Licensed practical nurse

Canada

In Canada, nursing, as with all other health care professions and trades, is regulated by the respective province or territory, through an enabling statute legal scheme where an act of the relevant legislature grants delegated authority to a non-sovereign entity such as a college of nurses with powers to regulate the profession within specific parameters and also grants to the respective minister of the Crown oversight and the powers to write regulations through a Ministerial Order in Council.

As an example, the Canadian province of British Columbia's enabling act is the Health Professions Act, RSBC 1996, c. 183, and the resulting nursing-specific regulation is incorporated into one Regulation together with a number of other practitioners such as audiologists and naturopaths in the Health Professions Designation Regulation, BC Reg 270/2008.

While the act and the regulation outline basic organizational architecture, each professional organization creates its own bylaws and codes of conduct and practice subject to ministerial and judicial review and must be in compliance with accepted norms of administrative law such as transparency and accountability in governance, fundamental principles of natural justice, an internal appeal process and compliance with the Canadian Charter of Rights and Freedoms.

Such legal schemes enable self-governance and save costs to governments by delegating regulatory responsibilities to a self-funded and self-administered professional entity, but are also known to engage in protectionist practices since the delegation also grants a monopoly for the provision of services to only one body, as widely studied by the late economist Uwe Reinhardt.

A nurse who is entitled to practice in one jurisdiction cannot work in another without applying to and being granted a license by the local regulatory body. Educational, legal and practice requirements are similar, so mobility is possible; however, the nurse still has to fulfill requirements, such as writing exams and paying fees, in each location they wish to practice. This is akin to all other regulated professions where the provincial government holds exclusive jurisdiction.

Practical nurse compensation

The average hourly practical nursing salary at the entry level is CA$24.00 an hour. The highest practical nursing salary at the experienced level is CA$48.00. However, some practical nurses may make upwards of CA$40.00 an hour. Many nurses also receive overtime compensation for the long hours and understaffing of many institutions.

Alberta

Licensed Practical Nurses (LPNs) in Alberta are regulated by the College of Licensed Practical Nurses of Alberta (CLPNA), which oversees licensing, standards of practice, and continuing competency requirements. LPNs complete a two‑year diploma program at an approved college and must pass the Canadian Practical Nurse Registration Exam (CPNRE) before entering practice.

Scope of practice

Alberta LPNs provide care across diverse settings including acute care, seniors’ health, long‑term care, community health, primary care clinics, education, occupational health and safety, and public health. Their scope of practice includes assessing patients, planning and implementing care, administering medications, performing procedures, and delivering health education. Many LPNs also hold specialized skills in areas such as the operating room, oncology, and leadership roles.

History

The profession in Alberta has evolved significantly since its introduction in the mid‑20th century. The Alberta Certified Nursing Aides Association (ACNAA) was established in 1955, later becoming the Alberta Association of Registered Nursing Assistants (AARNA) in 1978. By 1985, the Professional Council of Registered Nursing Assistants (PCRNA) was formed, marking steps toward self‑regulation. In 2003, the CLPNA gained full regulatory authority, reshaping the profession into its current form.

Current Status

Today, Alberta’s LPNs are recognized as autonomous practitioners responsible for their own actions and practice, with a scope that is increasingly aligned with registered nursing in providing direct patient care.

Ontario

Ontario uses the designation Registered Practical Nurse to refer to a role known as Licensed Practical Nurse in the rest of Canada and elsewhere. This should not be confused with Registered Psychiatric Nurse, a title used in certain other Canadian jurisdictions.

All nurses in the province of Ontario are regulated by the College of Nurses of Ontario (CNO), to which they must apply for and maintain membership. "College" in this case is used similarly to the word "board"; they are not a school or training provider themselves. To apply for membership, an applicant must satisfy requirements including completion of an approved two year post secondary training program, evidence of recent practice as a nurse, pass both an entrance and jurisprudence examination, be proficient in either English or French, have legal authorization to be employed in Canada, disclosure of certain past or ongoing legal proceedings, disclosure of certain proceedings involving practice of nursing in other jurisdictions and disclosure of certain kinds of health conditions and disabilities.

In 2008, there were 27,432 RPNs registered as practicing with the CNO. By 2017, this has increased to 48,748.

By comparison to other classes of nursing in Ontario, there were 104,483 RNs and 3,083 NPs. 90.9% of the 2017 RPNs were female and the average age was 40.8 years. 89.9% attended a nursing school in Ontario; however, members who previously attended nursing schools outside Ontario which were not accepted as valid by the CNO at the time of their registration are not reflected in that number.

The CNO's definition for a nurse's scope of practice is: "The practice of nursing is the promotion of health and the assessment of, the provision of care for, and the treatment of health conditions by supportive, preventive, therapeutic, palliative, and rehabilitative means in order to attain or maintain optimal function".

