2019 ANNUAL REPORT | College of Licensed Practical Nurses of Alberta

2019

ANNUAL REPORT

competent committed care

OUR MANDATE

OUR VISION

To regulate and lead the profession in a manner that protects and serves the public through excellence in Practical Nursing.

Influencing a quality person-centred system through regulatory excellence.

OUR MISSION Licensed Practical Nurses (LPNs) are progressive nursing professionals who provide safe, competent and ethical person-centred care in collaboration with clients, families and other providers.

CONTENTS MESSAGE FROM THE COUNCIL PRESIDENT

2

MESSAGE FROM THE CHIEF EXECUTIVE OFFICER

3

OUR YEAR IN NUMBERS 4 GOVERNANCE 6 MESSAGE FROM THE PUBLIC MEMBERS

8

MESSAGE FROM THE ESAC CHAIR

9

CORE FUNCTIONS REGISTRATION 12 CONDUCT 18 COMPETENCE 22 SUPPORTING FUNCTIONS RESEARCH

26

POLICY 28 COMMUNICATION

30

ORGANIZATIONAL CULTURE 32 FINANCIAL HIGHLIGHTS

36

COMPETENT COMMITTED CARE •

1

Message from the

COUNCIL PRESIDENT

T

he College of Licensed Practical Nurses of Alberta (CLPNA) regulates the licensed practical nurse profession in a manner that protects and serves the public. The Council approves this annual report highlighting the activities of the CLPNA in 2019.

Through a policy governance framework, Council ensures ongoing realization of our organizational goal of regulatory excellence. The CLPNA and Council continue to host an annual Think Tank, inviting LPNs and stakeholders to examine trends, research and opportunities to enhance and influence the healthcare system in Alberta.

In December, our CEO Linda Stanger announced her retirement for early 2020. Linda brought many strengths to her role at the CLPNA, most notably, her integrity, determination, entrepreneurial style and absolute commitment to regulatory excellence and belief in the LPN. We appreciate Linda’s dedicated service. The Council’s search for her successor is underway.

I’m honoured to serve as President of the CLPNA, along with the dedicated LPNs and public members of the Council. Our goal is that every interaction with an LPN positively impacts the health journeys of Albertans, and I personally thank all 17,264 LPNs who strive to meet this goal every day.

Sincerely, Valerie Paice, President

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COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

Message from the

CHIEF EXECUTIVE OFFICER

T

he CLPNA sets and maintains standards for licensed practical nurses so Albertans receive safe, competent and ethical care. This report highlights the work of a committed team as we honoured our mandate in 2019.

A major milestone this year was receiving approval of amendments to the Health Professions Act (HPA) Licensed Practical Nurses Profession Regulation (2003) to be effective February 1, 2020. These amendments support LPNs to work to the full extent of their education and make a greater contribution to the healthcare team and the health of Albertans.

Another highlight was completing the first year of mandatory enrollment of health care aides (HCAs) on the Alberta HCA Directory. Supporting this initiative contributes to the health human resource planning efforts within the province and establishes a milestone for HCAs in Alberta.

in Alberta, Canada and internationally.

I retire early in 2020 and will leave the CLPNA with sincere gratitude for the opportunity to have served Albertans through my work with this great profession.

All that our Council, staff, volunteers and collaborators have achieved to advance regulatory excellence over 14 years is a great source of pride. Most importantly, the competent, committed care provided by Alberta’s LPNs every day is an inspiration.

I am optimistic for the future of self-regulation, and for the LPN profession.

With respect and appreciation, Linda L. Stanger

Also important has been an increased focus on the CLPNA’s regulatory mandate, including stakeholder focus groups regarding LPNs in seniors care, increased research supporting regulatory decision-making, development and implementation of a Regulatory Impact Assessment, a refresh of our website with greater focus on public accessibility, and development of numerous timely standards and documents in support of quality LPN practice. Changes to enhance registration and conduct processes are in place and new standards for approval of specialty education programs (known as advanced practice as of 2020) have been implemented.

The CLPNA has expanded and strengthened collaborative relationships and continues our leadership contribution to health profession regulation

COMPETENT COMMITTED CARE •

3

CLPNA 2019 YEAR IN NUMBERS

1171 391 Alberta graduate registrations 2018 - 1047

Out of Province registrations 2018 - 434

17,264 total LPN registrations

169 complaints received

4 •

30 hearings completed

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

139

IEN registrations 2018 - 259

3.5% growth in registration

38

average age of LPNs

Top Places of Employment

93% H

of Alberta candidates passed CPNRE Exam on 1st write

H

H

Hospital

Continuing Care*

Community Care**

5009

3932

3829

37% 28% 28%

Employment

42% 40% 18% Full-time Part-time Casual 5753

5448

Continuing Competence Program Audit

3000

members selected

2480

6710 webinar attendees

Practice Consultations

1959

inquiry responses

9

practical nurse programs

*Continuing Care includes Nursing Home / Long Term Care, and Rehabilitation / Convalescent Centre. **Community Care includes Community Health / Health Centre, Home Care Agency, and Physician’s Office / Family Practice Unit.

COMPETENT COMMITTED CARE •

5

GOVERNANCE

The College of Licensed Practical Nurses of Alberta regulates the practical nurse profession to ensure LPNs provide safe and competent care for all Albertans.

The CLPNA: - sets education, registration and renewal requirements; - ensures compliance with healthcare legislation and regulations; - approves and reviews practical nurse diploma, refresher and specialty* programs

(*known as advanced practice as of 2020); - sets and enforces practice, conduct and professional standards; - establish and maintain the continuing competence program; and, - manages complaints and discipline.

Since the practical nursing profession began in Alberta in 1947, through education and regulation change, the role of the licensed practical nurse has advanced while maintaining a focus on safe, ethical, person-centred care. In 1987, the CLPNA was given the mandate to govern and regulate the practical nursing profession.

A Council of eight elected licensed practical nurses and three appointed public members regulate the licensed practical nurse profession in accordance with the Health Professions Act (HPA), the Licensed Practical Nurses Profession Regulation (2003) (pending amendments in force as of February 1, 2020), standards of practice, code of ethics and the CLPNA’s Bylaws (March 2019).

