2019
ANNUAL REPORT
competent committed care
OUR MANDATE
OUR VISION
To regulate and lead the profession in a manner that protects and serves the public through excellence in Practical Nursing.
Influencing a quality person-centred system through regulatory excellence.
OUR MISSION Licensed Practical Nurses (LPNs) are progressive nursing professionals who provide safe, competent and ethical person-centred care in collaboration with clients, families and other providers.
CONTENTS MESSAGE FROM THE COUNCIL PRESIDENT
2
MESSAGE FROM THE CHIEF EXECUTIVE OFFICER
3
OUR YEAR IN NUMBERS 4 GOVERNANCE 6 MESSAGE FROM THE PUBLIC MEMBERS
8
MESSAGE FROM THE ESAC CHAIR
9
CORE FUNCTIONS REGISTRATION 12 CONDUCT 18 COMPETENCE 22 SUPPORTING FUNCTIONS RESEARCH
26
POLICY 28 COMMUNICATION
30
ORGANIZATIONAL CULTURE 32 FINANCIAL HIGHLIGHTS
36
COMPETENT COMMITTED CARE •
1
Message from the
COUNCIL PRESIDENT
T
he College of Licensed Practical Nurses of Alberta (CLPNA) regulates the licensed practical nurse profession in a manner that protects and serves the public. The Council approves this annual report highlighting the activities of the CLPNA in 2019. Through a policy governance framework, Council ensures ongoing realization of our organizational goal of regulatory excellence. The CLPNA and Council continue to host an annual Think Tank, inviting LPNs and stakeholders to examine trends, research and opportunities to enhance and influence the healthcare system in Alberta. In December, our CEO Linda Stanger announced her retirement for early 2020. Linda brought many strengths to her role at the CLPNA, most notably, her integrity, determination, entrepreneurial style and absolute commitment to regulatory excellence and belief in the LPN. We appreciate Linda’s dedicated service. The Council’s search for her successor is underway. I’m honoured to serve as President of the CLPNA, along with the dedicated LPNs and public members of the Council. Our goal is that every interaction with an LPN positively impacts the health journeys of Albertans, and I personally thank all 17,264 LPNs who strive to meet this goal every day. Sincerely, Valerie Paice, President
2 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
Message from the
CHIEF EXECUTIVE OFFICER
T
he CLPNA sets and maintains standards for licensed practical nurses so Albertans receive safe, competent and ethical care. This report highlights the work of a committed team as we honoured our mandate in 2019. A major milestone this year was receiving approval of amendments to the Health Professions Act (HPA) Licensed Practical Nurses Profession Regulation (2003) to be effective February 1, 2020. These amendments support LPNs to work to the full extent of their education and make a greater contribution to the healthcare team and the health of Albertans. Another highlight was completing the first year of mandatory enrollment of health care aides (HCAs) on the Alberta HCA Directory. Supporting this initiative contributes to the health human resource planning efforts within the province and establishes a milestone for HCAs in Alberta.
in Alberta, Canada and internationally. I retire early in 2020 and will leave the CLPNA with sincere gratitude for the opportunity to have served Albertans through my work with this great profession. All that our Council, staff, volunteers and collaborators have achieved to advance regulatory excellence over 14 years is a great source of pride. Most importantly, the competent, committed care provided by Alberta’s LPNs every day is an inspiration. I am optimistic for the future of self-regulation, and for the LPN profession. With respect and appreciation, Linda L. Stanger
Also important has been an increased focus on the CLPNA’s regulatory mandate, including stakeholder focus groups regarding LPNs in seniors care, increased research supporting regulatory decision-making, development and implementation of a Regulatory Impact Assessment, a refresh of our website with greater focus on public accessibility, and development of numerous timely standards and documents in support of quality LPN practice. Changes to enhance registration and conduct processes are in place and new standards for approval of specialty education programs (known as advanced practice as of 2020) have been implemented. The CLPNA has expanded and strengthened collaborative relationships and continues our leadership contribution to health profession regulation
COMPETENT COMMITTED CARE •
3
CLPNA 2019 YEAR IN NUMBERS
1171 391 Alberta graduate registrations 2018 - 1047
Out of Province registrations 2018 - 434
17,264 total LPN registrations
169 complaints received
4 •
30 hearings completed
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
139
IEN registrations 2018 - 259
3.5% growth in registration
38
average age of LPNs
Top Places of Employment
93% H
of Alberta candidates passed CPNRE Exam on 1st write
H
H
Hospital
Continuing Care*
Community Care**
5009
3932
3829
37% 28% 28%
Employment
42% 40% 18% Full-time Part-time Casual 5753
5448
Continuing Competence Program Audit
3000
members selected
2480
6710 webinar attendees
Practice Consultations
1959
inquiry responses
9
practical nurse programs
*Continuing Care includes Nursing Home / Long Term Care, and Rehabilitation / Convalescent Centre. **Community Care includes Community Health / Health Centre, Home Care Agency, and Physician’s Office / Family Practice Unit.
COMPETENT COMMITTED CARE •
5
GOVERNANCE
The College of Licensed Practical Nurses of Alberta regulates the practical nurse profession to ensure LPNs provide safe and competent care for all Albertans.
The CLPNA: - sets education, registration and renewal requirements; - ensures compliance with healthcare legislation and regulations; - approves and reviews practical nurse diploma, refresher and specialty* programs (*known as advanced practice as of 2020); - sets and enforces practice, conduct and professional standards; - establish and maintain the continuing competence program; and, - manages complaints and discipline. Since the practical nursing profession began in Alberta in 1947, through education and regulation change, the role of the licensed practical nurse has advanced while maintaining a focus on safe, ethical, person-centred care. In 1987, the CLPNA was given the mandate to govern and regulate the practical nursing profession. A Council of eight elected licensed practical nurses and three appointed public members regulate the licensed practical nurse profession in accordance with the Health Professions Act (HPA), the Licensed Practical Nurses Profession Regulation (2003) (pending amendments in force as of February 1, 2020), standards of practice, code of ethics and the CLPNA’s Bylaws (March 2019).
