Free education for PSWs, but at what cost?

The Ontario government plans to train 6000 to 8,000 new PSWs by December 2021, offering free tuition, textbooks and a paid practicum. Given the devastating effects of COVID in Ontario LTC facilities it is so important to increase the numbers of PSWs in each home. But will increasing the pool of available PSWs actually translate into improved care? And what about the PSWs who are already educated – do they have work?

This funding will undoubtedly encourage people to enter PSW programs. It may help people who need to retrain find new work opportunities. Some who enter the PSW program may discover the joy and the rewards that come with caring for elders, they may love the sharing of laughter and tears and stories. 

However, the funding raises many questions. 

What about the PSWs who are already educated and unemployed or underemployed? There are many PSWs who historically worked at two sites to help meet their payments. Since COVID they have had to limit themselves to working at one site, and still many do not have full time work and benefits. The wages earned by PSWs have not been sufficient for many to support themselves and their families. The benefits are too often non-existent.

And the working conditions are difficult.

This July 2021 report about LTC identifies challenges that PSWs encounter in their work. It leaves me concerned that the following challenges for PSWs will not be addressed by the new funding.

Challenge: Keeping PSWs in the workforce

Did You Know? 40% of PSWs leave within within one year of training.  For every 10 people who graduate, 4 of those leave the profession in the first year.

Working conditions and burnout are the main reasons PSWs leave.

  • 50% of PSWs are retained in the health care sector for fewer than 5 years
    • 43% left the sector due to burnout or working short staffed
  • 25 % of PSWs with two or more years of experience leave the sector annually
  • Improved Staffing: Staffing levels need to change so that PSWs can realistically meet the care needs of residents without the risk of burn out. In addition to educating more PSWs, I hope that the next step for the Ontario government is to provide  increased funding for LTC staffing.
  • Valuing PSWs: PSWs need to be fully integrated into the team, including the way that PSWs are treated. PSWs need to be SEEN and HEARD and VALIDATED! As fully integrated members of the team, they need opportunities for leadership and education. 
  • Supporting PSWs: With increases in wages and benefits, and full-time jobs possibilities. I hope that the government now provides  increased funding for PSWs to encourage them to stay in their chosen field of work.

 Changes that would help to retain PSWs are:

Challenge: Preparing PSWs

The report acknowledges that “most residents reach end of life in LTC.” PSWs need education and training so that they can be prepared to care for people who are living, but are also dying. New PSWs must graduate with the skills and knowledge for providing palliative and end-of-life care, and how to integrate a palliative approach.

To fully prepare PSWs to care for people who are living and dying:

  • Provide sufficient education in core curriculum for PSWs to know how to provide palliative care, and integrate a palliative approach.
  • Provide continuing education opportunities on providing palliative care and integrating a palliative approach.

In closing, I raise my hands to PSWs, the work that they do and the care they provide. I hope that this free education will be followed with other changes that will benefit all PSWs, and that PSWs will be best able to provide excellent care.

In closing, I raise my hands to PSWs, the work that they do and the care they provide. I hope that this free education will be followed with other changes that will benefit all PSWs, and that PSWs will be best able to provide excellent care.


How do you infuse love in your organization?

Several years ago I was inspired as I read writings from Stephen Post and Thomas Kitwood defining love in dementia care.

“Love within the context of dementia care includes comfort in the original sense of tenderness, closeness, the calming of anxiety and bonding.” (Kitwood, 2003)

“Altruistic love involves both a judgement of worth, and a related affirmative affection. Love is manifest in care, which is love in response to the other in need; it is manifest in compassion, which is love in response to the other in suffering; it is manifest in companionship, which is love attentively present with the other in ordinary moments.” (Post 2003)

As I reflected on their writings, I thought of my esteemed colleague Misha Butot – Fourteen years after graduating as a social worker, while working as a counsellor, educator and yoga teacher, she recognized that love was a theme in all of her work. As a masters student Misha approached people across Western Canada who were involved in social justice work. She asked them if love was relevant in their work and what love in professional practice looked like for them. Even though they were diverse in age, gender, work and focus, ten common themes emerged. Fourteen years later, I approached Misha and asked if we could revisit those themes and translate them into plain English.