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COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

LPN Profession Regulation As part of an ongoing and comprehensive review and update of Alberta’s Licensed Practical Nurses Profession Regulation, LPNs were consulted in April 2019 on proposed amendments to the entire LPN Regulation. The CLPNA submitted regulation amendment proposals to Alberta Health on July 9, 2019. In September, the Government of Alberta commenced work on amendments to restricted activities. This work followed previous LPN consultation in June of 2016 on proposed changes to the restricted activities, submitted to the government in both 2016 and 2018.

On October 17, 2019, by Order in Council 204/2019, the Lieutenant Governor in Council approved amendments to the Licensed Practical Nurses Profession Regulation, effective February 1, 2020. These amendments affect restricted activities, registration categories, advanced authorizations and supervision requirements.

Standards of Practice As part of the legislative framework that governs the LPN profession in Alberta, standards of practice provide the minimum standard of behaviour that LPNs are expected to meet in their nursing practice.

Standards of Practice for Licensed Practical Nurses on Boundary Violations: Protecting Patients from Sexual Abuse and Sexual Misconduct: o Member consultation took place on December 12, 2018, o The Standards were provided to Alberta Health for their consultation on December 21, 2018, o These standards were approved by the Minister of Health, adopted by the Council, and came into force on March 19, 2019.

Drafted: Standards of Practice for Licensed Practical Nurses on Restricted Activities and Advanced Practice; anticipated to come into effect February 1, 2020. o LPN consultation survey commenced December 10, 2019, o The Standards were provided to Alberta Health for their consultation on December 10, 2019.

The fourth edition of the Competency Profile for LPNs was released in September, while the fifth edition will be released in February 2020 to reflect amendments to the Alberta LPN Profession Regulation (in effect February 1, 2020.)

Bylaws The CLPNA’s bylaws were amended on March 16, 2019 to add a membership category for students.

Committees The CLPNA is a member of the Alberta Federation of Regulated Health Professions’ (AFRHP) and participates in subcommittees on registration, continuing competence, legislative and regulatory affairs and complaints. The CLPNA is also a member of the board of the National Nursing Assessment Service.

Regulatory Consultation The CLPNA respects its responsibility as a regulator under the Health Professions Act and participated in the Minister of Health’s consultations by providing comments on the following documents: • Alberta Health: revisions to infection prevention and

control standards; • Alberta College of Combined Laboratory and X-Ray

Technologists: revisions to the college’s standards of practice; • Alberta College of Physicians and Surgeons: o revisions to their Code of Ethics; o Standards of Practice for Non-Hospital Surgical Facilities; o Revisions to Standards of Practice – Duty to Report a Colleague and Duty to Self-Report; • Alberta College of Pharmacy: revisions to their

Standards of Practice; • Alberta College and Association of Opticians:

revisions to their Standards of Practice; • Alberta College and Association of Chiropractors:

proposal to expand Scope of Practice; • Alberta College of Paramedics: revisions to their

Code of Ethics; • Alberta College of Speech-Language Pathologists

and Audiologists: Telehealth (Virtual Care) Standards

of Practice; • Alberta Dental Association and College: Anesthetic

Standards of Practice; • College of Alberta Dental Assistants: revisions to

their Standards of Practice; • College of Naturopathic Doctors of Alberta:

Advertising and Marketing Standards of Practice; • CARNA: o prescribing standards for nurse practitioners (NPs) which enable NPs to authorize use of medical cannabis; o revisions to standards on privacy and management of health information; o Medication Management Standards of Practice.

COMPETENT COMMITTED CARE •

7

Message from the

PUBLIC MEMBERS

A

s we come to the end of our first term as public members on the CLPNA Council, we reflect on a busy and exciting year. As public members, we play a unique role in providing a diverse perspective on the regulatory role and governance of the CLPNA and ensuring that the public receives safe, competent and ethical healthcare services from LPNs.

In the fall of 2019, an amendment to the Licensed Practical Nurses Profession Regulation was announced and will come into force on February 1st, 2020. This is the first change to the regulation in 17 years and as public members, we are pleased that these changes were approved by government to reflect the reality of an everchanging healthcare system and the evolving needs of Albertans accessing our healthcare system.

organization known for its innovation with impact across the healthcare system. As public members, we would like to thank Linda for her tireless work to advance the regulatory system in Alberta.

As we move into 2020, we are faced with a rapidly changing regulatory environment as well as an evolving healthcare system. As public members, we look forward to working with the CLPNA’s leadership and the new CEO to continue Linda’s legacy of regulatory excellence and contributions to a quality healthcare system for Albertans.

As a Council, we worked with a research firm to better understand the public perception of the CLPNA, which provided excellent insights into public knowledge of our role in the healthcare system. While 94% of people surveyed indicated that they had confidence that an LPN would provide them with safe and ethical healthcare, over 30% of those surveyed did not know about the CLPNA’s role in regulating the profession through discipline processes. This shows a need to better communicate with the public about our regulatory role and how to access the CLPNA when they have a concern about the care they have received by an LPN. In October 2019, the CLPNA hosted its 7th Annual Think Tank, presenting national and international experts on the subject of Empowering the Health System for Excellence.

At the end of 2019, Linda Stanger announced her retirement after leading the CLPNA as CEO for the past 14 years. Under her leadership, the CLPNA has tripled its membership, established collaborative provincial, national and international partnerships and become an

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COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

Austin Mardon, Lisa Stebbins, John Chapman Public Members

Message from the

ESAC CHAIR

T

he Education Standards Advisory Committee (ESAC) fulfilled the role of supporting public safety through the application of standards in practical nursing education in Alberta as reflected in the monitoring of the annual reports provided by the basic practical nurse diploma programs. The nursing education programs report on implementing improvements on their program performance, as recommended by the ESAC Review team in their recent program review.

HCA Provincial Exam Development and the HCA Licensing Assessment Process (Stage 1), with Stage 2 to follow in 2020.

These projects all reflected the leadership of the CLPNA with a focus on public protection.

ESAC completed a comprehensive Basic Diploma Program Standards revision process, and new Diploma Standards (June 2019) and Refresher Standards (December 2019) were approved by the CLPNA Council. Timely additions were made to the Standards and Indicators, and the committee also prepared a new electronic annual reporting template as well as a thorough Program Review Application Guide. These standards and supporting tools will be introduced in the next round of Program Reviews slated to begin in February and March of 2020.

