The following speech was presented by Laurel Brunke, CRNBC CEO/Registrar, at the RN Network's first annual meeting held May 19, 2010 at Vancouver General Hospital.
Thank you for the opportunity to be here tonight and speak to those gathered at the first general meeting of the RN Network of B.C.
In Canada, the self-regulation of nursing is just a century old. Over the course of those one hundred years we have seen many changes and we are here tonight because of one of those changes. Before I talk about where we are now and where we are going, I want to take us back a bit in history.
When the Graduate Nurses Association of B.C. successfully secured a registration act in 1918, the focuses of its efforts were on educational standards and working conditions for registered nurses. These same activities were the focus when RNABC came into being in 1935 with the passing of the Nurses (Registered) Act.
Over the years, RNABC was engaged in many activities with its prime focus being the regulation of registered nurses. In the mid-70s RNABC began work to more broadly influence B.C.’s health care system. Many of you may remember the ground-breaking work that RNABC did through the New Directions for Health Care Program and the Comox Valley Nursing Centre Project.
These and other initiatives were widely recognized as critical in positioning the primary health care agenda in BC and were made possible by the object under the RNABC constitution that permitted the Association “to uphold the integrity of the nursing profession and support its contributions to the health and welfare of the people of British Columbia.”
Time moves on and in the early 90s it became evident that the regulation of registered nursing would be brought under the Health Professions Act.
RNABC made significant efforts to achieve amendments to the Health Professions Act to provide for the College to continue its past involvement in health and social policy issues as it had under the Nurses (Registered) Act. These efforts were unfortunately not successful.
CRNBC’s primary duty under the HPA is to serve and protect the public. When we look at the differences in the objects under the Nurses (Registered) Act and the Health Professions Act, it becomes evident that government did not intend that the College “uphold the integrity of the nursing profession and support its contributions to the health and welfare of the people of British Columbia.” Some Canadian jurisdictions, such as Alberta, allow regulatory colleges to have a dual functions and it is evident in examining the history of regulatory bodies in B.C. that government does not intend them to have an advocacy role. The Health Professions Act removed the advocacy/association role from our work. Our work is regulatory which means registering, conducting inquiries, disciplining, setting standards and supporting registrants to meet standards.
Given this, CRNBC has been mindful of the obligation to act within the College’s legislated duty to protect the public through the regulation of registered nurses and nurse practitioners. To act outside of the College’s legislated mandate could jeopardize the continued ability of the profession to self-regulate.
Since becoming a College, we have carefully and thoughtfully explored the appropriateness of all the work we do to ensure alignment with the College’s mandate. It hasn’t been easy. It has meant that we have had to say no to getting engaged in important health policy issues, such as the provincial mental health plan and the integration of nurse practitioners. It also hasn’t been easy at the CNA Board table as our representative has been limited to providing input on the few matters that relate to regulation. The result has been the loss of the nursing’s voice on health and social policy issues in B.C. and the loss of B.C.’s voice on these issues at the national level through CNA.
Given that the mandate of the College is regulatory and that the mandate of the Canadian Nurses Association is primarily advocacy, it was decided, albeit not without much sober second thought, that we needed to examine the appropriateness of our relationship with CNA.
To do this we undertook a policy and legal review as well as a stakeholder consultation. The policy and legal review and analysis concluded that “the CNA function of ‘lobbying government’ creates a perceived, if not an actual, conflict for the College, given its public protection mandate under section 16 HPA.”
The stakeholder consultation identified strong and passionate views about the role of CRNBC and its relationship with CNA. The report stated that “many B.C. respondents noted the need for a provincial voice on professional nursing, ideally from a new organization that could play a focused role in this regard.”
The Board considered the report as well as possible options presented by CNA as to how the College could continue to be a jurisdictional member of CNA. As a member of the CNA governance task force that examined options for restructuring CNA, I had hoped a mechanism would be found so that CRNBC could remain a member of CNA. Our Board shared this hope. Our hopes were not realized and the Board made the very difficult decision to withdraw as a member of CNA. The silence in the Board room after this decision was made was profound. I have never heard the board room so quiet as board members reflected on the significance of the decision and the impact it would have for nurses in B.C. and Canada. It requires courage to be leaders and as difficult a decision as it was, it was the right decision for the Board to make. And it was right to take that decision when B.C. registered nurses now have the opportunity to consider how we can address the gap in policy decision-making that has been present since registered nurses have not been able to offer their perspective.
Today we are here to learn about the opportunity to close that gap through the creation of a new organization that will bring the voice of the profession of registered nursing on public policy issues in ways that CRNBC cannot. The CRNBC Board recognized that that this need exists and agree to provide one-time funding to the Network to help establish this organization The Board is pleased to have been able to do this and hopes that one result of this initiative will be that B.C. nurses will continue to be represented at the CNA board table.
As registered nurses in B.C., we have an opportunity we have not had for a very long time – the opportunity to create a strong and powerful voice for all nurses in B.C. that will help shape healthy public policy.
John Schaar said, “The future is not a result of choices among alternative paths offered by a present, but a place that is created – created first in the mind and will, created next in activity. The future is not some place we are going to, but one we are creating. The paths are not to be found, but made, and the activity of making them changes both the maker and the destination.”
On behalf of the College, I applaud the registered nurses who have taken the important first step of creating the RN Network of BC. Their leadership is inspiring and the College looks forward to the day when it will work collaboratively with this new organization on issues of mutual interest and concern.