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

Legislation

The battle for the regulation of the nursing profession in British Columbia has been fought on two fronts: regulation and legislation. From the beginning, regulation was seen as the only way to protect the public by ensuring that nurses registered with the regulatory body of the time were qualified to practise their chosen profession. Legislation was required to enshrine regulation into provincial law.

From 1918 to 1988, legislation was in place that prohibited anyone from using the title “registered nurse” unless that person was registered with RNABC. However, there was nothing stopping a person who was not registered from practising as a nurse in B.C. That finally changed when the provincial government approved RNABC’s proposed changes to the Nurses (Registered) Act to make registration with the appropriate regulatory body mandatory for all B.C. nurses.

Other changes to the Act required that nurses wishing to renew practicing membership would have to meet requirements designed to give reasonable assurance of their ability to competently practise nursing. Until then, nurses were only required to meet RNABC standards when they first registered.

In 1992, as the Royal Commission on Health Care and Costs (Seaton Commission) was winding down, and in anticipation of New Directions for a Healthy British Columbia issued by the government the following year, RNABC adopted a regulatory framework of promoting good practice, preventing poor practice and intervening when practice is unacceptable. This was done, in part, to provide a guide for the Association for the changes anticipated in professional regulation.

At the 1993 annual meeting, delegates voted to accept an amendment to the Association’s bylaws to permit one-third public representation on a restructured 24-person RNABC board of directors. Coincidentally the B.C. government had adopted a plan for health care reform that included greater public participation in regulatory boards. These public representatives were subsequently appointed by the minister of health and joined the RNABC Board of Directors in the fall.

In another demonstration of public accountability, the government introduced the Criminal Records Review Act in 1996. Designed originally to help protect children from individuals whose criminal record indicates they pose a risk of physical or sexual abuse, the Act was expanded in 2009 to help protect vulnerable adults from physical, sexual or financial abuse. CRNBC is one of many provincial regulatory bodies that require criminal record checks as a condition of registration.

In 1999, RNABC presented a joint submission with the B.C. Nurses Union to the Health Professions Council on the scope of practice for registered nursing in British Columbia. This too was in response to the Seaton Commission, which said that existing legislation governing health professions created “persistent jurisdictional disputes and a distinct lack of cooperation among the health professions” primarily because of its reliance on exclusive scopes of practice.

The Seaton Commission concluded that exclusive scopes of practice should be “narrowed to focus on preventing harm . . . (to provide) . . . more appropriate, cost-effective and timely health care to more patients.”

The RNABC/BCNU joint submission included a proposed scope of practice definition that clarified that the purpose of services provided by registered nurses is to promote, maintain and restore health, provide palliation, and prevent illness and injury as well as a proposal that registered nurses be granted several reserved acts.

In March 2000, the Health Professions Council released Safe Choices: A New Model for Regulating Health Professions in British Columbia, which included recommendations arising from the legislative and scope of practice reviews of a number of B.C. health professions, including registered nurses. Among the proposed changes was the regulation of registered nurses who achieved competencies required for registration as a nurse practitioner.

On October 23, 2003, the Health Professions Amendment Act was passed in the British Columbia legislature creating a common regulatory framework for the governance of all health professions in the province. Once enacted for registered nurses, it repealed the Nurses (Registered) Act, bringing registered nurses under the Health Professions Act. A significant achievement was that the essence of profession-led regulation – having responsibility for establishing the standards for registered nursing practice and codes of ethics – was not subject to government approval.

On August 19, 2005, the Registered Nurses Association of British Columbia was dissolved and the College of Registered Nurses of British Columbia was established. The College was empowered, under the Health Professions Act, to regulate the practice of registered nurses, licensed graduate nurses, nurse practitioners and student nurses.

Through all the changes in the last decade, the most important aspects of profession-led regulation remain the same. CRNBC’s mandate continues to be the protection of the public through regulation.

A new governance structure that came into effect in 2010 has resulted in a smaller Board, with nine elected registrants and five government-appointed members. All registrant board members are elected at large to a three-year term of office.

Restricted activities have been introduced for clinical activities that may present a significant risk of harm and therefore reserved for specified professionals only, such as diagnosing and managing labour. In addition, there are now College-certified practices, which are restricted activities that can only be carried out by registered nurses certified by CRNBC. Categories of certified practice include remote nursing, contraceptive management, sexually transmitted infections and RN First Call.

Unlike its predecessor RNABC, CRNBC does not have a dual role as a professional association and a regulatory body. With its establishment in 2005, CRNBC transitioned from an association to a regulatory college.

As history shows, changes in nursing and the regulation of nurses are more the norm than the exception.

The context of professional nursing has changed dramatically in B.C. over the last 100 years. Nurses are no longer the handmaidens of doctors, nor can they be treated and ordered about as domestics or servants. Nurses today have much more responsibility and are active participants in the development and delivery of health care services. They bring a strong nursing perspective to today’s multidisciplinary approach to health care.

Recognizing that changes in regulation as well as in health care and its delivery will continue to occur, CRNBC continues to take a leading role in protecting the public by effectively regulating registered nurses and nurse practitioners. For example, CRNBC will soon add Multisource Feedback to its Quality Assurance Program. Similar to the onsite peer review process for nurse practitioners, multisource feedback will enable registrants to assess professional performance. It is just another way CRNBC supports nurses’ professional growth so they can achieve high practice standards.

Today we live in an era where regulation is evolving perhaps faster than it has in any other time. In recognition of the need for a greater pan-Canadian focus and voice in nursing regulation, CRNBC became one of the founding members of the Canadian Council of Registered Nurse Regulators.

Advances in technology now enable the College to conduct much of its work online, including registration renewal and a comprehensive website housing a breadth of required information for registrants, supports for ongoing learning and development, and useful information for the public and employers.

As we acknowledge the centennial anniversary of the first gathering of nurses committed to legitimizing the nursing profession by achieving a registration act and setting standards to protect the public, today we take pride in being a leader in Canadian nursing regulation. We look forward to the opportunities and challenges ahead as we work to fulfill our public protection mandate.