The Registered Nurse - One of the Three Types of Nursing in Canada

There are three types of nursing if you are considering nursing as a career in Canada:

Licensed Practical Nurse, LPN
Registered Nurse, RN
Registered Psychiatric Nurse, RPN 

In Canada all nursing professions are regulated in the public interest and you must pass a licensing exam to become registered in order to practice nursing as a career.

Nursing education for each of these types of nursing has common curricular components and some specialty components. However, the length of nursing education varies and each category has a defined scope of practice.

Licensed Practical Nurse

The Licensed Practical Nurse has 1-2 years of education in a community college or private post-secondary training institute.  They have a limited nursing scope of practice that is completely contained within the scope of practice of a registered nurse and cannot work with clients who are complex or require multiple interventions.

In Ontario and some other provinces they are called a Registered Practical Nurse and this is abbreviated as RPN. This can be confusing because a registered psychiatric nurse is also abbreviated as RPN in the western provinces. In many provinces LPN's were not fully utilized for many years and the numbers of nurses practicing as a licensed practical nurse declined dramatically. Because of the pressures exerted by fiscal restraint and by the nursing shortage which is quite acute, the licensed practical nurse is now in demand again in provinces where they can legally practice.

Registered Psychiatric Nursing

Schools that prepare nurses to enter psychiatric nursing are limited to the four western provinces of British Columbia, Alberta, Saskatchewan, and Manitoba. There are over 5,000 Registered Psychiatric Nurses registered with the 4 regulatory authorities in these provinces.

Registered Psychiatric Nursing is not recognized as a separate type of nursing in the eastern provinces so that might be why they call practical nurses RPN's (Registered Practical Nurses). This term cannot be used in the western provinces because it already used for psychiatric nurses.

The association of Registered Psychiatric Nurses of Canada recommends that the minimum requirement for initial registrants for entry to practice into the profession of psychiatric nursing should be a baccalaureate degree by the year 2012.

On the Registered Psychiatric Nurses Association of Canada website there are 7 education programs listed for psychiatric nursing in all of Canada. There is no legally recognized classification of Psychiatric Technician in Canada. You may see this as a one of the different types of nursing in other countries such as the United States but it is not a recognized type of nursing in Canada.

Registered Nursing

Of the three types of nursing, registered nursing (the RN) is the most common type.  It is typically the registered nurse that people think of when they think of the nursing profession. Registered nursing has the broadest nursing scope of practice.  

There are no hospital based schools of nursing in Canada.   A university education is required. Some colleges have partnered with universities and students can enter a nursing program where the first two years are offered in the college setting and then complete the nursing degree at the university. 

Most provinces have registered nurse education programs that are 4 years in length ( 8-9 semesters) but some provinces are now implementing a three year program (9 semesters) as an accelerated program in order to bring more nurses into the Canadian health care system more quickly.

One province in Canada (British Columbia) is responding to increased pressures on the Canadian health care system by broadening the scope of practice of the registered nurse to include some tasks that were previously out of scope.

When these new regulations are put in place, under certain circumstances the registered nurse will be able to provide a broader range of services than that provided by the current regulations including:

ordering ultrasound or X-ray  diagnostics (in triage situations)
conducting tuberculosis screening
managing labor in hospital  when the primary  care provider is absent

These changes recognize the current education and skills of the registered nurse.  However, the changes are specific to British Columbia as the nursing profession in Canada  is regulated provincially.  It is quite possible and quite likely however, that other provinces will follow suit.

Beverly Hansen OMalley is a health promotion specialist and likes to write about health related topics that help people in their daily lives. She is the the owner of http://www.registered-nurse-canada.com where she explores the uniqueness of the nursing profession in Canada including comparison of the nursing entrance tests for the US and Canada, comparison of registered nurse salaries across the country and what it means to have a nursing license.

Nursing Careers - Three Types of Nursing Jobs in Canada For Advanced Nursing Practice

Nursing careers offer many opportunities for employment in nursing. Nursing careers are some of the most challenging and rewarding careers in health care.  Typically when one thinks of nursing as a career there is a mental image of working at the bedside of a hospitalized patient.  However, advanced practice nursing provides interesting and challenging work for nurses who want to add to their basic education. Such nursing practice does not necessarily occur at the bedside.