We are pleased to report that there are now four licensed practical nurses who bring the vital perspective of practicing LPNs to ESAC decision-making. LPN representation on ESAC represents a wide geographical area (North, Central, and South) and encompasses a broad practice perspective of care environments (urban, rural, community and specialty).

Our team utilized the new Advanced Education for Specialty Practice Standards approved by Council in 2018 to review the following programs: MacEwan’s Perioperative Nursing program, NorQuest’s Advanced Orthopedic program, Bow Valley College’s Immunization program and the Edmonton Foot Care and Alberta Foot Care Academy programs. Each received multi-year approval. NorQuest College acquired the Devon Foot Care program and completed a program review based on the new Advanced Education for Specialty Practice standards. The CLPNA Council awarded them interim approval to offer an Advanced Foot Care program for one year, effective December 2019.

While the ESAC members have been kept very busy with these projects, they found time to remain informed on healthcare trends reported at the annual CLPNA Think Tank, the annual general meeting and conference.

We are saddened by the recent passing of Mary Anne Fish from Calgary, a long-standing ESAC member and passionate nurse and educator. Her message was that we had an obligation to encourage our practical nurse programs “to be the best that they could be”. She was a woman of integrity who influenced the development of the students and faculty at Bow Valley College. Mary Anne made a significant contribution to the newly revised Diploma Program Standards. We will miss her and extend our sincere sympathies to her family.

Respectfully submitted, D. Jean Valgardson, Chair

The ESAC team supported several CLPNA initiatives during the 2019 year, namely, the Guanghua Nursing Education (China) project, the HCA (Health Care Aide) Substantial Equivalency Program Assessment, the HCA Curriculum Revision, the development of HCA Bridging courses, the

COMPETENT COMMITTED CARE •

9

CLPNA COUNCIL l-r: Joyce Rossiter, LPN; Jennifer Peace, LPN; Tiffany Smith, LPN; John Chapman, Public Member; Linda Stanger, CEO; Valerie Paice, President, LPN; Kurtis Kooiker, Vice President, LPN; Lisa Stebbins, Public Member; Jean Collins, LPN; Ashley Cesar, LPN; Sherry Kanarek, LPN not pictured: Austin Mardon, Public Member

10 •

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

CLPNA ORGANIZATIONAL STRUCTURE Minister of Health

Council

8 Elected Licensed Practical Nurses 3 Appointed Members of the Public

Regulated Committees Education Standards Advisory Committee Council Appeals Committee Hearing Tribunal Complaint Review Committee Competence Committee

Chief Executive Officer

Regulatory Affairs

ESAC Chairperson

Executive Officer

Executive Officer

Senior Director Communications

Registration

Finance

Operations

Complaints

Professional Practice

Research

Professional Development

Policy

COMPETENT COMMITTED CARE •

11

Core Function

REGISTRATION

Committed to excellence in registration standards.

The CLPNA is committed to registration processes that are procedurally fair, transparent and consistent.

A priority this year was updating the application form and process for LPN specializations. This resulted in increased understanding and improved monitoring around specializations for LPNs, known as advanced practice as of 2020. A review of English language testing requirements for applicants seeking to work as practical nurses in Alberta was also completed, resulting in clear direction for applicants while ensuring high standards of professional nursing.

Other registration initiatives included improving online registration for LPNs seeking reinstatement, for out-of-province and internationallyeducated nurses (IENs), and for new graduates. The CLPNA is also working to support the mobility of out-of-province and internationally-

12 •

REGISTRATION

educated nurses through increased understanding of potential barriers they may face to working in Alberta.

The CLPNA continues to set direction for membership to understand the Practical Nurse Refresher program standards, and for membership to understand and meet new practice hour requirements.

Internationally-educated nurses who seek work as LPNs in Alberta are first assessed by the National Nursing Assessment Service (NNAS). All applicants to the profession must also pass the CLPNA’s Jurisprudence Examination, which tests that practical nurses have the knowledge needed to practice safely within Alberta’s legislative framework.

Passing the Canadian Practical Nurse Registration Examination (CPNRE) is the final step required for practical nursing students and international applicants to obtain full registration with the CLPNA. The Alberta annual average for Canadian first-time writers is 93% as compared to the national average of 91%.Internationally-educated nurses who wrote the CPNRE through Alberta had an 86% average, well above the national average of 65%.

Alberta CPNRE Candidates 2019* Alberta Candidates

1st Exam

Registered

1293 126 148 24

1591

Writing

1217 112 145 24

1498

Not Writing

76

Repeat Exam

14

International** 1st Exam

3

International Repeat Exam

0

Total Candidates

93

Passing

1127 83 125 16 1351

Failing

90 29 20 8 147

% Passing

93%

74%

86%

67%

90%

* Statistics prepared by Yardstick Assessment Strategies. **International applicants

COMPETENT COMMITTED CARE •

13

BY THE NUMBERS

MEMBERSHIP

17,264

total LPN registrations

16657

3.5% growth

13921 12881

11766

15860

+5.0%

15082

+5.0%

2016

2017

2018

17264

+8.4%

+8.0%

+9.5%

+10.7%

10623 +10.0%

9015

9652

+7.0%

2010

2011

2012

+5.7%

14 •

REGISTRATION

2013

2014

2015

2019

Registrations

2018

2019

Alberta Graduates NEW Members

1047

1171

Canadian Out of Province NEW Members

434

391

International NEW Members

259

139

Reinstatements*

381 436

Re-Entry Renewals Courtesy Members

0 0 14536 15127 0

TOTAL 16657

0 17264

Registration Applications

2018

2019

Alberta Graduates NEW Applicants

1105

1234

Canadian Out of Province NEW Applicants

478

563

International NEW Applicants

296

143

Reinstatements*

421 468

Re-Entry Applicants

36

40

Renewal Applicants

14874

16956

Courtesy Applicants

0

0

TOTAL 17210

19404

*Reinstatement = a member whose practice permit has lapsed at least one day.

