RESULTADOS Y CONCLUSIONES DEL ESTUDIO 1 DATOS GENERALES
3. SOLUCIONES PROPUESTAS POR LOS ENTREVISTADOS
Are there any unique requirements in Alberta, which support this change?
There are certain unique features of Alberta, relative to other jurisdictions, that place this
province in a better position than others to realize the full benefit of a degree-prepared registered nurse workforce. The province’s commitment and its progress to date in moving to a primary health care focused system is one such feature, as evidenced by Alberta’s fully integrated regional system of health service delivery and by new programs such as alternative payment plans for physicians. This means that, more so than most other provinces, Alberta is poised to begin real health reform related to promotion/prevention, determinants of health, and chronic disease management. The vital contributions of a broadly educated and experienced workforce of 26,000 registered nurses will provide added impetus to such reform across the full range of service settings, and will multiply the ultimate benefits for Albertans.
This province is also distinguished by the extent to which collaborative nursing education programs have become the norm, and by the well-developed distance learning options that are available in nursing, both for completing an initial degree in nursing and for later upgrading to a degree. These features not only provide many options for education regardless of where a student lives, but also will make the transition to degree entry-to-practice less challenging than it has been in provinces without existing collaborative nursing education programs. Of note is the fact that Ontario is using Alberta’s model of collaborative nursing education in preparation for transition to baccalaureate entry-to-practice by 2005.
Does implementation of the proposal require any legislative changes? If so, what changes are needed?
No need for legislative change is anticipated. This new educational requirement for entry-to- practice, and its January 1, 2010 implementation date, will come into force as part of the Registered Nurse Regulation under Alberta’s Health Professions Act.
What does the proposed implementation schedule look like?
The final implementation date has been modified from January 1, 2005 to January 1, 2010. The reasons for this change were two-fold:
1. To address the health authorities’ expressed need for a more gradual transition to the new entry-to-practice standard, in order to avoid any possible short-term exacerbation of the nursing shortage problems during the transition year.
2. To address the reality that nursing education programs are already preparing calendars for the fall 2004 term, and some of these calendars continue to advertise a diploma-exit program option. The policy within these programs is to allow for a five-year maximum time frame for completion, in recognition of possible extenuating circumstances students may face.
The modified implementation schedule will allow nursing students who begin studies in a diploma-exit program in the fall of 2004 the ability to write the Canadian Registered Nurse Examination up to October 2009, and to apply for licensing after program completion. The implications of this timing are that:
• Nursing education programs will have the flexibility to initiate their own transition plans for completing planned diploma programs and implementing curriculum changes for the
baccalaureate stream.
• December 31, 2009 will be the last date on which graduates of Alberta’s diploma-exit nursing programs will be considered to have met the educational requirements for eligibility for licensure as a registered nurse in Alberta.
• Any new diploma nursing graduate who fails to pass the licensing exam in October 2009 will be treated as a special exception to the above, in consideration of the AARN’s policy to allow a maximum of three writings of the exam.
Experienced diploma-prepared registered nurses who are practicing in other jurisdictions will continue to be eligible to obtain a license to practice in Alberta, provided the diploma was
obtained prior to December 2009. For those receiving nursing diplomas after that date, Alberta’s new health professions legislation provides an alternative route for licensing through a
“substantially equivalent competency” provision. This will be done through Prior Learning Assessment and Recognition (PLAR), which will assess the applicant’s competencies. The same process will be applied after 2009 for applicants from other countries.
Describe the effects the proposed change might have on other jurisdictions.
Canadian nursing jurisdictions have developed the Mutual Recognition Agreement of the Regulatory Bodies for Registered Nurses, in consideration of the terms of Chapter 7 of the Agreement on Internal Trade. The purpose is to set out commonly held national
registration/licensure principles to facilitate mobility of registered nurses across the country. Because there is some variability in the legislation within provincial jurisdictions, the legislation supersedes the agreement. However, if jurisdictions have baccalaureate as their entry-to-practice requirement, it would be as an exception that they would recognize a new diploma prepared nurse from another jurisdiction. While the regulatory bodies are working towards commonality, the majority will greatly influence the accepted standard for mutual recognition.
