Back to the future – from evolution to devolution and back again, by Heather Mass, RN

As a granddaughter, daughter and mother of registered nurses (RNs) who, with me, have lived the history of nursing in B.C., and as a registered nurse who was privileged to be involved in the “Association” work of RNABC through the 1990’s and who was involved in the creation of ARNBC, it feels appropriate for me to share my thoughts on the history of nursing in this province at this time. It is my sincere hope that B.C. nurses will urge BCNU to put aside the belief that “power shared is power lost” and instead recognize wisdom of once again having three arms.

Evolution

Beginning in 1909 when a small group of registered nurses formed the Graduate Nurses Association of Vancouver (GNAV) through to today, RNs in British Columbia have worked to create organizations that would support us and our profession. As these nurses achieved their goals, or as circumstances changed, the nursing organizations evolved – the GNAV evolved into the Graduate Nurses Association of BC (GNABC) which, in turn, evolved into the Registered Nurses Association of British Columbia (RNABC), which ultimately spawned the BC Nurses Union.

While each evolution occurred in response to changing circumstances, each “new” organization also continued to carry out three key functions:

1.  Regulation of the profession to protect the public (a regulatory function): members of the GVAV/GNABC/RNABC all lobbied for legislation that would require nurses to be registered and to ensure that people who call themselves “trained” nurses had the necessary competencies to provide safe care. Although the first step – the passing of the Registered Nurses Act was achieved in 1918 (in GNABC days), regulation did not become mandatory until 1988.

2.  Advocacy on behalf of the profession for improvements to health care and nursing practice (an “Association” function): from the beginning members of the GVAV/GNABC advocated on many issues related to health care and the profession, including championing improvements in nursing education to ensure nurses providing care were competent. As a result nursing education moved out of the patch work of “apprentice” programs that were common in the early 1900’s into institutions of higher learning which are the norm today. With the passage of new legislation – the Nurses (Registered) Act – in 1935 GNABC evolved into RNABC. While continuing the work of pursuing improvements in nursing education and working conditions, the RNABC’s Objects also permitted the Association to carry out initiatives designed to “Uphold the integrity of the nursing profession and support its contributions to the health and welfare of the people of British Columbia”.

3.  Acting in the interests of registered nurses (a labour relations function): the GVAV/GNABC/RNABC also worked hard to address issues of pay and working conditions for nurses. In 1976 a labour relations arm was created at RNABC to serve as a negotiator for better wages and working conditions for RNs.

Devolution

By the late 1970’s it was becoming clear that while all three of these functions were necessary pillars of support for professional nursing, there was also a growing perception that having one organization perform them all was a conflict of interest. Once again, changing circumstances led to changes in the Organization and – over the next 30 years – resulted in the devolution of what was one all-encompassing organization into three separate ones. This devolution occurred in three steps:

1.  As efforts to address issues related to pay and working conditions of registered nurses grew, so did the recognition of a potential conflict of interest for organizations that were mandated to regulate nurses in the public interest also negotiating on their behalf for improved pay and working conditions. In keeping with similar actions in other Canadian provinces, in 1981 RNABC supported the severing of its labour relations arm. To assist with the development of a separate organization that would take up this work for nurses, RNABC provided both funding (2.7 million/year) plus staff to support the creation of the BC Nurses Union. With this devolution RNABC focused its efforts on the remaining two functions: regulating and, where it did not conflict with regulatory functions, upholding the integrity of the profession and enhancing the health and welfare of the people nurses served.

In 2005, as part of a broad restructuring of regulation for health professionals, registered nurses came under the provisions of the Health Professions Act, and nurse practitioners were introduced in B.C. The Act mandated that regulatory organizations focus exclusively on protecting the public through professional regulation. With this changing circumstance, RNABC evolved to become the College of Registered Nurses of BC (CRNBC) and once again the potential for conflict of interest arose. Although perhaps not as obvious as the conflict between regulating the profession and bargaining on its behalf, as CRNBC restructured to focus exclusively on regulation it gradually began to sever “association” functions. Among other things, it no longer launched projects and initiatives designed to demonstrate and build further awareness of the full scope of the practice of registered nurses or the importance of integrating nursing knowledge into policy decision-making at the government level. Projects that RNABC had once mounted, such as the “New Directions for Health Care” papers that made RNs among the first providers to advocate for primary health care and describe the role of nurses in it, and the Comox Valley Nursing Centre Demonstration Project or the RN First Call program that demonstrated the importance of nursing’s role in promoting health and preventing disease were now determined to be in conflict with the College’s regulatory mandate. Although BCNU made efforts to fill the resulting gap by picking up some of the “association-type” functions, concerns about a conflict of interest between negotiating on behalf of nurses on issues of salary and working conditions and “Upholding the integrity of the nursing profession and its contributions to the health and welfare of the people of British Columbia” began to arise. So even though the “association functions” were devolved – there was no organization developed to pick them up.