6 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
LPN Profession Regulation As part of an ongoing and comprehensive review and update of Alberta’s Licensed Practical Nurses Profession Regulation, LPNs were consulted in April 2019 on proposed amendments to the entire LPN Regulation. The CLPNA submitted regulation amendment proposals to Alberta Health on July 9, 2019. In September, the Government of Alberta commenced work on amendments to restricted activities. This work followed previous LPN consultation in June of 2016 on proposed changes to the restricted activities, submitted to the government in both 2016 and 2018. On October 17, 2019, by Order in Council 204/2019, the Lieutenant Governor in Council approved amendments to the Licensed Practical Nurses Profession Regulation, effective February 1, 2020. These amendments affect restricted activities, registration categories, advanced authorizations and supervision requirements. Standards of Practice As part of the legislative framework that governs the LPN profession in Alberta, standards of practice provide the minimum standard of behaviour that LPNs are expected to meet in their nursing practice. Standards of Practice for Licensed Practical Nurses on Boundary Violations: Protecting Patients from Sexual Abuse and Sexual Misconduct: o Member consultation took place on December 12, 2018, o The Standards were provided to Alberta Health for their consultation on December 21, 2018, o These standards were approved by the Minister of Health, adopted by the Council, and came into force on March 19, 2019. Drafted: Standards of Practice for Licensed Practical Nurses on Restricted Activities and Advanced Practice; anticipated to come into effect February 1, 2020. o LPN consultation survey commenced December 10, 2019, o The Standards were provided to Alberta Health for their consultation on December 10, 2019. The fourth edition of the Competency Profile for LPNs was released in September, while the fifth edition will be released in February 2020 to reflect amendments to the Alberta LPN Profession Regulation (in effect February 1, 2020.) Bylaws The CLPNA’s bylaws were amended on March 16, 2019 to add a membership category for students.
Committees The CLPNA is a member of the Alberta Federation of Regulated Health Professions’ (AFRHP) and participates in subcommittees on registration, continuing competence, legislative and regulatory affairs and complaints. The CLPNA is also a member of the board of the National Nursing Assessment Service. Regulatory Consultation The CLPNA respects its responsibility as a regulator under the Health Professions Act and participated in the Minister of Health’s consultations by providing comments on the following documents: • Alberta Health: revisions to infection prevention and control standards; • Alberta College of Combined Laboratory and X-Ray Technologists: revisions to the college’s standards of practice; • Alberta College of Physicians and Surgeons: o revisions to their Code of Ethics; o Standards of Practice for Non-Hospital Surgical Facilities; o Revisions to Standards of Practice – Duty to Report a Colleague and Duty to Self-Report; • Alberta College of Pharmacy: revisions to their Standards of Practice; • Alberta College and Association of Opticians: revisions to their Standards of Practice; • Alberta College and Association of Chiropractors: proposal to expand Scope of Practice; • Alberta College of Paramedics: revisions to their Code of Ethics; • Alberta College of Speech-Language Pathologists and Audiologists: Telehealth (Virtual Care) Standards of Practice; • Alberta Dental Association and College: Anesthetic Standards of Practice; • College of Alberta Dental Assistants: revisions to their Standards of Practice; • College of Naturopathic Doctors of Alberta: Advertising and Marketing Standards of Practice; • CARNA: o prescribing standards for nurse practitioners (NPs) which enable NPs to authorize use of medical cannabis; o revisions to standards on privacy and management of health information; o Medication Management Standards of Practice.
COMPETENT COMMITTED CARE •
7
Message from the
PUBLIC MEMBERS
A
s we come to the end of our first term as public members on the CLPNA Council, we reflect on a busy and exciting year. As public members, we play a unique role in providing a diverse perspective on the regulatory role and governance of the CLPNA and ensuring that the public receives safe, competent and ethical healthcare services from LPNs. In the fall of 2019, an amendment to the Licensed Practical Nurses Profession Regulation was announced and will come into force on February 1st, 2020. This is the first change to the regulation in 17 years and as public members, we are pleased that these changes were approved by government to reflect the reality of an everchanging healthcare system and the evolving needs of Albertans accessing our healthcare system.
organization known for its innovation with impact across the healthcare system. As public members, we would like to thank Linda for her tireless work to advance the regulatory system in Alberta. As we move into 2020, we are faced with a rapidly changing regulatory environment as well as an evolving healthcare system. As public members, we look forward to working with the CLPNA’s leadership and the new CEO to continue Linda’s legacy of regulatory excellence and contributions to a quality healthcare system for Albertans.
As a Council, we worked with a research firm to better understand the public perception of the CLPNA, which provided excellent insights into public knowledge of our role in the healthcare system. While 94% of people surveyed indicated that they had confidence that an LPN would provide them with safe and ethical healthcare, over 30% of those surveyed did not know about the CLPNA’s role in regulating the profession through discipline processes. This shows a need to better communicate with the public about our regulatory role and how to access the CLPNA when they have a concern about the care they have received by an LPN. In October 2019, the CLPNA hosted its 7th Annual Think Tank, presenting national and international experts on the subject of Empowering the Health System for Excellence. At the end of 2019, Linda Stanger announced her retirement after leading the CLPNA as CEO for the past 14 years. Under her leadership, the CLPNA has tripled its membership, established collaborative provincial, national and international partnerships and become an
8 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
Austin Mardon, Lisa Stebbins, John Chapman Public Members
Message from the
ESAC CHAIR
T
he Education Standards Advisory Committee (ESAC) fulfilled the role of supporting public safety through the application of standards in practical nursing education in Alberta as reflected in the monitoring of the annual reports provided by the basic practical nurse diploma programs. The nursing education programs report on implementing improvements on their program performance, as recommended by the ESAC Review team in their recent program review.
HCA Provincial Exam Development and the HCA Licensing Assessment Process (Stage 1), with Stage 2 to follow in 2020. These projects all reflected the leadership of the CLPNA with a focus on public protection.
ESAC completed a comprehensive Basic Diploma Program Standards revision process, and new Diploma Standards (June 2019) and Refresher Standards (December 2019) were approved by the CLPNA Council. Timely additions were made to the Standards and Indicators, and the committee also prepared a new electronic annual reporting template as well as a thorough Program Review Application Guide. These standards and supporting tools will be introduced in the next round of Program Reviews slated to begin in February and March of 2020.
