those in the other two provinces. The reason is that Saskatchewan only has one LPN program (SIAST), as compared to several in Manitoba and in British Columbia. Transferability across provinces seems to be more an issue in Manitoba, followed by British Columbia, and less significant in Saskatchewan. Finally, career mobility, overlap of qualifications and foreign trained workers are of greater concerns to British Columbia than the other two provinces. British Columbia has an aggressive foreign recruitment program and therefore validating credentials would be an issue with them. With almost no in-migration, this is not a big issue in Saskatchewan or Manitoba. It may be useful to see whether the significance of utilization and mobility issues were perceived differently by various types of LPNs. An analysis was done comparing ratings on this question by several demographic variables. The results are presented in the following tables.

28 Table 5: LPN Challenges and Issues by Work Setting Challenge/Issue 39. Lack of knowledge among employers regarding LPN competencies and capabilities 37. Lack of standardized competency requirements across jurisdictions 38. Lack of standardization among provincial LPN regulatory bodies 40. Role and responsibility conflicts with other nursing professions % Reporting Very Significant Hospital Other All N=82 N=49 N= Provincial legislation and regulations Different educational and training programs Lack of credential and qualifications transferability across provinces 43. Clear and reasonable career mobility paths among nursing professions 36. Overlap of qualifications with other nursing professions 42. Validating credentials and upgrading of foreign trained health care workers Table 5 compares the ratings of LPNs working in a hospital setting versus other locations. Overall there were not many differences based on this variable. A couple of differences do show up. Those working in a hospital setting (90%) felt that lack of knowledge among employers was a bigger issue than those working in other settings (85%) Hospital LPNs (74%) see a greater issue with lack of standardization among provincial LPN regulatory bodies than do the other group (61%).

29 Table 6: LPN Challenges and Issues by Age Category Challenge/Issue 39. Lack of knowledge among employers regarding LPN competencies and capabilities 37. Lack of standardized competency requirements across jurisdictions 38. Lack of standardization among provincial LPN regulatory bodies 40. Role and responsibility conflicts with other nursing professions % Reporting Very Significant < 45 Yrs N= Yrs N=78 All N= Provincial legislation and regulations Different educational and training programs Lack of credential and qualifications transferability across provinces 43. Clear and reasonable career mobility paths among nursing professions 36. Overlap of qualifications with other nursing professions 42. Validating credentials and upgrading of foreign trained health care workers Table 6 compares the ratings on the issues of LPNs under 45 years of age versus those who are 46 years and older. Except in a couple of cases (Items 40 and 42), the younger LPNs consistently rated the issues higher than their older colleagues. Some notable differences include greater concern by younger LPNs with provincial legislation and regulations, different educational and training programs, lack of transferability across provinces, and overlap of qualifications with other nursing professions. Being some time away from retirement, the younger LPNs would be more concerned about these aspects that affect their career advancement and mobility.

30 Table 7: LPN Challenges and Issues by Years of Experience Challenge/Issue 39. Lack of knowledge among employers regarding LPN competencies and capabilities 37. Lack of standardized competency requirements across jurisdictions 38. Lack of standardization among provincial LPN regulatory bodies 40. Role and responsibility conflicts with other nursing professions % Reporting Very Significant < All N=51 N=56 N=24 N= Provincial legislation and regulations Different educational and training programs Lack of credential and qualifications transferability across provinces 43. Clear and reasonable career mobility paths among nursing professions Overlap of qualifications with other nursing professions Validating credentials and upgrading of foreign trained health care workers Table 7 compares workshop participants with 20 or less years of experience, 21 to 30 years of experience and those with more than 30 years of experience. Overall, there was not much differences among the three groups on their perceptions regarding challenges and issues. Lack of standardization among provincial LPN regulatory bodies seems to be of a less concern among those with 30 or more years of experience compared to the group. However, the most experienced group is more concerned about provincial legislation and regulations. The year group also seems to be less concerned about the lack of credential and qualifications transferability across provinces.

