Patients will be hurt if Ford government erases safeguards

June 27, 2019

Ontarians who have endured a decade of eroding health care will face even graver threats if their government erases rules that protect the safety of patients.

Until now, when nurses were called to make critical decisions about patients at medical risk because of the complexity of their ailments and the possibility of sudden decline, only highly educated and skilled nurses could do so – that was the domain of registered nurses (RNs) with four years of education and a track record of knowledge, skill and judgment.

However, that fundamental protection for patients will be lost if the government follows through with its plan to allow those critical judgments to be made by less-educated, less-skilled registered practical nurses (RPNs), with only two years of education.

Life and limb are at stake. Think of a patient with diabetes whose foot ulcer is getting worse. If the government removes this critical safeguard, a less educated nurse might assess and treat the wound but not understand that the change reveals something more ominous – the worsening of diabetes that can lead to an amputation.

"Each nurse plays a role in our complex health system but that role must fit the needs of each patient," says Dr. Angela Cooper-Brathwaite, president of the Registered Nurses' Association of Ontario (RNAO). "The College of Nurses of Ontario (CNO) regulates all nurses to protect the safety of the public, and to achieve that goal, CNO limits care by RPNs to patients with stable conditions and predictable outcomes. Since RNs receive four years of education, CNO has deemed that RNs can best care for patients whose condition can deteriorate, including patients with unstable or unpredictable outcomes. Why is government pushing the regulatory body to loosen the safety rules?" asks Cooper-Brathwaite.

The Ford government has pledged to transform health care in ways that serve patients. RNAO supports those efforts. But such a cause is ill-served by a policy that would accelerate a frightening trend on the frontlines of care that was driven home today in a report by the Canadian Institute for Health Information:

  • Ten years ago, Ontarians in need of health services were cared for by a nursing force largely made up of RNs, who receive four years of education.
  • In 2009, there were three RNs in Ontario for every RPN, the latter receiving only two years of education.
  • Last year, there were only two Ontario RNs for each RPN, the lowest share in Canada.

"Patients should be assigned health providers based on patient needs and clinical considerations and not on budgetary pressures," says Dr. Doris Grinspun, RNAO's Chief Executive Officer. "It's bad enough that care for patients has eroded so much over the past decade, when funding for hospitals didn't keep pace with demand – creating fiscal pressure for hospitals to replace better educated and trained RNs with less educated and trained health workers. But that steady decline will steepen dramatically if the Ford government pushes through changes that overnight would erase differences in the scope of practice between RNs and RPNs that were designed to protect patients," Grinspun adds.

While some argue that de-skilling the health care workforce will save money, the opposite is true, according to evidence by world-renowned researchers such as Dr. Linda Aiken. When hospitals use more RNs, costs are reduced because patients suffer fewer complications and re-admissions. Evidence also shows that a higher RN workforce results in lower mortality rates. In short, it pays to use health providers with the appropriate educational attainment and clinical competency.

The Ontario government purports to follow evidence-based health policy that promotes the well-being of Ontarians. This is an opportunity for the government to follow its own advice.   

RNAO is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses' contribution to shaping the health- care system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit or follow us on Facebook and Twitter.