We are pleased to report that there are now four licensed practical nurses who bring the vital perspective of practicing LPNs to ESAC decision-making. LPN representation on ESAC represents a wide geographical area (North, Central, and South) and encompasses a broad practice perspective of care environments (urban, rural, community and specialty).
Our team utilized the new Advanced Education for Specialty Practice Standards approved by Council in 2018 to review the following programs: MacEwan’s Perioperative Nursing program, NorQuest’s Advanced Orthopedic program, Bow Valley College’s Immunization program and the Edmonton Foot Care and Alberta Foot Care Academy programs. Each received multi-year approval. NorQuest College acquired the Devon Foot Care program and completed a program review based on the new Advanced Education for Specialty Practice standards. The CLPNA Council awarded them interim approval to offer an Advanced Foot Care program for one year, effective December 2019.
While the ESAC members have been kept very busy with these projects, they found time to remain informed on healthcare trends reported at the annual CLPNA Think Tank, the annual general meeting and conference.
We are saddened by the recent passing of Mary Anne Fish from Calgary, a long-standing ESAC member and passionate nurse and educator. Her message was that we had an obligation to encourage our practical nurse programs “to be the best that they could be”. She was a woman of integrity who influenced the development of the students and faculty at Bow Valley College. Mary Anne made a significant contribution to the newly revised Diploma Program Standards. We will miss her and extend our sincere sympathies to her family. Respectfully submitted, D. Jean Valgardson, Chair
The ESAC team supported several CLPNA initiatives during the 2019 year, namely, the Guanghua Nursing Education (China) project, the HCA (Health Care Aide) Substantial Equivalency Program Assessment, the HCA Curriculum Revision, the development of HCA Bridging courses, the
COMPETENT COMMITTED CARE •
9
CLPNA COUNCIL l-r: Joyce Rossiter, LPN; Jennifer Peace, LPN; Tiffany Smith, LPN; John Chapman, Public Member; Linda Stanger, CEO; Valerie Paice, President, LPN; Kurtis Kooiker, Vice President, LPN; Lisa Stebbins, Public Member; Jean Collins, LPN; Ashley Cesar, LPN; Sherry Kanarek, LPN not pictured: Austin Mardon, Public Member
10 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
CLPNA ORGANIZATIONAL STRUCTURE Minister of Health
Council
8 Elected Licensed Practical Nurses 3 Appointed Members of the Public
Regulated Committees Education Standards Advisory Committee Council Appeals Committee Hearing Tribunal Complaint Review Committee Competence Committee
Chief Executive Officer
Regulatory Affairs
ESAC Chairperson
Executive Officer
Executive Officer
Senior Director Communications
Registration
Finance
Operations
Complaints
Professional Practice
Research
Professional Development
Policy
COMPETENT COMMITTED CARE •
11
Core Function
REGISTRATION
Committed to excellence in registration standards.
The CLPNA is committed to registration processes that are procedurally fair, transparent and consistent. A priority this year was updating the application form and process for LPN specializations. This resulted in increased understanding and improved monitoring around specializations for LPNs, known as advanced practice as of 2020. A review of English language testing requirements for applicants seeking to work as practical nurses in Alberta was also completed, resulting in clear direction for applicants while ensuring high standards of professional nursing. Other registration initiatives included improving online registration for LPNs seeking reinstatement, for out-of-province and internationallyeducated nurses (IENs), and for new graduates. The CLPNA is also working to support the mobility of out-of-province and internationally-
12 •
REGISTRATION
educated nurses through increased understanding of potential barriers they may face to working in Alberta. The CLPNA continues to set direction for membership to understand the Practical Nurse Refresher program standards, and for membership to understand and meet new practice hour requirements. Internationally-educated nurses who seek work as LPNs in Alberta are first assessed by the National Nursing Assessment Service (NNAS). All applicants to the profession must also pass the CLPNA’s Jurisprudence Examination, which tests that practical nurses have the knowledge needed to practice safely within Alberta’s legislative framework. Passing the Canadian Practical Nurse Registration Examination (CPNRE) is the final step required for practical nursing students and international applicants to obtain full registration with the CLPNA. The Alberta annual average for Canadian first-time writers is 93% as compared to the national average of 91%.Internationally-educated nurses who wrote the CPNRE through Alberta had an 86% average, well above the national average of 65%.
Alberta CPNRE Candidates 2019* Alberta Candidates
1st Exam
Registered
1293 126 148 24
1591
Writing
1217 112 145 24
1498
Not Writing
76
Repeat Exam
14
International** 1st Exam
3
International Repeat Exam
0
Total Candidates
93
Passing
1127 83 125 16 1351
Failing
90 29 20 8 147
% Passing
93%
74%
86%
67%
90%
* Statistics prepared by Yardstick Assessment Strategies. **International applicants
COMPETENT COMMITTED CARE •
13
BY THE NUMBERS
MEMBERSHIP
17,264
total LPN registrations
16657
3.5% growth
13921 12881
11766
15860
+5.0%
15082
+5.0%
2016
2017
2018
17264
+8.4%
+8.0%
+9.5%
+10.7%
10623 +10.0%
9015
9652
+7.0%
2010
2011
2012
+5.7%
14 •
REGISTRATION
2013
2014
2015
2019
Registrations
2018
2019
Alberta Graduates NEW Members
1047
1171
Canadian Out of Province NEW Members
434
391
International NEW Members
259
139
Reinstatements*
381 436
Re-Entry Renewals Courtesy Members
0 0 14536 15127 0
TOTAL 16657
0 17264
Registration Applications
2018
2019
Alberta Graduates NEW Applicants
1105
1234
Canadian Out of Province NEW Applicants
478
563
International NEW Applicants
296
143
Reinstatements*
421 468
Re-Entry Applicants
36
40
Renewal Applicants
14874
16956
Courtesy Applicants
0
0
TOTAL 17210
19404
*Reinstatement = a member whose practice permit has lapsed at least one day.
