celebrating the evolution of nursing regulation in british columbia 100 Years of Nursing Regulation 1912 - 2012

Advocacy

Although we tend to think of social awareness and advocacy as something that grew out of the 1960s, nurses have been speaking out on health care issues since the turn of the 20th century. Nurses began advocating for their profession when they worked towards securing a registration act from the provincial government, and they were advocates for their patients when, in 1918, the Graduate Nurses Association of B.C. appealed to government to provide care for “mentally defective and delinquent children” and “aged men and women.”

A more formalized role in B.C.’s health care system came in the 1970s, when RNABC began lobbying for and was finally included in a number of provincial health care planning committees. In 1978, then RNABC president Stephany Grassett challenged nurses to enter the political arena to alter the future of nursing and improve the health care system. Nurses began actively lobbying the federal government to improve the proposed Canada Health Act.

In 1978, RNABC was embroiled in a dispute at Vancouver General Hospital (VGH) when the administration refused to allow the director of nursing access to policy-making on a level comparable to other major Canadian hospitals. The issue was really about how much control nursing should have over its practice, and the outcome was seen as precedent-setting. At the height of the dispute, 800 VGH nurses signed a petition calling for change. Major health and service organizations joined RNABC in supporting the nurses and news media focused attention on the problem. In the end, the health minister stepped in and replaced VGH trustees with a public administrator, changed the hospital’s corporate structure and accepted virtually all requests made by RNABC.

RNABC’s talent for advocacy reached a new level when provincial hospital budgets were slashed in 1979. Within weeks, nursing staff shortages reached the critical stage – a situation that was dangerous for patients – and nurses began to protest to their hospitals and the public. In 1981, RNABC prepared and published a report entitled, Nurses: Are We at the Breaking Point? It concluded that it was time B.C. nurses “threw off the ‘slow, cautious and non-assertive approaches’ that were part of their heritage.”

During the 1980s, RNABC had achieved an increased profile for nursing in B.C., with stepped up political advocacy, public awareness campaigns and representation on numerous committees ranging from education institutions to provincial government advisory committees.

In 1989, RNABC developed the initiative, New Directions for Health Care, which articulated the Association’s perspective on the future of the health care system. It espoused “registered nurses influencing changes in the health care system instead of merely reacting to them.” The plan was based on shifts in nursing and the Canadian health care system, and the belief that “Nursing is moving away from a tradition of trained servitude to expert caring, and nurses themselves are ready for substantive changes in the environments and ways in which they practise.” It promoted good practice and the effective use of nurses through activities that facilitate the application of primary health care principles in nursing practice and education. The impact of RNABC’s work was evident in the many aspects of the B.C. government’s policy for health care reform, New Directions for a Healthy British Columbia, introduced in early 1993.

To show what nurses can do when they are allowed to practise to the full scope of their profession, RNABC established the Comox Valley Nursing Centre Demonstration Project, with a grant from the B.C. government. It was the first nursing centre of its kind in Canada, providing an alternative system of care delivery incorporating the principles of primary health care that allowed nurses to act as an entry point to the existing health care system. Following completion of the two-year project in 1996, the nursing centre changed locations and portfolios several times, and today functions within the Vancouver Island Health Authority.

Throughout the 1990s, RNABC continued to speak out and develop position statements on issues of concern to nurses and their patients.

As a regulatory body under the Health Professions Act, the College of Registered Nurses of B.C. has moved away from political advocacy, as have regulatory colleges throughout the province. Advocating on behalf of the profession is seen to be in conflict with CRNBC’s mandate and its responsibility for regulating nurses in the public’s interest.