Three different types of nursing that are considered advanced practice nursing jobs in Canada are the clinical nurse specialist, the nurse practitioner and the occupational health nurse.  Each of these career specialities could occur in a variety of settings such as a hospital, a community, or even in industry.

Clinical Nurse Specialist

The role of the clinical nurse specialist can vary greatly depending on the needs of the community and the employer.  The clinical nurse specialist may be directly involved with patients and families and often provides leadership to the nursing staff in a hospital or a community setting.

 A clinical nurse specialist is a registered nurse with a master's degree who is specialized in a particular aspect of nursing  with a specialized client group such as pediatrics or gerontology.  The clinical nurse specialist may also be specialized within a particular clinical area such as oncology,cardiology, or critical care. 

The role of a clinical nurse specialist falls within the legally defined scope of nursing practice for a registered nurse.

Occupational Health Nurse

The occupational health nurse (OHN) works in settings not typically associated with the nursing profession. Uniforms, nursing caps. and shoes have been traded for overalls, steel toe boots, and a hard hat.  Patients are not in hospital beds but are able bodied workers in factories, paper mills, and chemical plants.

According to the Canadian Association of Occupational HealthNurses the scope of nursing practice for an Occupational Health Nurse includes:

"...managing and administering an occupational health service within legal and professional parameters; conducting health examinations; assessing the work environment; providing primary, secondary, and tertiary prevention strategies; providing health education programs; providing health promotion programs; providing counseling interventions and programs; managing the information system; conducting health surveillance programs; monitoring injury/illness trends; as well as program planning, policy development, and cost-containment strategies."

The main focus of the occupational health nurse is promoting and maintaining the health of workers in their work environment.  Nursing practice in this specialty requires a strong knowledge base of :

case management
counselling and crisis intervention
health promotion and risk reduction
legal and regulatory requirements for worker safety
occupational hazard detection and reduction including ergonomic risks

 The occupational health nurse works within the same nursing scope of practice as the bedside nurse or the clinical nurse specialist and is responsible for maintaining the same practice standards as any other nurse registered with the regulatory nursing organization.

 Nurse Practitioner

The nurse practitioner has been a legally defined part of nursing practice in the United states for many years but it is one of the newer  types of nursing jobs in Canada.  The nurse practitioner is still not a legally defined type of nursing in all provinces.   British Columbia is one of the provinces that most recently made the move to include the category of nurse practitioner as one of the types of nursing regulated by the College of Registered Nurses of British Columbia.

Because a nurse practitioner practices in an advanced role as a registered nurse, an advanced education is necessary.  Typically this requires a university degree plus two additional years of nurse practitioner education resulting in a educational qualification equivalent to a master's degree.

Specific competencies for the nurse practitioner must be in place.  Within a legally defined scope of practice a nurse practitioner can engage in activities that may be outside the legal scope of practice of a registered nurse or even a clinical nurse specialist. Such activities include prescribing certain medications and treatments for specified medical problems and ordering diagnostic tests.

The clinical nurse specialist, nurse practitioner, and occupational health nurse are three different types of nursing careers in Canada.  The clinical nurse specialist and the occupational health nurse practice within  the same nursing scope of practice but the nurse practitioner practices outside of this scope of practice and therefore legislation must be in place that defines and regulates this type of nursing practice.  Not all provinces have this in place so the nurse practitioner is not a legally defined type of nursing career in all provinces in Canada.

All nursing jobs in Canada provide for challenge, but these three types of nursing careers have diversity and challenge that goes beyond that typically associated with the bedside nurse in a hospital setting.  However, all these three types of nursing careers are regulated in the public interest and nursing practice in each specialty must adhere to the nursing practice standards set by the regulatory organizations.

Beverly Hansen OMalley is a registered nurse who is passionate about the nursing profession in Canada. http://www.registered-nurse-canada.com explores the uniqueness of the nursing profession in Canada including comparison of the nursing entrance tests for the US and Canada, comparison of registered nurse salaries across the country and how to become a nurse in Canada.