COMPETENT COMMITTED CARE •
15
Age of Active LPNs
38
average age 2018 - 38
Internationally Educated Nurse Registrations Belize 1 19-25 |
26-30 |
31-35 |
36-40 |
41-45 |
46-50 |
51-55 |
1844 3151 3541 2648 1916 1455 1025
56-60 61-65+ | |
856
828
China
1
Columbia 1 Congo 1 India 31 Japan 1
Out of Province Registrations
Kenya 3 Malaysia 1 Nepal 2
391
Nigeria 5 Philippines
out of province registrations
UK 1 USA 1
2018 - 434
BC |
78
16 •
SK |
11
REGISTRATION
MN |
ON |
14 241
QC |
4
NB |
10
NS |
13
PEI |
2
NL |
14
Zimbabwe 1
YT NWT NU | | |
2
2
89
0
139
IEN registrations 2018 - 259
Active LPNs by Location AHS Area
2019
%
Area 0 - Out of Province/Country
1234
7.1%
AHS Area 1 - South Zone (Lethbridge & Medicine Hat)
1300
7.6%
AHS Area 2 - Calgary Zone
5321
30.8%
AHS Area 3 - Central Zone (Red Deer)
2448
14.1%
AHS Area 4 - Edmonton Zone
5786
33.5%
AHS Area 5 - North Zone
1175
6.9%
17264
100%
TOTAL
Active LPNs by Place of Employment & Status Place of Employment
Full-time
Part-time
Casual
2019
%
Association / Government
104
97
36
237
1.8%
Business / Industry / Occupational Health Centre
49
5
8
62
0.4%
Community Health / Health Centre
773
853
385
2011 14.7%
Educational Institution
140
45
67
252
1.9%
Home Care Agency
317
167
248
732
5.3%
Hospital (General/Maternal/Pediatric/Psychiatric)
1706
2377
926
5009
36.7%
92
44
36
172
1.2%
1636
1516
588
3740 27.4%
0
1
1
2
0.0%
Physician’s Office / Family Practice Unit
728
240
118
1086
7.9%
Private Nursing Agency / Private Duty
1
0
0
1
0.0%
Rehabilitation / Convalescent Centre
95
68
29
192
1.4%
Self-Employed
4
1
0
5
0.0%
Other**
108
34
38
180
1.3%
TOTAL
5753 (42%)
Mental Health Centre Nursing Home / Long Term Care Nursing Stations (Outposts or Clinics)
5448 (40%) 2480 (18%)
13681* 100%
*527 are working out of province or out of country. ** Enhancements to the LPN database resulted in increased accuracy of data being reported in 2019 from 2018. COMPETENT COMMITTED CARE •
17
Core Function
CONDUCT
Enforce standards of professional practice.
The public relies on licensed practical nurses for safe, competent, ethical care, and LPNs rely on the CLPNA to outline the expectations and provide guidance on professional conduct. This is provided through regular communications, practice consultation and the CLPNA’s guiding documents and standards. Under the authority of the Health Professions Act (HPA), the CLPNA is responsible for regulating the LPN profession in a manner that protects the public from unsafe or unethical practice of licensed practical nurses. This is accomplished through the provision of guiding documents and practice consultation for regulated LPNs. These documents and advice provide evidence-informed information to guide and support LPN professional practice. When Standards, the Code of Ethics, or other legislation which guides the profession are not met by an LPN, a complaint may be generated
18 •
CONDUCT
against the regulated member or former regulated member of CLPNA (if it’s within two years since the lapse of their registration). The Conduct Department receives, investigates, manages, and resolves complaints made against regulated members. The Conduct Department holds public safety as a priority and is committed to efficiency and transparency in all their processes. Complaints are received from a variety of sources. The CLPNA is focused on timely resolutions, that meet or exceed all requirements in the Health Professions Act. Amendments to the HPA to protect patients from sexual abuse and sexual misconduct by a regulated health professional were implemented in 2019 through Bill 21: An Act to Protect Patients. Changes were made to conduct processes, including how sexual abuse or sexual misconduct files are managed. The CLPNA’s website was updated and now provides additional specific information to the public to better understand how to file a complaint and what to do if they have been subjected to sexual abuse or misconduct by an LPN. In addition, members had the opportunity to participate in educational webinars, and committee members and staff of the CLPNA received trauma-informed training. To increase transparency all hearing decisions are now published on the website. In 2019, the CLPNA received one complaint with reference to sexual abuse of a patient; this complaint was handled expeditiously. Following a thorough and objective investigation, there was no evidence to support any allegation of sexual abuse and/or sexual misconduct; therefore, the complaint was dismissed. Information about regulation, practice, research, ethics and other relevant news for LPNs is communicated in CARE magazine, published four times yearly. It remains a reliable regulatory source for licensed practical nurses and stakeholders.
Historical Comparison
2018 2019
New Complaints Received
212
169
Previous Years’ Complaints in Process
82
35
Complaints Currently In Progress as of December 31, 2019
Incapacity 11 Investigation - In Progress
46
Investigation Report - Internal Review
16
Investigation - Legal Review
4
Referred to Hearing / Hearing Pending
2
Hearing Complete / Decision Pending
2
Monitoring Orders
11
Undertaking Pending
2
Files Closed
75
Total Complaints Received
169
Files Related to Incapacity Concerns regarding an LPN’s behaviour may initially be received by the Conduct Department as a complaint lodged against the LPN. However, after a preliminary investigation or during an investigation, it may be determined the LPN’s conduct is more likely a result of incapacity. The complaint file is then managed under section 118 of the HPA. These complaints are then not considered to be a matter of unprofessional conduct. In 2019, there were 11 complaint files where the status was changed to incapacity; one regulated member had three complaints submitted and the three files are considered to be an incapacity concern.
COMPETENT COMMITTED CARE •
19
Type of Complaints Received
Source of Complaints
Abandonment 1
2019
Employer (128)
Breach of Confidentiality / Privacy
12
Bullying 2 Clinical Competence - Documentation
5
Clinical Competence - Health Assessment
3
Complaints Director (18)
Clinical Competence - Medication Administration 32
Other (0)
Clinical Competence - Multiple
49
Protection for Persons in Care (0)
Drug Diversion
2
Failed to Cooperate with Investigation
1
Incapacity (Mental / Physical)
2
Member of Public (23)
Neglect 3
2018
Non-Nursing Conduct
2
Patient Abuse - Mental
4
Patient Abuse - Physical
7
Patient Abuse - Verbal
1
Practicing Without a Permit
17
Other (2)
Sexual Abuse - Patient
1
Protection for Persons in Care (6)
Sexual Misconduct - Co-worker
2
Substance Abuse
1
Employer (154)
Complaints Director (26) Member of Public (24)
Theft 3 Therapeutic Nurse-Client Relationship
2
Unethical Conduct
10
Unprofessional Communication
6
Working Outside Scope of Practice
1
Total Complaints Received in 2019
169
*Non-Nursing Conduct includes behaviour that harms the profession and isn’t directly related to nursing care.