Describe any jurisdictional comparisons where a similar change has been made or considered.
Please see Section 3.0.
Is the request consistent with other current health, education and labour policy decisions? Describe.
There is no identified inconsistency with such decisions; indeed, this change is very supportive of many of the Alberta government’s health reform priorities. However, the Ministry of Learning and the educational institutions currently offering a nursing diploma-exit stream will, over the next few years, need to address this transition through resource reallocation and related strategies.
The proposed change in the registered nurse entry-to-practice requirement is also entirely
consistent with national and international trends and decisions concerning nursing education and regulation.
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APPENDIX A: HISTORICAL OVERVIEW OF NURSING EDUCATION IN
ALBERTA
Historical Overview of Nursing Education In Alberta
(references available on request)
1894 to 1930
• As the railroad reached Alberta and new immigrants rapidly arrived, so came the need for hospitals. With the establishment of hospitals, came the need for nurses. The early “nurses” were lay nurses that came from England, the United States, and other parts of Canada. • The first nursing program began at the Medicine Hat General Hospital in 1894; the first
nurses graduated from this program in 1896.
• The second nursing program began at the Calgary General Hospital School of Nursing in 1895.
• Nursing training was an apprenticeship system where the students were labourers and service took precedent over everything else. The doctors undertook what formal lectures there were. The doctors prepared the examinations and a certificate was presented by the hospital
providing the training. Each hospital determined the length of the program. Work of the students was not confined to the hospitals; they were also hired to do private nursing in private homes, but the hospitals generally kept the fees.
• All the schools of nursing in Alberta (except St. Michael’s, Lethbridge, and Foothills) opened between 1895 and 1915. Three schools (at Banff, High River, and Camrose) were short lived, but the remaining schools continued in operation as service units for hospitals until the mid-sixties.
• In 1907, a private duty registry was established in Calgary. The nurse in charge ensured that all individuals registering had a diploma from a training program. This related to the concern that many people working as “nurses” were untrained lay workers.
• In 1918, the first registration examinations were held in Calgary; they included both written and oral examinations.
• The first degree in nursing to provide community health nurses and educators was offered in 1926, but until 1937 students had to attend the University of British Columbia for classes in their final year.
• In Alberta, the University of Alberta did not offer a post-RN diploma in teaching until 1940, although a sandwich-type degree had been offered since 1924 – this included one year of arts and science, three years in a diploma nursing program, and a “professional” year at
The 1930s
• No other event in the history of nursing affected the profession as profoundly as the Weir
Report: Survey of Nursing Education In Canada published by CNA in 1932. The Weir
Report was an extensive survey and some of the recommendations contained in the report were:
• nursing education must become a integral part of the general education system and be funded by government,
• the minimum size for any hospital continuing with a nursing program must be seventy- five beds,
• greater consistency among programs, both in the program content and in reporting on the programs,
• nurses to instruct nurses,
• better prepared nursing instructors,
• minimum entrance to be a senior matriculation.
• Weir also recommended that schools of nursing should be independent of hospitals.
• During this decade, schools of nursing were well established in large urban centers and some small towns (e.g., Camrose and High River).
The 1940s
• In 1941, the Registered Nurses Act of 1916 was amended to include a grade 12 educational requirement to enter a school of nursing in Alberta.
The 1950s
• The 1950s saw the formation of a Student Nurses Association (SNA).
• There was concern regarding the amount of time students spent providing care to patients vs. the quality of their educational programs.
• Under legislation, the General Faculties Council (University of Alberta) was responsible for the inspection of schools of nursing. The Post-AARN Meeting/Convention notes of May 1958 record appreciation to the University of Alberta for appointing a full-time advisor to schools of nursing.