31 Table 8: LPN Challenges and Issues by Employment Status Challenge/Issue 39. Lack of knowledge among employers regarding LPN competencies and capabilities 37. Lack of standardized competency requirements across jurisdictions 38. Lack of standardization among provincial LPN regulatory bodies 40. Role and responsibility conflicts with other nursing professions % Reporting Very Significant Full-time Part-time All N=80 N=38 N= Provincial legislation and regulations Different educational and training programs Lack of credential and qualifications transferability across provinces 43. Clear and reasonable career mobility paths among nursing professions 36. Overlap of qualifications with other nursing professions 42. Validating credentials and upgrading of foreign trained health care workers Table 8 compares the ratings of full-time versus part-time LPNs regarding their perceptions about utilization and mobility. Part-time participants were more concerned about lack of knowledge among employers. There were stories at the workshops about part-time LPNs who worked at several different facilities and experienced great differences of what they were allowed, and not allowed, to do in each setting. Full-time LPNs were also more likely to be concerned about career mobility paths and overlap of qualifications with other nursing professions as compared to the part-timers.

32 Table 9: LPN Challenges and Issues by Supervision Challenge/Issue 39. Lack of knowledge among employers regarding LPN competencies and capabilities 37. Lack of standardized competency requirements across jurisdictions 38. Lack of standardization among provincial LPN regulatory bodies 40. Role and responsibility conflicts with other nursing professions % Reporting Very Significant Yes Temp. No All N=62 N=35 N=34 N= Provincial legislation and regulations Different educational and training programs Lack of credential and qualifications transferability across provinces 43. Clear and reasonable career mobility paths among nursing professions 36. Overlap of qualifications with other nursing professions 42. Validating credentials and upgrading of foreign trained health care workers Workshop respondents were asked to indicate whether they had regular supervisory responsibilities, occasional or temporary supervision, or did not supervise others at all. Table 9 shows how these three groups rated the issues and challenges. Non-supervisors were more concerned about lack of standardized competency requirements across jurisdiction, lack of standardization among provincial LPN regulatory bodies and conflicts with other nursing professions. Supervisors were more concerned about validating credentials of foreign trained health care workers than were the other two groups.

33 Table 10: LPN Challenges and Issues by Community Size Challenge/Issue 39. Lack of knowledge among employers regarding LPN competencies and capabilities 37. Lack of standardized competency requirements across jurisdictions 38. Lack of standardization among provincial LPN regulatory bodies 40. Role and responsibility conflicts with other nursing professions % Reporting Very Significant City Town Rural All N=38 N=45 N=46 N= Provincial legislation and regulations Different educational and training programs Lack of credential and qualifications transferability across provinces 43. Clear and reasonable career mobility paths among nursing professions Overlap of qualifications with other nursing professions Validating credentials and upgrading of foreign trained health care workers The final demographic variable used to compare rating on utilization and mobility issues was the size of the community (Table 10). Generally, the respondents from the rural areas had greater concerns than other participants. Those working in the city had less concerns about lack of standardized competency requirements across jurisdictions, lack of standardization among LPN regulatory bodies, conflicts with other nursing professions, provincial legislations and regulations, different educational and training programs and validating credentials of foreign workers. Summary Hopefully this more detailed analysis of the utilization/mobility challenges and issues has identified the concerns of different groups LPNs. This information may be of use to the LPN Colleges/Association when moving ahead to further develop and implement continuing competency management systems in their jurisdictions.

34 Participant comments The following are the comments and suggestions made by the workshop participants regarding the challenges and issues of LPN utilization and mobility. British Columbia If the employer had a list of our competencies, they would utilize us better. For foreign workers, we need to be careful that their education is equivalent and comparable to ours. How do we obtain all the education within the binder (not including the specialty areas)? Funding issues, overwhelming differences among LPNs in our own province and other provinces. How to get the funding, government, public and our facility (management and RNs) to understand, support and promote the LPN role. Overwhelming challenge to obtain all this education (in BC) to be on the same level as other western provinces, namely Alberta. Easier bridging programs for LPNs to RNs. Need greater access to programs for regions in the north and for specialized areas. A tool like the competency document will help create a much needed team-like workplace. Saskatchewan In the past employers have chosen not to or did not know the full scope of practice of LPNs. I believe this is beginning to change however it will take a lot of work. Recognition too many RN managers are protecting their turf and RN employees. RNs are the decision-makers. They should be business administration managers other than only RN qualifications. Until they change, there will be very little change for the LPNs. It is important to get LPN to take medication course so that they can work at full scope. Any ideas on how to educate them? It would then make it easier for employers to use LPNs to full scope and scheduling would be easier. I feel there is or could be a problem with assignment of functions and the education LPNs receive to perform such procedures, e.g., reinsert cecostomy tube. Saskatchewan Union of Nurses (SUN) needs to be brought up to speed regarding the scope of the LPN as this is an obstacle in some instances. The governing bodies of other nursing professions do not work collaboratively with our association to enhance the quality of health care we provide.