20 •
CONDUCT
Disposition of Complaints Closed in 2019 (this includes files from previous years)
Complaint Withdrawn
3
Complaints Dismissed
18
Hearings Completed and Files Closed
22
Handled at the Workplace
6
Informal Resolution (Agreement & Undertaking)
71
Employer Resolution with Sanction
3
Registration Surrendered
2
Resolution with Sanction
32
Section 55 – Undertaking - Practicing Without A Permit
13
Hearing Discipline Actions Taken Reprimand 26 Partial Hearing Costs
25
Fines 2 Education 21 Reflection Paper
5
Random Drug Screening
1
Counselling 1 Supervised Practice
1
Interim Suspension Removed
1
Condition - Performance Appraisals
2
Resolved 4
Education - Prior to Reinstatement
5
Unresolved 1
Hearing Costs - Prior to Reinstatement
1
Section 118 (Non-Disciplinary)
Fitness to Work Assessment
1
Education - Prior to Restriction Being Removed
1
Supervised Practice upon Return to Work
1
Appeals in 2019
Condition - Will not practice in specialized areas without authorization from Registrar
1
Council Appeal Committee – There were no appeals requested in 2019; however, there was a final written decision received from the Council Appeal Committee in 2019 for a file from 2018.
Suspension for a total time of 12 months
1
Complaints Closed
2 177
Complaints Review Committee – There were no requests for a review of any dismissal made in 2019; however, the Complaints Review Committee met in March 2019 to review the submissions made for a review for a file in December 2018.
Hearings There were 30 hearings held in 2019 (22 of which were completed and closed), comprising 36 complaint files (two members had multiple files.) All hearings were open to the public. Four hearings are awaiting hearing tribunal decisions.
COMPETENT COMMITTED CARE •
21
Core Function
COMPETENCE
Establish and uphold standards to support competence.
The CLPNA sets standards of competence to prepare licensed practical nurses to meet the changing needs of the healthcare system. By providing access to resources and education, continuing competence is supported, as are processes to evaluate competence. Practical nurse education programs throughout the province require students to meet competence outcomes within the two-year diploma program, which typically includes approximately 1650 hours of instruction: 750 theoretical and 900 clinical / laboratory. Under the CLPNA Council’s oversight and approval, the Education Standards Advisory Committee (ESAC) establishes the standards for program approval and reviews program compliance. This year, the Standards were enhanced to include details on simulation, ehealth, safety,
22 •
COMPETENCE
professionalism and more, along with improved reporting templates and review processes. Details of this year’s program reviews can be found on page 9, in the Message from the ESAC Chair. The CLPNA’s Continuing Competence Program (CCP) is a formal system for LPNs to assess, monitor and reflect on their nursing practice and ongoing competence needs. By identifying appropriate learning activities and implementing them into practice, LPNs commit to selfdirected learning to build and enhance their competence. This ensures patients, colleagues and the healthcare system of the profession’s commitment to safeguarding the public interest. While all LPNs participate in the Continuing Competence program, the Audit process verifies the process and outcome within a random selection of LPNs annually. In June of each year, approximately 20% of LPNs are selected to participate in the Continuing Competence Program Audit process. CCP supports for members this year included a video tutorial (viewed over 3000 times), a CCP guide, multiple webinars, and an update of the online audit form and webpage.
Practical Nurse Programs in Alberta • Bow Valley College, Calgary • Columbia College, Calgary
• Keyano College, Fort McMurray
• Lethbridge College, Lethbridge
• Medicine Hat College, Medicine Hat • NorQuest College, Edmonton
• Northern Lakes College, Slave Lake/Grande Prairie/Lloydminster/ High Level/Peace River
• Portage College, Lac La Biche/Cold Lake • Red Deer College, Red Deer
An addition to the CCP is the requirement for LPNs to meet a minimum of 1000 practice hours in the previous four registration years. This requirement is being implemented over a three-year transition period from 2019 to 2021 with practice hour audits beginning in 2020. As the health system continues to evolve, the CLPNA supports LPNs to maintain competence to protect the public. Projects with a competence focus in 2019 included: • An ongoing and complete review of the Continuing Competence Program.
• Creation of a practice guideline and webinar on Professional Boundaries; a video is in development.
COMPETENT COMMITTED CARE •
23
CCP Audit
3000 practicing members audited 98% compliant, 2% incomplete:
• • •
8 members suspended 23 compassionate leave 85 non-renewal
• Creation of webinars on Unconscious Bias; PTSD Awareness and Mental Health and Wellness Strategies; How Protecting Patients from Sexual Misconduct Impacts LPNs (Bill 21); Learning to Learn: Professional Development Strategies for LPNs; and more.
•
Participation on the steering committee for the Canadian Patient Safety Institute Competency Review and Update.
• Creation of learning modules related to restricted activities and regulation amendment changes.
•
Participation in the Canadian Council for Practical Nurse Regulators’ committee on the new Entry-Level Competencies for Licensed Practical Nurses, and planning for review of Standards of Practice for Licensed Practical Nurses in Canada.
• Continued clarification of learning requirements around practice hours, including issues around specialties, independent practice and non- traditional roles.
•
Extensive member and stakeholder engagement to build system collaboration on topics including rural medicine, geriatrics, palliative care and seniors health.
• Collaboration with the College and Association of Registered Nurses of Alberta and the College of Registered Psychiatric Nurses of Alberta on tri-nursing documents including,
Webinars and workshops for LPNs on 32 diverse topics were well-attended. Focus groups were also held to gather information from key stakeholders and LPNs to better understand the needs for care of seniors and the frail elderly.
o The Collaborative Practice in Nursing resource document,
o Aesthetic Nursing FAQs webinar and video,
o Social Media E-Professionalism for Nurses resource document. • Participation on the advisory group and steering committee for Alberta Palliative Care competency development. 24 •
COMPETENCE
The CLPNA’s AGM and Conference, held in Edmonton May 6 and 7, had over 300 attendees, with initial evaluations showing high marks for the format, speakers, sponsor involvement and overall event.