The 1960s
• In 1963, the Alberta Department of Health clearly stated that the hospital schools of nursing would continue to provide diploma programs as a two-year college program would be too expensive. This was because the hospitals would have to hire nurses to replace the third year students. The government’s position was emphasized by the approval of the Foothills
Hospital School of Nursing, which opened in 1966.
• In 1966, there were still no purely independent schools of nursing in Alberta. • The last half of the 1960s saw the introduction of the college nursing programs.
• On September 19, 1966, twenty-nine students enrolled in a new four-year integrated
baccalaureate program at the University of Alberta. Prior to this date, students enrolled in a five-year program during which the three-year clinical experience was received in the University of Alberta Hospitals.
• In 1967, the new two-year diploma nursing program commenced at Mount Royal College in Calgary.
• The first students were admitted to the Red Deer College Program in September 1968. • The Lethbridge Community College Program commenced one year later in September 1969. • In 1966, the University of Calgary gained independence from the University of Alberta. The
school of nursing was established in 1969 and accepted its first students in 1970.
The 1970s
• The Edmonton General Hospital gave up its school of nursing in the early 1970s at the onset of the Grant MacEwan Nursing Program. St. Michaels in Lethbridge was phased out, a new school was established at Lethbridge Community College, and the Medicine Hat hospital program also transferred to the community college. Thus in a little over five years, five new college programs and one new university program were developed.
• By 1975 there were two basic baccalaureate programs in nursing, five two-year college programmes, and six hospital schools all preparing registered nurses. Programs leading to a registered nurse were two, three, and four years in length.
• The Alberta Task Force on Nursing Education was commissioned on January 24, 1975 (following the creation of the Department of Advanced Education by the Government of Alberta), to prepare a framework for the planning and coordination of the education of nursing personnel in Alberta. The task force report completed in September 1975 and
released in February 1976 recommended that by 1985 that there be two routes of professional nursing preparation:
• a university based baccalaureate program, and
• an articulated baccalaureate program between a university and non-university setting. It further recommended that by 1990 the minimum educational preparation for professional nursing be the baccalaureate degree.
• In August 1975, government released a draft of legislation entitled The Adult Education Act. It attempted to combine all legislation regarding advanced education under one act. This omnibus concept was not well received by various institutions and professional associations. The concerns regarding this legislation were that it gave the Minister of Advanced Education very broad powers to control institutions including fees, services, faculties, programs of study, budget. In addition, the Act would give cabinet (on the recommendation of the Minister) very broad powers with respect to academic qualifications and standards for entrance into professional associations. The Adult Education Act was withdrawn in January 1976.
• In November 1977, the government provided another framework for the planning and coordination of education of nursing personnel presented in the document Position Paper on
Nursing Education: Principles and Issues. This paper noted that baccalaureate education
was desirable, but did not agree that it should be the minimum entry requirement. • The AARN further refined its position and in 1979 released a position statement that
supported the goal of the baccalaureate degree (basic or post-RN) as the minimum
educational preparation for professional nursing. It further stated that by the year 2000, the baccalaureate degree in nursing be the minimum requirement for entry into the nursing profession in the province of Alberta.
The 1980s
• In 1983, the funding and administration for hospital schools of nursing were transferred from the Department of Hospitals to the Department of Advanced Education.
• The University of Lethbridge School of Nursing opened in 1980.
• During the 1980s, nursing education became united with the goal of baccalaureate entry-to- practice by the year 2000.
• Work began on the development of collaborative programs as a strategy to accomplish baccalaureate entry-to-practice by the year 2000.
The 1990s
• The University of Alberta and Red Deer College collaborative program began in September 1990.
• The Edmonton Collaborative Program began in September 1991. • The Calgary Conjoint program began in 1993.
• The Medicine Hat and Lethbridge Community College and University of Lethbridge collaboration began in 1998.
• In May 1999, a letter of agreement between the Universities Coordinating Council (UCC) and the AARN was signed transferring the UCC functions under Section 54 and 55 of the
Nursing Profession Act to the AARN. AARN Provincial Council subsequently established
the Nursing Education Program Approval Board (NEPAB) by bylaw effective April 1, 1999