June 10, 2011 — Let me say once again how very pleased I am to welcome you to the 2011 Annual General Meeting — the sixth AGM for the College. Now, it is my privilege to present the Report from the Board.
Next year, 2012, will be our centennial year, and so this is the 99th such gathering for the groups and organizations that evolved into today’s College of Registered Nurses of British Columbia.
We’ve come a very long way since 1912. I appreciate all whose commitment and wisdom started us on our path. I am even more grateful to those who work so hard in this current stage of our evolution.
We have changed a great deal in the short time since becoming a College. Today, we have a more complete understanding of who we are and who we must be.
We are definitive about our responsibilities and scope as a regulator. It is apparent what falls within our mandate. And, it is now apparent where — and why — others must take responsibility for matters that fall outside our mandate, matters that are important to promoting and advancing the profession of nursing.
Nowhere has the separation between regulatory matters and association-related work been more emotional than with our decisions about the College’s membership in the Canadian Nurses Association.
The Board is acutely aware that these decisions have caused anxiety and even distress for some of our registrants, and for CNA, itself.
Although we don’t know the extent to which registrant concern is felt, I want to assure you that we are continuing to negotiate with CNA. In fact, I was on the phone with CNA this morning at 0700. Both the College and CNA are committed to finding a consensual means of allowing the College to withdraw while at the same time finding a way to allow B.C.’s nurses to remain affiliated with CNA, such that all the services that you currently receive through your membership in CNA will be continued.
It is important to know that we have not issued the required one-year formal notice of our withdrawal from CNA. Negotiations are on-going. What we have issued is our “intention” to withdraw our membership.
These negotiations are complex and continue to take a considerable amount of time. Notice may not be necessary depending on the solution we arrive at.
Let me assure you that we remain committed to keeping all registrants informed of our progress, when there is information to share.
In 2010, the College became a founding member of a newly formed organization, the Canadian Council of Registered Nurse Regulators.
This organization has as its members every registered nurse regulatory body, in Canada, and is committed to working collectively on important matters to advance best practices in the regulation of registered nurses.
Over time, the Council will undoubtedly strengthen relations with similar councils such as the Canadian Council for Practical Nurse Regulators and the Federation of Medical Regulatory Authorities of Canada.
Another change is how we have become even more attentive and responsive to our overriding reasons for our existence — our responsibility to the public.
For nearly a century, now, this has been an indisputable component of our purpose. But the context today is very different — regulation, and more significantly self-regulation — is under political and social microscopes around the world.
What is happening to the health professions’ ability to self-regulate, in other places in the world, keeps us vigilant and serves as a benchmark for Canadians.
In the U.K., for example, the General Medical Council came under scrutiny when it was judged to have failed to react aggressively to situations that arose from physician-caused harm.
It was found that the Council’s lack of action resulted from greater emphasis being placed on physicians’ interests, rather than the public interest.
Not surprisingly, there was little public outcry when the government limited the power of self-regulation — not just for physicians, but for all self-regulating health professions in the U.K.
Changes introduced in New Zealand focus on, among other things, the public complaint process where now the Minister of Health is responsible for a single shared disciplinary body for all professions.
There, the Health Practitioners Disciplinary Tribunal hears and determines the outcomes of the most serious cases against health practitioners. These changes resulted from events that pointed to there being conflicting loyalties between professional self-regulation and the protection of the public.
Although these changes are no doubt justified, I raise them because they show heightened government sensitivity to how, at least in some countries, health professionals self regulate.
In B.C, in Canada, and in North America, we are not only a part of the global complexion; we are also affected by the situations, issues, and decisions of others.
In Canada, we have had a somewhat stable regulatory framework and have had so for some time. Four provinces have brought all or most of their self-regulating health professions under common legislation.
In Quebec, this common legislation embraces ALL self-regulating professions — a full 51 professions.
The Quebec government opted for a system that accords broad powers and decision-making autonomy to the professions, while subjecting them to a form of monitoring.
All of these are examples of “umbrella” legislation that means:
What can registrants do to participate in and help preserve self-regulation?
There are several ways, but I suggest these five things as fundamental. As nurses, we must:
What can the public do? That’s actually a bit easier to answer.