STUDY with CLPNA self-study courses 18,975 completed certificate exams at www.StudywithCLPNA.com 1060
Anaphylaxis
1168
Diagnostic Tests & Laboratory Values
1963
Elder Abuse
1645
Health Assessment
2058
Infection Prevention and Control 806
Intravenous Infusion Therapy Learning to Learn
141
Medical Language and Terminology
1075 1414
Medication Administration Medication Drug Calculation
818 4334
Nursing Documentation Pressure Ulcers Relational Practice
790 1703
NOTE: These courses are open to the public and do not represent solely Alberta LPN registrants.
Professional Development Webinars
31 Webinars
(21 more than 2018)
6710 Attendees (3860 more than 2018)
COMPETENT COMMITTED CARE •
25
Supporting Function
RESEARCH
Lead and collaborate on research to support regulatory excellence and the creation of knowledge on LPN practice.
The CLPNA leads and collaborates on research projects on regulation and nursing practice. CLPNA and Alberta Innovates: Advancing Knowledge Grant In collaboration with Alberta Innovates, the CLPNA partners with academic researchers to fund projects focused on LPN practice, utilization and quality. The following ‘Advancing Knowledge’ projects were completed in 2019: LPNs as Change Agents: Building LPN Leadership Capacity to Enable Practice Change in Residential Care Homes. Partner: Dr. Sienna Caspar, University of Lethbridge. Presentations related to this project took place at the Brenda Strafford Foundation Way Annual Symposium, the CLPNA AGM and Conference, and the 20th Biennial Conference of the Canadian Gerontological Nursing Association. A related article was published in CARE magazine.
26 •
RESEARCH
Enhancing LPN-Family Communication to Reduce Avoidable Transfers of Long-Term Care/Assisted Living Residents to the Emergency Department: A Mixed Methods Study. Partner: Dr. Jude Spiers, University of Alberta. A presentation took place at the CLPNA AGM and Conference, and a related article appeared in CARE magazine. Optimizing Licensed Practical Nurses in Home Care: Their Role, Scope and Opportunities. Partner: Dr. Kim Fraser, University of Alberta. This research was published in the Canadian Journal of Nursing Leadership.
The CLPNA contributed to several independent research projects in 2019. LPNs’ Perceptions of and Motivation to Meet Professional Standards. Partner: Renata Neufeld, College of Licensed Practical Nurses of Manitoba and Research Fellow at the Institute of Regulatory Excellence. Results were presented at the 2019 National Council of State Boards of Nursing Annual Meeting and Delegate Assembly. Securing Accessible, Quality Early Learning and Care for Families Working Non-Standard Hours in Alberta: A Systematic Scoping Review. Partner: Dr. Rebecca Gokiert, University of Alberta. The CLPNA, in partnership with the University of Alberta’s Community-University Partnership, received funding for a Mitacs Accelerate Grant to fund a doctoral student. Chelsea Freeborn completed the scoping review in May 2019. The Influence of Health Work Environments on the Intent to Stay Among Nurses: Perspectives from Canada and the United Kingdom. Partners: Dr. Sandra Goldsworthy, University of Calgary and Nicola Witton, Keele University, UK. A presentation on moral distress among UK critical care nurses took place at the 34th Annual British Association of Critical Care Nurses Conference.
Building Citizen Engagement in Translating Research in Elder Care. Partner: Dr. Andrea Grunier, University of Alberta. The CLPNA participated in a James Lind Alliance workshop to create priority areas for community engagement research, affecting the quality of care for seniors provincially and nationally. Project: Healthy & Professional Knowledge Workers: Examining the Gendered Nature of Mental Health Issues, Leaves of Absence & Return to Work Experiences. Partner: Dr. Ivy Bourgeault, University of Ottawa. This $1.4 million Social Sciences and Humanities Research Council and Canadian Institutes of Health Research grant explores evidence-based, genderresponsive interventions to foster well-being among LPNs. The CLPNA is a community partner. The CLPNA contributed to regulatory research through the following activities: • Overview of Nursing Regulation Concepts and Frameworks internal white paper • Regulatory Impact Assessment on CLPNA processes to evaluate regulatory effectiveness • Published the report of the 2018 CLPNA Member survey.
COMPETENT COMMITTED CARE •
27
Supporting Function
POLICY
Create evidence informed policy to support regulatory processes.
The CLPNA’s policies outline the requirements and the expected behaviours of LPNs as part of the larger mandate of serving and protecting the public. The following documents represent the ongoing efforts of the CLPNA to maintain a high regulatory standard for the licensed practical nurse profession.
Policies • Temporary Registration – establishes the requirements to register and practice on the temporary register including supervision requirements; released January 2019.
• English Language Proficiency Standard – clarification of require- ments for English language proficiency; released June 2019.
28 •
POLICY
Interpretive Documents • Privacy Legislation in Alberta; released January 2019.
• Duty to Report; released January 2019.
Practice Guidelines • Confidentiality; released January 2019. • Professional Boundaries – complements the Standards of Practice on Boundary Violations: Protecting Patients from Sexual Abuse and Sexual Misconduct; released July 2019.
• Cultural Competence and Inclusive Practice – includes self-reflection strategies and actions; released December 2019.
Info Sheets • LPN Regulation Changes for Educators – explains changes to LPN regulation effective February 1, 2020 and necessary enhancements needed to practical nursing courses; December 2019.
Other • CLPNA’s LPN Decision-Making Tool - helps LPNs evaluate the appropriateness of performing a healthcare activity; released January 2019.
• Canadian Council for Practical Nurse Regulators’ Entry-Level Competencies completed; CLPNA administrated a national survey specific to the Entry-Level Competencies and related practice.
• CLPNA’s Policy Framework - outlines policy development processes within CLPNA including internal and external-facing policies; updated spring 2019.
COMPETENT COMMITTED CARE •
29
Supporting Function
COMMUNICATION
Facilitate responsive and relevant communication with the public, LPNs and stakeholders.
