B.C. nurses are concerned a recent round of layoffs at Inglewood Care Centre will result in a lesser level of care for residents at the West Vancouver facility.
Kath-Ann Terrett, chairwoman of the Coastal Mountain region of the B.C. Nurses Union, said the union was informed that 11 registered nurses have been let go from Inglewood and will be replaced with licensed practical nurses, though she said she did not know how many LPNs will be joining the staff.
"We really are concerned about the care that we provide our patients, so this was very unsettling for all of us," she said.
The move to replace RNs with LPNs is nothing new in B.C. residential care facilities, Terrett added.
"It's the de-skilling of long-term care, and it's very distressing," she said, noting that several other residential care homes on the North Shore already use what is known as a "skill mix" or "collaborative practice" staffing model.
Both RNs and LPNs are governed by the Health Professions Act. The main difference is the depth of their education and the procedures they are allowed to deliver to patients. RNs require a bachelor's degree, while LPNs go through a shorter training program.
"There's been a real move to up-skill the licensed practical nurses," Terrett said, explaining LPN training has become more comprehensive in recent the years. "They've got an increase in their ability to do skills, but they haven't got the theory."
There is also a salary difference. Terrett said the starting hourly wage is around $20 for LPNs and $30 for RNs.
She believes care home staffing changes are fuelled by the bottom line.
"We all know it's about the money, otherwise they wouldn't do it," she said. "It doesn't make sense care-wise or ethically."
While she said there is nothing wrong with the care provided by LPNs, they don't have the educational background to deal with the complex needs of some residential care patients.
"If anyone is critically ill or has fluctuating health needs, (LPNs) don't have the expertise or the understanding of how to deal with that. That's what (registered) nurses do."
Care facilities that staff few or no RNs tend to send more patients to the emergency room than those facilities that do staff RNs, Terrett said.
Representatives from Inglewood have not returned phone calls from the North Shore News.
Vancouver Coastal Health does not operate Inglewood, but it does operate three North Shore residential care facilities. A spokeswoman for the health authority said Cedarview Lodge and Kiwanis Care Centre have long used a mixed-staff model, but Evergreen House just switched to collaborative practice a year ago.
"It matches staff to the residents' needs so that you're providing the right care," said Anna Marie D'Angelo, senior media relations officer at VCH. "It also allows the professional health-care staff to use the full scope of their training."
Seven full-time equivalent RNs were let go from Evergreen and replaced with seven LPNs, three care aides, a full-time recreational therapist and a part-time dietitian.
D'Angelo said there was no job loss, because the displaced RNs found other work within the health authority.
She said the North Vancouver facility moved to collaborative care after the health authority conducted a residents' needs assessment, in consultation with the BCNU, Hospital Employees' Union and Heath Sciences Association.
LPNs have skills well-suited to facilities such as Evergreen, D'Angelo added.
"They work well in residential care because their practice is really concentrated on chronic, stable residents."
Any cost savings incurred from the staffing change at Evergreen would stay within the residential care budget, she added.