COMPETENT COMMITTED CARE •

15

Age of Active LPNs

38

average age 2018 - 38

Internationally Educated Nurse Registrations Belize 1 19-25 |

26-30 |

31-35 |

36-40 |

41-45 |

46-50 |

51-55 |

1844 3151 3541 2648 1916 1455 1025

56-60 61-65+ | |

856

828

China

1

Columbia 1 Congo 1 India 31 Japan 1

Out of Province Registrations

Kenya 3 Malaysia 1 Nepal 2

391

Nigeria 5 Philippines

out of province registrations

UK 1 USA 1

2018 - 434

BC |

78

16 •

SK |

11

REGISTRATION

MN |

ON |

14 241

QC |

4

NB |

10

NS |

13

PEI |

2

NL |

14

Zimbabwe 1

YT NWT NU | | |

2

2

89

0

139

IEN registrations 2018 - 259

Active LPNs by Location AHS Area

2019

%

Area 0 - Out of Province/Country

1234

7.1%

AHS Area 1 - South Zone (Lethbridge & Medicine Hat)

1300

7.6%

AHS Area 2 - Calgary Zone

5321

30.8%

AHS Area 3 - Central Zone (Red Deer)

2448

14.1%

AHS Area 4 - Edmonton Zone

5786

33.5%

AHS Area 5 - North Zone

1175

6.9%

17264

100%

TOTAL

Active LPNs by Place of Employment & Status Place of Employment

Full-time

Part-time

Casual

2019

%

Association / Government

104

97

36

237

1.8%

Business / Industry / Occupational Health Centre

49

5

8

62

0.4%

Community Health / Health Centre

773

853

385

2011 14.7%

Educational Institution

140

45

67

252

1.9%

Home Care Agency

317

167

248

732

5.3%

Hospital (General/Maternal/Pediatric/Psychiatric)

1706

2377

926

5009

36.7%

92

44

36

172

1.2%

1636

1516

588

3740 27.4%

0

1

1

2

0.0%

Physician’s Office / Family Practice Unit

728

240

118

1086

7.9%

Private Nursing Agency / Private Duty

1

0

0

1

0.0%

Rehabilitation / Convalescent Centre

95

68

29

192

1.4%

Self-Employed

4

1

0

5

0.0%

Other**

108

34

38

180

1.3%

TOTAL

5753 (42%)

Mental Health Centre Nursing Home / Long Term Care Nursing Stations (Outposts or Clinics)

5448 (40%) 2480 (18%)

13681* 100%

*527 are working out of province or out of country. ** Enhancements to the LPN database resulted in increased accuracy of data being reported in 2019 from 2018.

COMPETENT COMMITTED CARE •

17

Core Function

CONDUCT

Enforce standards of professional practice.

The public relies on licensed practical nurses for safe, competent, ethical care, and LPNs rely on the CLPNA to outline the expectations and provide guidance on professional conduct. This is provided through regular communications, practice consultation and the CLPNA’s guiding documents and standards.

Under the authority of the Health Professions Act (HPA), the CLPNA is responsible for regulating the LPN profession in a manner that protects the public from unsafe or unethical practice of licensed practical nurses. This is accomplished through the provision of guiding documents and practice consultation for regulated LPNs. These documents and advice provide evidence-informed information to guide and support LPN professional practice. When Standards, the Code of Ethics, or other legislation which guides the profession are not met by an LPN, a complaint may be generated

18 •

CONDUCT

against the regulated member or former regulated member of CLPNA (if it’s within two years since the lapse of their registration).

The Conduct Department receives, investigates, manages, and resolves complaints made against regulated members. The Conduct Department holds public safety as a priority and is committed to efficiency and transparency in all their processes.

Complaints are received from a variety of sources. The CLPNA is focused on timely resolutions, that meet or exceed all requirements in the Health Professions Act. Amendments to the HPA to protect patients from sexual abuse and sexual misconduct by a regulated health professional were implemented in 2019 through Bill 21: An Act to Protect Patients. Changes were made to conduct processes, including how sexual abuse or sexual misconduct files are managed. The CLPNA’s website was updated and now provides additional specific information to the public to better understand how to file a complaint and what to do if they have been subjected to sexual abuse or misconduct by an LPN. In addition, members had the opportunity to participate in educational webinars, and committee members and staff of the CLPNA received trauma-informed training.

To increase transparency all hearing decisions are now published on the website.

In 2019, the CLPNA received one complaint with reference to sexual abuse of a patient; this complaint was handled expeditiously. Following a thorough and objective investigation, there was no evidence to support any allegation of sexual abuse and/or sexual misconduct; therefore, the complaint was dismissed.

Information about regulation, practice, research, ethics and other relevant news for LPNs is communicated in CARE magazine, published four times yearly. It remains a reliable regulatory source for licensed practical nurses and stakeholders.

Historical Comparison

2018 2019

New Complaints Received

212

169

Previous Years’ Complaints in Process

82

35

Complaints Currently In Progress as of December 31, 2019

Incapacity 11 Investigation - In Progress

46

Investigation Report - Internal Review

16

Investigation - Legal Review

4

Referred to Hearing / Hearing Pending

2

Hearing Complete / Decision Pending

2

Monitoring Orders

11

Undertaking Pending

2

Files Closed

75

Total Complaints Received

169

Files Related to Incapacity Concerns regarding an LPN’s behaviour may initially be received by the Conduct Department as a complaint lodged against the LPN. However, after a preliminary investigation or during an investigation, it may be determined the LPN’s conduct is more likely a result of incapacity. The complaint file is then managed under section 118 of the HPA. These complaints are then not considered to be a matter of unprofessional conduct.

In 2019, there were 11 complaint files where the status was changed to incapacity; one regulated member had three complaints submitted and the three files are considered to be an incapacity concern.

COMPETENT COMMITTED CARE •

19

Type of Complaints Received

Source of Complaints

Abandonment 1

2019

Employer (128)

Breach of Confidentiality / Privacy

12

Bullying 2 Clinical Competence - Documentation

5

Clinical Competence - Health Assessment

3

Complaints Director (18)

Clinical Competence - Medication Administration 32

Other (0)

Clinical Competence - Multiple

49

Protection for Persons in Care (0)

Drug Diversion

2

Failed to Cooperate with Investigation

1

Incapacity (Mental / Physical)

2

Member of Public (23)

Neglect 3

2018

Non-Nursing Conduct

2

Patient Abuse - Mental

4

Patient Abuse - Physical

7

Patient Abuse - Verbal

1

Practicing Without a Permit

17

Other (2)

Sexual Abuse - Patient

1

Protection for Persons in Care (6)

Sexual Misconduct - Co-worker

2

Substance Abuse

1

Employer (154)

Complaints Director (26) Member of Public (24)

Theft 3 Therapeutic Nurse-Client Relationship

2

Unethical Conduct

10

Unprofessional Communication

6

Working Outside Scope of Practice

1

Total Complaints Received in 2019

169

*Non-Nursing Conduct includes behaviour that harms the profession and isn’t directly related to nursing care.