30 •
COMMUNICATION
Communication efforts this year focused on ensuring the public clearly understands the regulatory role of the CLPNA and the accountability of LPNs. The CLPNA’s website was redesigned with a focus on public protection, accessibility and transparency, including highlighting and simplifying the process of making a complaint. Website revisions were completed to reflect Bill 21; a webinar webpage was added to improve accessibility to ongoing education for LPNs; and the LPN practice decision-making tool is now available online in three platforms, making safe practice guidance even easier to access. Web information for the CLPNA’s AGM and Conference was also updated and enhanced.
With the goal of maintaining LPN knowledge and commitment to their regulatory requirements, a National Nursing Week quiz provided a chance for LPNs to find answers on the CLPNA website. CARE magazine, the quarterly publication of the CLPNA, prioritized regulatory content, and offered members the most current information on regulation, research and competence.
Public awareness campaigns aimed to inform the public of regulatory standards and accountability of LPNs, using digital and radio platforms, and included ongoing social media messaging to deliver necessary regulatory information to members and stakeholders.
COMPETENT COMMITTED CARE •
31
Supporting Function
ORGANIZATIONAL CULTURE
Create a productive environment built on trust, respect, safety, collaboration and a commitment to continuous improvement and fiscal responsibility.
As an organization that exists to serve the public, the CLPNA prioritizes effective stewardship of resources in a responsive and responsible workplace. The CLPNA works to be an employer of choice, where staff are engaged and valued. To support this, a formalized policy and modern process for recruitment was developed and implemented, including processes for onboarding and orientation. Implementation of a new document management system is underway to meet organizational goals of security and efficiency, and a new team charter was developed and signed by all staff to guide the organization in accountability and corporate wellness.
32 •
ORGANIZATIONAL CULTURE
The CLPNA continued its collaboration with China’s Guanghua International Nursing Alliance, as part of our commitment to the improvement of standards of nursing education internationally. Nursing Education Standards and a resource toolbox for this initiative were completed in 2019.
Our Team Charter Our Team Charter
Through our collective knowledge and experience, in an envi of Trust and Respect, we fulfill the mandate of the CLP Through our collective knowledge and experience, in an enviro of Trust and Respect, we fulfill the mandate of the CLPN
WHO WE ARE ACCOUNTABLE TO WHO WE ARE ACCOUNTABLE TO Key Stakeholders: Key Stakeholders:
CLPNA Staff
Service Providers Service Providers
Council CLPNA
Committees Staff Council Committees
Consultants Consultants
Education Providers Education Providers
Regulators Regulators
HOW WE WORK
To support healthy work HOWaWE WORK TO professional, positive cultu
To •support a healthy work-lif We value and encourag professional, positive culture continuous improveme We support profes • We value and encourage growth in a safe an continuous improvement. environment. - We support professio in aa safe andas • Wegrowth support diverse environment. environment. - We collaborate to • We support a diverse and ideas and perspec environment. - We collaborate to • We communicate in exc an ideas and perspective manner.
• We communicate in an op • We resolve conflict in a manner.
• We resolve conflict in a re
HOW WE FULFILL O
HOW WE FULFILL OU
Registrants & Applicants Registrants & Applicants
Employers Government Government
An excerpt from the new CLPNA team charter.
Employers
In all that we do, we are c excellence: In all that we do, we are com • Quality: We produce o excellence: based on performance • Quality: We produce out best practice. based on performance m •best Resources: practice. We are fisc when using supplies an • Resources: We are fiscall operating costs within when using supplies and s costsWe within bu •operating Timeliness: respon meeting or exceeding • Timeliness: We respond while recognizing theagn meeting or exceeding COMPETENT COMMITTED CARE • 33 while recognizing the nee
Encouraging LPNs to increasingly strive to enhance their competencies. The Fredrickson-McGregor Education Foundation for LPNs is a non-profit which distributes educational grants, awards and bursaries to members of the College of Licensed Practical Nurses of Alberta to enhance their nursing knowledge, skills and ability, and honour their achievements. The Foundation administers the proceeds of a $3 million endowment fund to enhance LPN nursing knowledge, skills and ability. Some of the activities of the Foundation include authorizing grants for continuing education, managing the Awards of Excellence, and fundraising. In 2019, the Foundation Education Grant Program approved 679 applicants for a total of $309,806.74. Since the Education Grant Program began in September 2006, the Foundation has approved 6831 applications for a total of $2,996,114.41 in grants, and distributed 72% of the approved funds. 2019 APPROVED EDUCATION The Grant Administrator is currently approving education that enhances the LPN’s current role, or that will allow them to advance into another LPN role. The education that is most applied for includes Immunization, Foot Care, and one-day seminars, such as Physical Assessment Pearls, Supplements and Alternative Therapies, and Leg Ulcers. The Foundation pre-approved grants of $150 to CLPNA members towards the cost of the 2019 CLPNA AGM and Conference registration fee. Members must meet the criteria by attending the full two-day conference, hold an active practice permit and reside in Alberta. In 2019, 88 members received funding through the program.
34 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
Top Grant-Approved Education of 2019: CLPNA AGM & Conference
88
NURS9501/Immunization 169 Foot Care
65
Physical Assessment Pearls Conference
34
Supplements and Alternative Therapies
27
NURS9504/Phlebotomy 26 Leg Ulcers
26
Challenging Geriatric Behaviour
24
NURS9213/Intravenous Initiation, Infusion and Medication Administration
20
Perioperative Specialty Applications (contains 4 courses)
16
Orthopedic Specialty Applications (contains 4 courses)
15
FOUNDATION INITIATIVES This year, recruitment efforts were successful as three new members joined the Foundation’s Board. Continued progress was made in updating the Foundation Bylaws, with a draft prepared for legal review. A new fundraising initiative was implemented in 2019 with the launch of the online LPN swag store with 100 percent of the proceeds supporting education grants for LPNs. The awards nomination method was enhanced to provide a user-friendly online system with the goal of streamlining the process.
The Ministry of Health issued a directive in December 2018 mandating the enrollment of all health care aides (HCAs) employed by Alberta Health Services, contracted operators and publicly funded third-party contractors into the Alberta Health Care Aide Directory within one year. The project is being led by the CLPNA, and an extensive amount of effort and work has been done to ensure that the Directory is able to meet the required directive by the extended date of January 31, 2020.