2.  Withdrawing from CNA: The Canadian Nurses Association (CNA) is primarily an “Association of Associations”. CRNBC – with its mandate is to regulate the profession in the interests of the public – was now a regulatory college. Since it was no longer an “association” CRNBC Board served notice that its membership in CNA was inappropriate. Again, because there was no organized developed at the time CRNBC was established to take up the “association” arm of RNABC (and no transfer of funding and resources to support its work) there was no organization that could readily assume the role of representing B.C.’s RNs and NPs at CNA.

Evolution – Round 2

At the same time as RNs began to notice the withdrawal from CNA and the loss of a professional voice for registered nurses in British Columbia, nurse practitioners, the newest addition to the nursing family under the Health Professions Act, came together to form the BC Nurse Practitioner Association (BCNPA) which has a rich 10 year history of advocating for NP professional issues in B.C. and provided an answer to the very same concerns that RNs were facing with the introduction of the Health Professions Act.

For many nurses in B.C. the notice of withdrawal of CRNBC from CNA was a “wake up call”. For others who had watched this progressive loss of an Association it was the “final straw”.

Once again a group of registered nurses came together to create a Nursing Association that could pick up the third function: to advocate for improvements in health care for those we serve, and to ensure the involvement of RNs in the forums where decisions that will effect both the health care system and nurses role within it are made.  In 2009, out of this effort, “evolution – round 2” was begun. In 2010 ARNBC was born, and, like BCNU before it, negotiated the transfer of funding and resources from CRNBC that had once supported “association-type” work at RNABC.  The association now works closely with its three counterpart professional associations (ARPNBC, BCNPA and LPNABC) to work collaboratively on health and nursing policy issues.

Today RNs are once again supported by three separate but essential organizations – college, union and association. Ideally these organizations would, while each carrying out their unique mandate, collaborate and cooperate with each other to ensure that the vision of our colleagues in 1909 lives on. Sadly, it seems that this vision is at risk because of BCNU challenging ARNBC’s right to exist and to undermine its role with registered nurses, nurse practitioners and others. It seems that the Union believes that the new Association will somehow undermine its power.

If we can work together we will all be stronger!

ABOUT HEATHER MASS, RN

heathermHeather Mass is a nurse consultant. Prior to retiring she has held a variety of senior positions in nursing and health care administration, including the Chief Nursing Officer position for the British Columbia Children’s and Women’s Health Centre, and the Provincial Health Services Authority (PHSA). In the 1990’s she worked with the Registered Nurses Association of British Columbia as a Policy Consultant. During her time there she managed several innovative projects, including the Comox Valley Nursing Centre Demonstration Project and the RN First Call Project. She was a founding member of the group of nurses who initiated the development of the Association for Registered Nurses in British Columbia and continues to take an active interest in its success.

4 thoughts on “Back to the future – from evolution to devolution and back again, by Heather Mass, RN

  1. Cathryn Aune

    Thank you Heather for reminding us of the history of Nursing support in BC. While I was part of BCNU and working in hospital, I still found great value in the Practice Groups that were part of RNBC and really missed that connection when they were disbanded. I now work in a non-unionized area and do not get regular updates or feel particularly supported by BCNU. It is important to remember that the needs of nurses working in diverse areas and the people we serve can not be met by one organization. Life is complicated, nursing is complicated, but our relationships can always be respectful and collaborative if we choose to make them so.

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  2. ruth mcintosh

    Thank you for your excellent summary of why we are where we are. I was very active in the association activities of RNABC and was very distressed when the membership was severed from this involvement. I felt the disconnect really hurt the profession and depleted the involvement of the membership drastically. I was in a rural facility and often sought support from the association and the members I had connected with during my involvement with BCORNG, Rural nurses interest group, chapter presidents etc. We still had regulation but the bottom dropped out when it came to anything else. I am hopeful that the issues brought by BCNU can be resolved, and that the association can rebuild the network that nurses need to support each other and the profession along with the system we live and work in.

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  3. Anonymous

    I found this to be a very well written history of the RN pillars – with many similarities to other nursing groups – for example the history of the LPNABC being the originator leading to the formation of the College/regulator – CLPNBC.

    Very much appreciated the evolution of the organizations – 3 pillars of nursing.

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  4. Sally Thorne

    Thank you Heather for providing this very helpful perspective on our history and the evolution of the three organizational functions over time. Nursing cannot afford to compromise on any of these three functions, and your arguments explain why activities that could once have been managed by a single organization have had to evolve over time into two, and now three distinct organizational entities. Our profession needs all of these functions, and in an ideal world, the organizations mandated to champion each of them will all come together as a respectful and collaborative whole to optimize the work of our profession in serving the public of BC.

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