The College of Nurses of Ontario (CNO) outlines 13 controlled acts, 4 of which can be performed by RPNs and RNs. The 4 Controlled Acts available to be performed by RNs and RPNs are:

• Performing a prescribed procedure below the dermis or mucous membrane
• Administering a substance by injection or inhalation
• Putting an instrument, hand, or finger:
  • Beyond the external ear canal
  • Beyond the point in the nasal passages where they normally narrow
  • Beyond the larynx
  • Beyond the opening of the urethra
  • Beyond the labia majora
  • Beyond the anal verge or
  • Into an artificial opening in the body
• Dispensing a drug

The College of Nurses of Ontario (CNO) has 4 principal roles in the regulation of Ontario nurses:

• Articulating and Promoting Practice Standards
• Establishing Requirements for Entry to Practice
• Administering a Quality Assurance Program
• Enforcing Standards of Practice and Conduct

The CNO has set 7 standards of practice for all nurses in Ontario:

• Accountability
• Continuing Competence
• Ethics
• Relationships (Therapeutic Nurse-Client Relationships and Professional Relationships)
• Knowledge
• Knowledge Application
• Leadership

Registered Nurses are expected to have a higher level of competency in the last three of these standards of practice than RPNs. In Alberta, LPN's have a greater scope of practice than most provinces. They can perform most tasks that an RN can do; however, the complexity of the patient's condition determines whether the LPN is in charge of care, or collaborating on care with an RN. In Ontario, RPNs are actively expanding their roles and scope of practice, modelling similarly to Alberta, with the exception that in Ontario, both RNs and RPNs are regulated by the same regulatory body. This model allows for both categories of nurses to be practising under the same guidelines and accountability models. In Canada, in home-care settings LPNs sometimes act as the liaison between the care provider and the local health authority, coordinating care.

United Kingdom

The state enrolled nursing qualification can no longer be gained in Britain. Prior to the implementation of Project 2000 which radically altered the face of nurse education in the mid-1990s, SEN students used to be trained within two years. Their course was a simplified version of the longer training offered to state registered nurses (SRNs, later to be renamed RGNs, registered general nurses and now known as level-one nurses). Some auxiliary nurses with many years of experience were selected to progress to enrollment as a SEN. People training to be SRNs who failed their exams at the third attempt were also able to enter the nursing register as a SEN. No new SENs are trained in the UK today. The Nursing and Midwifery Council (the regulatory body for nurses in the UK) used to allow people to be added to the register as level two nurses if they are moving from a similar position from within the European Union; however, this has now stopped. Level-two nurses from the EU wishing to gain entry to the Register in the UK must be willing to train as a first level (staff) nurse. This is by two different means: starting their training from scratch as a pre-registration student nurse, or by joining an existing cohort of student nurses starting their second year of training, and completing years 2 and 3 with them.

Formerly, there was a large segregation between the "green" SENs and "blue" SRNs, which were the colours of uniform typically worn. SENs were very much complementary to the nursing team; however, they did not have the status of SRNs and were ineligible to be promoted, e.g., to ward sister. Many SENs sat or re-sat the SRN exams; however, a large number did not and were quite content being SENs. Nowadays, the divide between level one and two nurses is diminishing owing to the small number of SENs still in practice. The demise of the SEN is lamented by many who saw it as a balanced way to staff a ward. However, the divide also meant that potentially the gap in clinical excellence could be too wide. In many areas, ENs and SENs are being replaced with lesser qualified healthcare assistants educated to S/NVQ Level 3 or 4, being awarded titles such as Senior Healthcare Assistant, Senior Auxiliary Nurse, Senior Clinical Support Worker, Care Team Leader or Senior Care Assistant.

Although originally viewed as a less qualified nurse, ENs and SENs are now able to hold the rank of Deputy Charge Nurse in the NHS and Deputy Home Manager in the private sector, as well as unit manager, both within the NHS and the private sector, and in some instances higher, technically out-ranking a staff nurse (first-level RN).

Auxiliary nurses draw blood samples, change bandages, and record ECGs. At present, they work under the direct supervision of a registered nurse.

Australia

The national Australian Health Practitioner Regulation Agency (AHPRA) issues permission to practise. Enrolled nurses (EN), or Division 2 nurses, in Australia must now complete the Diploma of Nursing and usually spend 18 months training, consisting of 36 weeks theoretical component at TAFE colleges, some universities or private institutions, followed by practical experience in hospital wards for the remainder of the time. The majority of ENs eventually move on to attend university and become registered nurses, although a substantial number remain as ENs in public and private hospitals, and nursing homes. Trainee enrolled nurses (TENs) become employees of the hospital for the twelve-month training period, meaning that, as well as gaining practical experience on the wards, they are paid for hours worked. This attracts a substantial number of applicants, who may wish to pursue nursing as a career, but are unable to afford to become full-time university students. As of 2009, however, the government has stopped working with the NSW Department of Health, and those wishing to become enrolled nurses are not being paid. The enrolled nurse programme also allows people to ascertain whether or not they are suited to nursing before they make the decision to study it at university level.

The role of enrolled nurses in Australia has greatly increased in recent years in response to the continuing shortage of registered nurses in the Australian public health care system. In 2004, a medication endorsement certificate was introduced, allowing ENs to administer some oral medication (excluding schedule 8 drugs of addiction) upon completion, although medication endorsement is now included in the diploma. Endorsement also permits the administration of some intravenous (IV) medications and fluids (intravenous therapy or IVT), as well as intramuscular (IM) and subcutaneous (SC) injections. Enrolled nurses (ENs) are also permitted to check and give Schedule 4 and Schedule 8 medications with a registered nurse. Most enrolled nurses working in public hospitals are permitted to conduct ECGs, collect pathology specimens, and routinely take a patient load under the direct supervision of a registered nurse.

Despite the fact that the role of the EN in Australia has been greatly expanded in recent years, opportunities for career progression remain somewhat limited, and for this reason, many choose to go on and study to become registered nurses. In terms of financial remuneration, the earning capacity of an enrolled nurse is capped at five years of service, whereas registered nurses continue to eight years before salary capping is applied.