20 •

CONDUCT

Disposition of Complaints Closed in 2019 (this includes files from previous years)

Complaint Withdrawn

3

Complaints Dismissed

18

Hearings Completed and Files Closed

22

Handled at the Workplace

6

Informal Resolution (Agreement & Undertaking)

71

Employer Resolution with Sanction

3

Registration Surrendered

2

Resolution with Sanction

32

Section 55 – Undertaking - Practicing Without A Permit

13

Hearing Discipline Actions Taken Reprimand 26 Partial Hearing Costs

25

Fines 2 Education 21 Reflection Paper

5

Random Drug Screening

1

Counselling 1 Supervised Practice

1

Interim Suspension Removed

1

Condition - Performance Appraisals

2

Resolved 4

Education - Prior to Reinstatement

5

Unresolved 1

Hearing Costs - Prior to Reinstatement

1

Section 118 (Non-Disciplinary)

Fitness to Work Assessment

1

Education - Prior to Restriction Being Removed

1

Supervised Practice upon Return to Work

1

Appeals in 2019

Condition - Will not practice in specialized areas without authorization from Registrar

1

Council Appeal Committee – There were no appeals requested in 2019; however, there was a final written decision received from the Council Appeal Committee in 2019 for a file from 2018.

Suspension for a total time of 12 months

1

Complaints Closed

2 177

Complaints Review Committee – There were no requests for a review of any dismissal made in 2019; however, the Complaints Review Committee met in March 2019 to review the submissions made for a review for a file in December 2018.

Hearings There were 30 hearings held in 2019 (22 of which were completed and closed), comprising 36 complaint files (two members had multiple files.) All hearings were open to the public. Four hearings are awaiting hearing tribunal decisions.

COMPETENT COMMITTED CARE •

21

Core Function

COMPETENCE

Establish and uphold standards to support competence.

The CLPNA sets standards of competence to prepare licensed practical nurses to meet the changing needs of the healthcare system. By providing access to resources and education, continuing competence is supported, as are processes to evaluate competence.

Practical nurse education programs throughout the province require students to meet competence outcomes within the two-year diploma program, which typically includes approximately 1650 hours of instruction: 750 theoretical and 900 clinical / laboratory. Under the CLPNA Council’s oversight and approval, the Education Standards Advisory Committee (ESAC) establishes the standards for program approval and reviews program compliance. This year, the Standards were enhanced to include details on simulation, ehealth, safety,

22 •

COMPETENCE

professionalism and more, along with improved reporting templates and review processes. Details of this year’s program reviews can be found on page 9, in the Message from the ESAC Chair.

The CLPNA’s Continuing Competence Program (CCP) is a formal system for LPNs to assess, monitor and reflect on their nursing practice and ongoing competence needs. By identifying appropriate learning activities and implementing them into practice, LPNs commit to selfdirected learning to build and enhance their competence.

This ensures patients, colleagues and the healthcare system of the profession’s commitment to safeguarding the public interest.

While all LPNs participate in the Continuing Competence program, the Audit process verifies the process and outcome within a random selection of LPNs annually.

In June of each year, approximately 20% of LPNs are selected to participate in the Continuing Competence Program Audit process. CCP supports for members this year included a video tutorial (viewed over 3000 times), a CCP guide, multiple webinars, and an update of the online audit form and webpage.

Practical Nurse Programs in Alberta • Bow Valley College, Calgary • Columbia College, Calgary

• Keyano College, Fort McMurray

• Lethbridge College, Lethbridge

• Medicine Hat College, Medicine Hat • NorQuest College, Edmonton

• Northern Lakes College, Slave Lake/Grande Prairie/Lloydminster/ High Level/Peace River

• Portage College, Lac La Biche/Cold Lake • Red Deer College, Red Deer

An addition to the CCP is the requirement for LPNs to meet a minimum of 1000 practice hours in the previous four registration years. This requirement is being implemented over a three-year transition period from 2019 to 2021 with practice hour audits beginning in 2020.

As the health system continues to evolve, the CLPNA supports LPNs to maintain competence to protect the public. Projects with a competence focus in 2019 included: • An ongoing and complete review of the Continuing Competence Program.

• Creation of a practice guideline and webinar on Professional Boundaries; a video is in development.

COMPETENT COMMITTED CARE •

23

CCP Audit

3000 practicing members audited 98% compliant, 2% incomplete:

• • •

8 members suspended 23 compassionate leave 85 non-renewal

• Creation of webinars on Unconscious Bias; PTSD Awareness and Mental Health and Wellness Strategies; How Protecting Patients from Sexual Misconduct Impacts LPNs (Bill 21); Learning to Learn: Professional Development Strategies for LPNs; and more.

•

Participation on the steering committee for the Canadian Patient Safety Institute Competency Review and Update.

• Creation of learning modules related to restricted activities and regulation amendment changes.

•

Participation in the Canadian Council for Practical Nurse Regulators’ committee on the new Entry-Level Competencies for Licensed Practical Nurses, and planning for review of Standards of Practice for Licensed Practical Nurses in Canada.

• Continued clarification of learning requirements around practice hours, including issues around specialties, independent practice and non- traditional roles.

•

Extensive member and stakeholder engagement to build system collaboration on topics including rural medicine, geriatrics, palliative care and seniors health.

• Collaboration with the College and Association of Registered Nurses of Alberta and the College of Registered Psychiatric Nurses of Alberta on tri-nursing documents including,

Webinars and workshops for LPNs on 32 diverse topics were well-attended. Focus groups were also held to gather information from key stakeholders and LPNs to better understand the needs for care of seniors and the frail elderly.

o The Collaborative Practice in Nursing

resource document,

o Aesthetic Nursing FAQs webinar and video,

o Social Media E-Professionalism for Nurses

resource document.

• Participation on the advisory group and steering

committee for Alberta Palliative Care competency development.

