I arrived at a new job early in my career as a Registered Nursing Assistant (RNA). As I reported to the nursing station, I realized I was in for a challenge. Although RNAs were expected to be in the room, the report itself was between the night and day Registered Nurses (RN); they decided what information they thought we needed to know.
The RNs were not deliberately trying to be unfriendly or disrespectful. It was the culture that did not recognize RNAs as nurses. Perhaps because, at that time, we couldn’t even refer to ourselves as “nurses”, a legally protected title.
In that moment, I recalled a leader from the Ontario Association of Registered Nursing Assistants (OARNA), as WeRPN was called in those days, talking to my nursing class about advocating for us to refer to ourselves as nurses.
“Of course, we would be able to be called nurses,” I thought at the time. After all, our job was nursing.
Years later, I realized how idealistic and optimistic I had been. OARNA had to fight that uphill battle for all of us.
Over the next decade, there were subtle changes in how RNAs were viewed in the workplace. More team-based conversations were taking place, and organizations were being more imaginative about roles for RNAs. Reporting became more collaborative, with everyone providing input.
In 1991, the introduction of the Nursing Act ushered in a new era. The title of RNA changed to Registered Practical Nurse (RPN), along with a change in scope of practice to include medication administration and asepsis. This was a huge step forward for practical nurses and a major win for their professional association, which by then was known as the Registered Practical Nurses Association of Ontario (RPNAO).
And yet, RPNs continued to fight to be recognized as actual nurses. It felt like a slap in the face every time a physician or team member would arrive on a unit and ask an RPN if any nurses were working that day.
The late 90s and early 2000s were the most devastating for RPNs. At a time of better funding and an overabundance of RNs,Ontario continually saw hospitals move to all-RN staffing models. Each staffing announcement seemed like a chance to showcase a badge of honour. RPNAO was now facing its most significant challenge to date: to ensure that nurses, organizations and the public understood the value of a diverse workforce and the knowledgeable and compassionate care that RPNs could provide for patients with a more predictable path of care.
The association engaged multiple strategies to help paint a complete picture of the impact RPNs have on patient care. We connected leaders and promoted evidence-based models of care to combat turfism. We showcased the excellence that RPNs demonstrate as a symbol of what must be preserved. It took time and was not easy, but we are proud that RPNs are now recognized as distinct from, albeit equally as important as, RNs.
What came next was a surprise. While we were anticipating a nursing shortage, we did not expect the tsunami-like impact of a pandemic, nor could we have predicted that RPNs would be the most negatively impacted of all care providers.
Throughout the pandemic, RPNs have faced the same traumas as other nurses. They have risked their health, witnessed loss of life, endured crushing workloads leading to burnout and faced wage compression. While their Personal Support Worker (PSW) colleagues have seen well-deserved pay increases, RPNs’ wages have remained stagnant. Now it’s not uncommon for RPNs to receive the same pay or sometimes even less than the PSWs they supervise; however, RPNs are also taking on roles akin to RNs’.
In the face of these challenges, WeRPN has engaged in the difficult, albeit important, task of ensuring RPNs in Ontario have reasonable workloads, appropriate recognition and competitive wages reflecting the importance of their role.
While, as a professional association, we don’t negotiate wages, our role is to ensure decision-makers understand the realities RPNs face and do everything possible to support them in delivering the care their patients, residents and clients deserve.
Bringing about positive change requires constant effort and attention. Our association’s name and the name and role of RPNs have evolved incrementally over the last four decades, but our commitment to advocate for nurses has remained unchanged. And as we move forward through whatever comes next, we need all of you to engage with us — through your membership and advocacy — so that we can continue to lead change for this incredible profession.
Dianne Martin, RPN
CEO, WeRPN