The public can expect to receive competent and ethical care from their health professionals, including registered nurses. And if they don’t receive it from their nurses, they need to talk to the nurse, the employer, or to us, the College.
I don’t mean to diminish how difficult and challenging it is to express a concern or complaint. But without the public’s involvement, none of us can do our job in ensuring that our standards are met.
Legislation makes us, as a regulator, strongly accountable to the public. The future of self-regulation depends on how it demonstrates its benefits to British Columbians.
The Board looks forward with great interest to the work we have just begun, to establish a regulatory philosophy and framework. As you may be aware, regulation can run a full continuum — from ‘pure regulation’ meaning the regulatory body registers and disciplines — all the way to a broader, more encompassing approach where any of a number of supports can be put in place to support registrants in their competent and ethical practice. And then, of course, there are all the areas in between.
This work to ‘land’ on a regulatory framework will include identifying research related to best practices, as well as hosting a variety of focus groups with our various stakeholders. The resulting philosophy and framework will provide us with important guidance for our decisions.
I’d like to pose some questions that can be pondered when thinking about the ways the College does its work and the direction we could take in the future which I imagine will be addressed in this work.
So, I ask —
Establishing a philosophical stance on these and other approaches comes with budgetary implications.
This year’s budget reflected the cost of several requirements we had to meet, and was reflected in the Board’s review and approval of the 2011 operational budget. For registrants, these costs became even more evident when they were informed of the changes in registration fees for this year.
The Finance and Audit Committee and the Board deliberated at length before concluding that these fee changes were necessary. The decision was not an easy one for the Board to make.
To fulfill its obligation to protect the public, the College carries out foundational work related to registration and renewal, standards of practice, supporting registrants to meet standards, and governance. Significant costs drove up the budget for 2011.
I would like to point out that these costs are not exclusive to our College. When I talk with colleagues from other health regulatory organizations, I hear similar comments about budgetary pressures.
Some of the budget contributors that we faced include:
In addition, the College now needs to review and update decision support tools for certified practice. There are currently almost 1,000 registrants on the Certified Practice register in the categories of RN First Call, Reproductive Health, and Remote Nursing.
The activities I have mentioned are not ‘instead of,’ but rather ‘in addition to’ what the College delivers within the foundational work.
Since the College was established in 2005, our fees remained constant for three years until 2008, when a $10 change was implemented. In 2010, a $20 change was implemented; and, of course, we had a $53 change this year. Over the last six years, our fees have changed, on average, $13.83 per year.
This year, the change was compounded by the requirement to implement the HST.
The Board recognizes that a portion of our registrants were not happy with this year’s fee change. The Board did, however, recognize it was necessary. And, although the following may not make the reality more palatable, the College’s fees fall close to or below the fees of comparable nursing regulatory bodies in Canada. The same is true of a comparison of the fees of the health regulatory bodies of B.C., where legislated requirements are the same for all the colleges.
Other important changes that occurred this year were those made to our governance structure. A full review of best practices supported the Board’s decisions relating to our governance. These decisions affected, amongst other things, the size of the Board and at-large elections for registrant positions on the Board.
Of all of the governance changes that were made, one that is particularly relevant to me is the Board’s election of its chair. I’d like to thank the Board for the privilege of acting in this capacity and for their support. I am very proud to say that the Board is committed to ensuring that the College responds effectively and correctly to the issues at hand and does not shy away from making tough decisions.
I would also like to acknowledge the staff of the College. I have had the opportunity of working with many organizations, but I have never worked with one where there has been so much loyalty and support for the Board.
This applies to all the staff, from the people in reception, to those who ensure that we are housed and fed, and importantly, to those who develop the excellent reports upon which we make our decisions. They make the work of the Board that much easier.
I’d like to close with a statement of confidence that the College is well positioned to meet the public’s expectation that they will receive competent and ethical nursing care — that we will not shy away from addressing problems when they are identified.
There is no doubt that the College has responded to government’s concerns in such a way that we will continue to be granted the privilege of formulating and ensuring compliance with our standards, which have been designed to ensure proper professional nursing practice.
And for that confidence, I thank the Board, the staff, and you. Thank you.