24 •

COMPETENCE

The CLPNA’s AGM and Conference, held in Edmonton May 6 and 7, had over 300 attendees, with initial evaluations showing high marks for the format, speakers, sponsor involvement and overall event.

STUDY with CLPNA self-study courses 18,975 completed certificate exams at www.StudywithCLPNA.com 1060

Anaphylaxis

1168

Diagnostic Tests & Laboratory Values

1963

Elder Abuse

1645

Health Assessment

2058

Infection Prevention and Control 806

Intravenous Infusion Therapy Learning to Learn

141

Medical Language and Terminology

1075 1414

Medication Administration Medication Drug Calculation

818 4334

Nursing Documentation Pressure Ulcers Relational Practice

790 1703

NOTE: These courses are open to the public and do not represent solely Alberta LPN registrants.

Professional Development Webinars

31 Webinars

(21 more than 2018)

6710 Attendees (3860 more than 2018)

COMPETENT COMMITTED CARE •

25

Supporting Function

RESEARCH

Lead and collaborate on research to support regulatory excellence and the creation of knowledge on LPN practice.

The CLPNA leads and collaborates on research projects on regulation and nursing practice.

CLPNA and Alberta Innovates: Advancing Knowledge Grant In collaboration with Alberta Innovates, the CLPNA partners with academic researchers to fund projects focused on LPN practice, utilization and quality.

The following ‘Advancing Knowledge’ projects were completed in 2019: LPNs as Change Agents: Building LPN Leadership Capacity to Enable Practice Change in Residential Care Homes. Partner: Dr. Sienna Caspar, University of Lethbridge. Presentations related to this project took place at the Brenda Strafford Foundation Way Annual Symposium, the CLPNA AGM and Conference, and the 20th Biennial Conference of the Canadian Gerontological Nursing Association. A related article was published in CARE magazine.

26 •

RESEARCH

Enhancing LPN-Family Communication to Reduce Avoidable Transfers of Long-Term Care/Assisted Living Residents to the Emergency Department: A Mixed Methods Study. Partner: Dr. Jude Spiers, University of Alberta. A presentation took place at the CLPNA AGM and Conference, and a related article appeared in CARE magazine.

Optimizing Licensed Practical Nurses in Home Care: Their Role, Scope and Opportunities. Partner: Dr. Kim Fraser, University of Alberta. This research was published in the Canadian Journal of Nursing Leadership.

The CLPNA contributed to several independent research projects in 2019.

LPNs’ Perceptions of and Motivation to Meet Professional Standards. Partner: Renata Neufeld, College of Licensed Practical Nurses of Manitoba and Research Fellow at the Institute of Regulatory Excellence.

Results were presented at the 2019 National Council of State Boards of Nursing Annual Meeting and Delegate Assembly.

Securing Accessible, Quality Early Learning and Care for Families Working Non-Standard Hours in Alberta: A Systematic Scoping Review. Partner: Dr. Rebecca Gokiert, University of Alberta. The CLPNA, in partnership with the University of Alberta’s Community-University Partnership, received funding for a Mitacs Accelerate Grant to fund a doctoral student. Chelsea Freeborn completed the scoping review in May 2019.

The Influence of Health Work Environments on the Intent to Stay Among Nurses: Perspectives from Canada and the United Kingdom. Partners: Dr. Sandra Goldsworthy, University of Calgary and Nicola Witton, Keele University, UK. A presentation on moral distress among UK critical care nurses took place at the 34th Annual British Association of Critical Care Nurses Conference.

Building Citizen Engagement in Translating Research in Elder Care. Partner: Dr. Andrea Grunier, University of Alberta. The CLPNA participated in a James Lind Alliance workshop to create priority areas for community engagement research, affecting the quality of care for seniors provincially and nationally.

Project: Healthy & Professional Knowledge Workers: Examining the Gendered Nature of Mental Health Issues, Leaves of Absence & Return to Work Experiences. Partner: Dr. Ivy Bourgeault, University of Ottawa. This $1.4 million Social Sciences and Humanities Research Council and Canadian Institutes of Health Research grant explores evidence-based, genderresponsive interventions to foster well-being among LPNs. The CLPNA is a community partner.

The CLPNA contributed to regulatory research through the following activities: • Overview of Nursing Regulation Concepts and

Frameworks internal white paper • Regulatory Impact Assessment on CLPNA processes

to evaluate regulatory effectiveness • Published the report of the 2018 CLPNA Member survey.

COMPETENT COMMITTED CARE •

27

Supporting Function

POLICY

Create evidence informed policy to support regulatory processes.

The CLPNA’s policies outline the requirements and the expected behaviours of LPNs as part of the larger mandate of serving and protecting the public.

The following documents represent the ongoing efforts of the CLPNA to maintain a high regulatory standard for the licensed practical nurse profession.

Policies • Temporary Registration – establishes the requirements to register and practice on the temporary register including supervision requirements; released January 2019.

• English Language Proficiency Standard – clarification of require- ments for English language proficiency; released June 2019.

28 •

POLICY

Interpretive Documents • Privacy Legislation in Alberta; released January 2019.

• Duty to Report; released January 2019.

Practice Guidelines • Confidentiality; released January 2019.

• Professional Boundaries – complements the Standards of Practice on Boundary Violations: Protecting Patients from Sexual Abuse and Sexual Misconduct; released July 2019.

• Cultural Competence and Inclusive Practice – includes self-reflection strategies and actions; released December 2019.

Info Sheets • LPN Regulation Changes for Educators –

explains changes to LPN regulation effective

February 1, 2020 and necessary enhancements

needed to practical nursing courses; December 2019.

Other • CLPNA’s LPN Decision-Making Tool - helps LPNs evaluate the appropriateness of performing a healthcare activity; released January 2019.

• Canadian Council for Practical Nurse Regulators’ Entry-Level Competencies completed; CLPNA administrated a national survey specific to the Entry-Level Competencies and related practice.

• CLPNA’s Policy Framework - outlines policy development processes within CLPNA including internal and external-facing policies; updated spring 2019.

COMPETENT COMMITTED CARE •

29

Supporting Function

COMMUNICATION

Facilitate responsive and relevant communication with the public, LPNs and stakeholders.