RENEWAL An annual renewal is required by policy to allow HCAs the opportunity to update their contact, education and employment information. An annual renewal also allows HCAs the option to change their status to inactive if they no longer work as health care aides, or have moved out of province.
HCAs Approved by Month as of December 31, 2019 (n=21,148)
7421
67
27
Jan-19
Feb-19
801
185
Mar-19 Renewal Apr-19 Mar-19
67
27
Jan-19
Feb-19
14411
19
670
May-19
801
185
Mar-19 Renewal Apr-19 Mar-19
May-19
1353
Jun-19
Jul-19
1353
Jun-19
1689
Jul-19
2211
1876
2172
Aug-19 Oct-19 2211 Sep-19 2172
1876
Aug-19 Sep-19 Oct-19
2657
7421
2657
Nov-19
Nov-19
Dec-19
Dec-19
Approved HCAs as at December 31, 2019
|
14411
|
4754
|
232
|
Certified
The directory had its first renewal in 2019 and will have the second renewal in 2020.
670
19
1689
|
232
Certified -| In Progress
Certified
Certified 232 In Progress
14411
232
14411
1828
4754
Substantially Equivalent Substantially 4754 Equivalent
Directory4754 Statuses
20
|
1828
| Deemed
Competent
|
20
Deemed | Competent In Progress
Deemed 1828 Competent
Deemed 20 Competent In Progress
1828
20
Directory Statuses
COMPETENT COMMITTED CARE •
35
FINANCIAL HIGHLIGHTS
36 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
Statement of Financial Position 2019
December 31, 2019
ASSETS CURRENT Cash Cash held for restricted funds Investments Accounts receivable Prepaid expenses
$
4,998,679 $ 3,985,580 92,246 161,996 7,113,089 6,638,722 23,963 143,872 217,795 357,060
12,445,772 11,287,230 - 303,175 3,163,154 2,977,605 1,313,933 1,356,704
INVESTMENTS INVESTMENTS RESTRICTED FOR ENDOWMENT FUND CAPITAL ASSETS LIABILITIES CURRENT Accounts payable and accrued liabilities Deferred grant revenue Prepaid registration fees
2018
$ 16,922,859 $
$ 15,924,714
963,530 $ 833,544 90,817 229,327 5,700,632 5,381,845
LEASE INDUCEMENT
6,754,979 6,444,716 352,521 399,844 7,107,500 6,844,560
NET ASSETS Unrestricted Internally restricted for Seniors Care Education Restricted net assets
4,811,899 4,195,846 526,373 550,000
Capital Fund
1,313,933 1,356,703
Endowment Fund
3,163,154 2,977,605
9,815,359 9,080,154
$ 16,922,859
$ 15,924,714
Approved by the Council
President
Vice President
COMPETENT COMMITTED CARE •
37
Statement of Operations Year Ended December 31, 2019
REVENUE Registration fees Active Out of province assessment Late Reinstatement Fines Associate License verification Consulting Health Care Aide special projects Program development National examinations Annual general meeting Jurisprudence examination Program fees Advertising Interest income Miscellaneous Alberta Directory grant Directory Enhancement grant Foreign Qualifications Recognition Innovation grant
38 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
2019
2018
$ 5,935,331 284,737 110,100 - 21,200 31,707 43,995
$ 5,698,527 254,452 112,900 3,650 14,250 32,977 28,171
294,435 40,036 9,990 34,000 466,617 485,963 131,844 159,970 46,509 54,084 45,000 10,095 8,920 9,990 174,735 153,629 517 2,127 229,327 165,239 209,183 - 27,127 $ 8,044,147
7,287,187
Statement of Operations 2019
Year Ended December 31, 2019
2018
EXPENSES Administration Public information Rent and occupancy costs Office and computer Amortization of capital assets Bank charges and interest Postage Professional fees Telephone and utilities Consulting fees Printing Travel Jurisprudence project Health Care Aide special projects Seniors care education Alberta Directory grant Directory Enhancement grant Schedule of Personnel Costs Schedule of Cost of Services
32,687 116,735 348,477 406,529 423,786 397,583 218,561 209,705 153,142 140,228 20,691 23,194 80,560 89,276 35,524 35,287 20,974 44,105 1,536 4,340 83,591 93,585 26,399 44,888 296,014 29,066 23,627 229,327 165,239 209,183 3,436,001 3,108,028 2,033,246 2,015,444
7,673,326
6,923,232
370,821
363,955
INCOME FROM OPERATIONS OTHER INCOME
Unrealized gain (loss) on investments
196,815
(107,517)
Loss on disposal of investments
(17,980)
-
178,835
(107,517)
EXCESS OF REVENUE OVER EXPENSES
$
549,656
$
256,438
COMPETENT COMMITTED CARE •
39
Endowment Fund - Statement of Operations 2019
Year Ended December 31, 2019
REVENUE Investment income Unrealized gain (loss) on portfolio investments Gain on disposal of long-term portfolio investments
$
2018
66,871 255,168 60,700
$
64,160 (253,913) 36,688
382,739 (153,065)
EXPENSES Brokerage fee Donation to Fredrickson McGregor Education Foundation
27,190 170,000
23,541 170,000
197,190
193,541
EXCESS OF REVENUE OVER (UNDER) EXPENSES
$
185,549
$
(346,606)
Statement of Changes in Net Assets Year Ended December 31, 2019
2018 Balance
Excess of revenue over (under) expenses
Invested in capital assets
2019 Balance
Unrestricted
$ 4,195,846
$ 791,844
$ (175,791)
$ 4,811,899
Internally restricted for Seniors Care Education
550,000
(23,627)
-
526,373
Capital Fund
1,356,703
(218,561)
175,791
1,313,933
Endowment Fund
2,977,605
185,549
-
3,163,154
$ 9,080,154
$ 735,205
-
$ 9,815,359
$
The complete audited financial statements are available by contacting the CLPNA at 780.484.8886
40 •
COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT
competent committed care
St. Albert Trail Place 13163 -146 Street Edmonton, AB T5L 4S8 Phone 780.484.8886 Toll Free 1.800.661.5877 Fax 780.484.9069
www.clpna.com
