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Last modified: June 14, 2005

Long-term care teleconference: Working with Unregulated Care Providers

Highlights for May 17, 2005

The College of Nurses of Ontario has initiated a series of teleconferences to further explore the realities of long-term care practice settings, and to provide opportunities for nurse leaders to engage in collective problem-solving.

During the Working with Unregulated Care Providers session, the second teleconference in the series, the discussion was focused around questions submitted by participants. Below is a list of themes and discussion points raised by participants.

The regulation of Unregulated Care Providers (UCP)

Participants saw benefits for regulating UCPs to be:

  • an increase in standardization of UCP programs and basic competencies across the province;
  • a greater accountability for completing the care that they provide to residents;
  • an accountability for ongoing education through quality assurance mechanisms; and
  • an assurance that UCPs terminated for abuse or resident neglect are unable to start working at another home by making information public. (CNO staff clarified the process related to investigating termination of regulated health professionals by explaining that regulation does not prevent them from working at another facility, nor does it guarantee that information about the regulated professional will be made public).

The economic issues related to hiring UCPs was raised and concern identified that if UCPs are regulated, another category of unregulated providers will likely emerge.

Accountability of UCPs

Strategies and comments shared by participants related to promoting accountability of UCPs (other than by regulation) include:

  • developing clear expectations of UCPs – through role descriptions and performance review mechanisms;
  • providing mandatory in-service education for all staff and making attendance part of the annual performance evaluation;
  • offering education at different times to accommodate different shifts;
  • developing protocols for behaviour, pain management, falls, etc., and providing focussed education related to collaborative practice and accountability of UCPs for monitoring and reporting resident status according to protocols;
  • enforcing that UCPs document care they provide; and
  • hiring UCP grads from an accredited community college with a minimum of 500 hours training.

Role clarity and delegating or assigning procedures to UCPs

Knowledge shared includes:

  • use the controlled acts to help delineate regulated and unregulated staff roles within individual organizations/facilities;
  • RNs who delegate a controlled act are accountable for:
    • ensuring that it is appropriate to delegate the controlled act procedure to a UCP;
    • providing education about the procedure;
    • ensuring that the UCP is competent to perform the procedure and that ongoing competence will be monitored; and
    • ensuring ongoing monitoring and assessment of the client to be sure the client’s status does not change and it becomes inappropriate for a UCP to continue to perform the procedure.
  • many procedures performed by UCPs are not controlled acts and, therefore, do not require formal delegation (e.g. applying topical creams), however nurses should follow the same process for determining appropriateness of the UCP performing the procedure, education, competence assessment and monitoring the client and outcomes.
  • success also depends on the interest/willingness of the UCP to perform the procedure, understand why the client is having the procedure, the outcomes, and who the UCP should report concerns to.

Staff mix, in terms of professional nursing staff to unregulated health workers, and the increasing complexity of residents in LTC.

Concerns related to:

  • the role of CNO speaking out about the issues;
  • the perceived devaluation of nursing as nursing care is divided into tasks which are performed by UCPs; and
  • the appropriate mix of regulated and unregulated health care providers.

With regard to the issue about appropriate staff mix of regulated to unregulated health care providers CNO is not considering setting a benchmark as decisions should be based on:

  • the complexity of the individual patient care needs;
  • the competencies of the staff (novice to expert); and
  • the resources and supports available in the practice environment – which varies between organizations and shifts.

The tendency for minimum staffing levels to quickly be viewed as maximum was also discussed.

Supporting novice nurses

The relative lack of practical experience many graduating nurses receive in LTC was raised as a recruitment and clinical competence issue. One participant spoke of improving the transition of student to employee by working with the local educational facility to invite students to do their preceptorship experience in the LTC setting.

The next teleconference, "RN and RPN Roles," is scheduled for September 2005. For registration information, visit the College website.

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