30 •

COMMUNICATION

Communication efforts this year focused on ensuring the public clearly understands the regulatory role of the CLPNA and the accountability of LPNs. The CLPNA’s website was redesigned with a focus on public protection, accessibility and transparency, including highlighting and simplifying the process of making a complaint. Website revisions were completed to reflect Bill 21; a webinar webpage was added to improve accessibility to ongoing education for LPNs; and the LPN practice decision-making tool is now available online in three platforms, making safe practice guidance even easier to access. Web information for the CLPNA’s AGM and Conference was also updated and enhanced.

With the goal of maintaining LPN knowledge and commitment to their regulatory requirements, a National Nursing Week quiz provided a chance for LPNs to find answers on the CLPNA website. CARE magazine, the quarterly publication of the CLPNA, prioritized regulatory content, and offered members the most current information on regulation, research and competence.

Public awareness campaigns aimed to inform the public of regulatory standards and accountability of LPNs, using digital and radio platforms, and included ongoing social media messaging to deliver necessary regulatory information to members and stakeholders.

COMPETENT COMMITTED CARE •

31

Supporting Function

ORGANIZATIONAL CULTURE

Create a productive environment built on trust, respect, safety, collaboration and a commitment to continuous improvement and fiscal responsibility.

As an organization that exists to serve the public, the CLPNA prioritizes effective stewardship of resources in a responsive and responsible workplace. The CLPNA works to be an employer of choice, where staff are engaged and valued.

To support this, a formalized policy and modern process for recruitment was developed and implemented, including processes for onboarding and orientation. Implementation of a new document management system is underway to meet organizational goals of security and efficiency, and a new team charter was developed and signed by all staff to guide the organization in accountability and corporate wellness.

32 •

ORGANIZATIONAL CULTURE

The CLPNA continued its collaboration with China’s Guanghua International Nursing Alliance, as part of our commitment to the improvement of standards of nursing education internationally. Nursing Education Standards and a resource toolbox for this initiative were completed in 2019.

Our Team Charter Our Team Charter

Through our collective knowledge and experience, in an envi of Trust and Respect, we fulfill the mandate of the CLP Through our collective knowledge and experience, in an enviro of Trust and Respect, we fulfill the mandate of the CLPN

WHO WE ARE ACCOUNTABLE TO WHO WE ARE ACCOUNTABLE TO Key Stakeholders: Key Stakeholders:

CLPNA Staff

Service Providers Service Providers

Council CLPNA

Committees Staff Council Committees

Consultants Consultants

Education Providers Education Providers

Regulators Regulators

HOW WE WORK

To support healthy work HOWaWE WORK TO professional, positive cultu

To •support a healthy work-lif We value and encourag professional, positive culture continuous improveme We support profes • We value and encourage growth in a safe an continuous improvement. environment.

- We support professio in aa safe andas • Wegrowth support diverse environment. environment.

- We collaborate to • We support a diverse and ideas and perspec environment.

- We collaborate to • We communicate in exc an ideas and perspective manner.

• We communicate in an op • We resolve conflict in a manner.

• We resolve conflict in a re

HOW WE FULFILL O

HOW WE FULFILL OU

Registrants & Applicants Registrants & Applicants

Employers Government Government

An excerpt from the new CLPNA team charter.

Employers

In all that we do, we are c excellence: In all that we do, we are com • Quality: We produce o excellence: based on performance • Quality: We produce out best practice. based on performance m •best Resources: practice. We are fisc when using supplies an • Resources: We are fiscall operating costs within when using supplies and s costsWe within bu •operating Timeliness: respon meeting or exceeding • Timeliness: We respond while recognizing theagn meeting or exceeding COMPETENT COMMITTED CARE • 33 while recognizing the nee

Encouraging LPNs to increasingly strive to enhance their competencies.

The Fredrickson-McGregor Education Foundation for LPNs is a non-profit which distributes educational grants, awards and bursaries to members of the College of Licensed Practical Nurses of Alberta to enhance their nursing knowledge, skills and ability, and honour their achievements.

The Foundation administers the proceeds of a $3 million endowment fund to enhance LPN nursing knowledge, skills and ability. Some of the activities of the Foundation include authorizing grants for continuing education, managing the Awards of Excellence, and fundraising.

In 2019, the Foundation Education Grant Program approved 679 applicants for a total of $309,806.74.

Since the Education Grant Program began in September 2006, the Foundation has approved 6831 applications for a total of $2,996,114.41 in grants, and distributed 72% of the approved funds.

2019 APPROVED EDUCATION The Grant Administrator is currently approving education that enhances the LPN’s current role, or that will allow them to advance into another LPN role. The education that is most applied for includes Immunization, Foot Care, and one-day seminars, such as Physical Assessment Pearls, Supplements and Alternative Therapies, and Leg Ulcers.

The Foundation pre-approved grants of $150 to CLPNA members towards the cost of the 2019 CLPNA AGM and Conference registration fee. Members must meet the criteria by attending the full two-day conference, hold an active practice permit and reside in Alberta. In 2019, 88 members received funding through the program.

34 •

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

Top Grant-Approved Education of 2019: CLPNA AGM & Conference

88

NURS9501/Immunization 169 Foot Care

65

Physical Assessment Pearls Conference

34

Supplements and Alternative Therapies

27

NURS9504/Phlebotomy 26 Leg Ulcers

26

Challenging Geriatric Behaviour

24

NURS9213/Intravenous Initiation, Infusion and Medication Administration

20

Perioperative Specialty Applications (contains 4 courses)

16

Orthopedic Specialty Applications (contains 4 courses)

15

FOUNDATION INITIATIVES This year, recruitment efforts were successful as three new members joined the Foundation’s Board.

Continued progress was made in updating the Foundation Bylaws, with a draft prepared for legal review. A new fundraising initiative was implemented in 2019 with the launch of the online LPN swag store with 100 percent of the proceeds supporting education grants for LPNs. The awards nomination method was enhanced to provide a user-friendly online system with the goal of streamlining the process.

The Ministry of Health issued a directive in December 2018 mandating the enrollment of all health care aides (HCAs) employed by Alberta Health Services, contracted operators and publicly funded third-party contractors into the Alberta Health Care Aide Directory within one year.

The project is being led by the CLPNA, and an extensive amount of effort and work has been done to ensure that the Directory is able to meet the required directive by the extended date of January 31, 2020.

RENEWAL An annual renewal is required by policy to allow HCAs the opportunity to update their contact, education and employment information. An annual renewal also allows HCAs the option to change their status to inactive if they no longer work as health care aides, or have moved out of province.

HCAs Approved by Month as of December 31, 2019 (n=21,148)

7421

67

27

Jan-19

Feb-19

801

185

Mar-19 Renewal Apr-19 Mar-19

67

27

Jan-19

Feb-19

14411

19

670

May-19

801

185

Mar-19 Renewal Apr-19 Mar-19

May-19

1353

Jun-19

Jul-19

1353

Jun-19

1689

Jul-19

2211

1876

2172

Aug-19 Oct-19 2211 Sep-19 2172

1876

Aug-19 Sep-19 Oct-19

2657

7421

2657

Nov-19

Nov-19

Dec-19

Dec-19

Approved HCAs as at December 31, 2019

|

14411

|

4754

|

232

|

Certified

The directory had its first renewal in 2019 and will have the second renewal in 2020.

670

19

1689

|

232

Certified -| In Progress

Certified

Certified 232 In Progress

14411

232

14411

1828

4754

Substantially Equivalent Substantially 4754 Equivalent

Directory4754 Statuses

20

|

1828

| Deemed

Competent

|

20

Deemed | Competent In Progress

Deemed 1828 Competent

Deemed 20 Competent In Progress

1828

20

Directory Statuses

COMPETENT COMMITTED CARE •

35

FINANCIAL HIGHLIGHTS

36 •

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

Statement of Financial Position 2019

December 31, 2019

ASSETS CURRENT

Cash

Cash held for restricted funds

Investments

Accounts receivable

Prepaid expenses

$

4,998,679 $ 3,985,580 92,246 161,996 7,113,089 6,638,722 23,963 143,872 217,795 357,060

12,445,772 11,287,230 - 303,175 3,163,154 2,977,605 1,313,933 1,356,704

INVESTMENTS INVESTMENTS RESTRICTED FOR ENDOWMENT FUND CAPITAL ASSETS

LIABILITIES CURRENT

Accounts payable and accrued liabilities

Deferred grant revenue

Prepaid registration fees

2018

$ 16,922,859 $

$ 15,924,714

963,530 $ 833,544 90,817 229,327 5,700,632 5,381,845

LEASE INDUCEMENT

6,754,979 6,444,716 352,521 399,844 7,107,500 6,844,560

NET ASSETS

Unrestricted

Internally restricted for Seniors Care Education

Restricted net assets

4,811,899 4,195,846 526,373 550,000

Capital Fund

1,313,933 1,356,703

Endowment Fund

3,163,154 2,977,605

9,815,359 9,080,154

$ 16,922,859

$ 15,924,714

Approved by the Council

President

Vice President

COMPETENT COMMITTED CARE •

37

Statement of Operations Year Ended December 31, 2019

REVENUE Registration fees Active Out of province assessment Late Reinstatement Fines Associate License verification Consulting Health Care Aide special projects Program development National examinations Annual general meeting Jurisprudence examination Program fees Advertising Interest income Miscellaneous Alberta Directory grant Directory Enhancement grant Foreign Qualifications Recognition Innovation grant

38 •

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

2019

2018

$ 5,935,331 284,737 110,100 - 21,200 31,707 43,995

$ 5,698,527 254,452 112,900 3,650 14,250 32,977 28,171

294,435 40,036 9,990 34,000 466,617 485,963 131,844 159,970 46,509 54,084 45,000 10,095 8,920 9,990 174,735 153,629 517 2,127 229,327 165,239 209,183 - 27,127 $ 8,044,147

7,287,187

Statement of Operations 2019

Year Ended December 31, 2019

2018

EXPENSES Administration Public information Rent and occupancy costs Office and computer Amortization of capital assets Bank charges and interest Postage Professional fees Telephone and utilities Consulting fees Printing Travel Jurisprudence project Health Care Aide special projects Seniors care education Alberta Directory grant Directory Enhancement grant Schedule of Personnel Costs Schedule of Cost of Services

32,687 116,735 348,477 406,529 423,786 397,583 218,561 209,705 153,142 140,228 20,691 23,194 80,560 89,276 35,524 35,287 20,974 44,105 1,536 4,340 83,591 93,585 26,399 44,888 296,014 29,066 23,627 229,327 165,239 209,183 3,436,001 3,108,028 2,033,246 2,015,444

7,673,326

6,923,232

370,821

363,955

INCOME FROM OPERATIONS OTHER INCOME

Unrealized gain (loss) on investments

196,815

(107,517)

Loss on disposal of investments

(17,980)

-

178,835

(107,517)

EXCESS OF REVENUE OVER EXPENSES

$

549,656

$

256,438

COMPETENT COMMITTED CARE •

39

Endowment Fund - Statement of Operations 2019

Year Ended December 31, 2019

REVENUE

Investment income

Unrealized gain (loss) on portfolio investments

Gain on disposal of long-term portfolio investments

$

2018

66,871 255,168 60,700

$

64,160 (253,913) 36,688

382,739 (153,065)

EXPENSES

Brokerage fee

Donation to Fredrickson McGregor Education Foundation

27,190 170,000

23,541 170,000

197,190

193,541

EXCESS OF REVENUE OVER (UNDER) EXPENSES

$

185,549

$

(346,606)

Statement of Changes in Net Assets Year Ended December 31, 2019

2018 Balance

Excess of revenue over (under) expenses

Invested in capital assets

2019 Balance

Unrestricted

$ 4,195,846

$ 791,844

$ (175,791)

$ 4,811,899

Internally restricted for Seniors Care Education

550,000

(23,627)

-

526,373

Capital Fund

1,356,703

(218,561)

175,791

1,313,933

Endowment Fund

2,977,605

185,549

-

3,163,154

$ 9,080,154

$ 735,205

-

$ 9,815,359

$

The complete audited financial statements are available by contacting the CLPNA at 780.484.8886

40 •

COLLEGE OF LICENSED PRACTICAL NURSES OF ALBERTA, 2019 ANNUAL REPORT

competent committed care

St. Albert Trail Place 13163 -146 Street Edmonton, AB T5L 4S8 Phone 780.484.8886 Toll Free 1.800.661.5877 Fax 780.484.9069

www.clpna.com