As we worked on this “translation” we were inspired by the stories from the research participants, we reflected on our own lives and we wrote a personal commitment to love in our professional practice.

This year, as we consider the most important theme of cultural safety in health care, I am inspired by the thoughts of Dr. James Makokis, an indigenous physician, “Racism is hate. The opposite of hate is love.” and he asks, “How will you infuse love into your organization?”

Racism is hate. The opposite of hate is love.” and he asks, “How will you infuse love into your organization?

Dr James Makokis

In this month of February, as many celebrate Valentine’s Day, love and friendship, I invite you to consider:

What does love look like in your practice?

How do you infuse love into your organization?

I’d love to hear your thoughts.

Once upon a time, there were competencies

Once upon a time, competencies were developed for health care providers in palliative and end of life care. There were competencies written for nurses, health care workers (nursing assistants, personal support workers, hospice aides), physicians and social workers, and others. There were competencies developed in many lands, in Ireland and the United States, in Nova Scotia and Alberta, in Ottawa and Vancouver, to name just a few. After creation, competencies struggled to be heard and adopted and too often were not used to inform curriculum or education development.

According to the Palliative Care and End of Life Working Group (2009) in their article, Competency-Based Education Approaches in Palliative and End-of-Life Care in Cancer, sponsored by the Canadian Partnership against Cancer, (pp. 15) they suggest that competencies may not have been adopted because they were misunderstood as being the same as “goals” or “learning outcomes.” In other places, it is possible that they were not adopted because there was confusion about how to define the competencies1.

And it is possible that certain educators, (myself included), just did not know where the competencies were, and that they could be incredibly helpful, inspiring and an essential resource for planning and developing education and educational materials.

For me, it was exciting when hospice palliative end-of-life care (HPEOLC) competencies came to life in my heart and in my hands. Here is my story:

I was writing a book – a textbook (Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse). I wanted the text to be useful for nurses in Canada and the United States. I wanted the text to help prepare students to meet the national competencies set for registered and practical nurses.

At first, I took the competencies and put them in a table format. I compared the competencies. I looked for differences and I looked for similarities. I went cross-eyed and just about went nuts.

Then I took one set of competencies, spread them across a football field (also called a mind-map). Then I took competencies developed by other groups and placed them individually, alongside other like-minded competencies. Eventually all the competencies were grouped together.

I returned to the outline for my textbook and asked myself whether to, and how to address the competencies in the text. Then I researched and I wrote. A few months ago, the textbook, Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse was published. Competency based, competency driven, competency inspired.

Now, we (myself and my great team) asked, “What types of companion teaching and learning resources can we develop that will help nurse educators to teach the different members of the nursing family to meet their respective competencies?” and “What can we do to help educators integrate hospice and palliative care in core curriculum?”

On a personal level, as a new year begins, I returned to the competencies to help me reflect on my practice and determine what I need to learn, and what I need to do to improve my practice. The competencies guided me in my writing, and now inspire me in my personal professional reflection.

Following is a list of the competencies that I refer to when planning education, and is the list of competencies that I refer people to when they are looking for HPEOLC competencies.

My Favorite Competency Documents

There are differences in the competencies written by different professions in different countries and for different purposes. Each group has a unique way of articulating, formatting, prioritizing and organizing. I think that most of the competencies represent similar knowledge, skills, and attitudes. Regardless of whether you align with competencies for this group or that group, this country or that country, all the competencies guide health care providers toward similar outcomes. While you may be required to use a set of competencies designed in the area where you work, it is also possible that you may still be inspired by the competencies developed outside of your area. There are provinces and states that have not identified competencies related to hospice palliative end-of-life care for members of the health care team or have very limited competencies. If you are in such an area, you may find one of these documents helpful.

A guided tour of the competency documents that I refer to in my practice

These competency documents help me when planning education, reviewing, and reflecting on education, and reflecting on my own practice. The competencies may be of help to you as you identify what you want to address in education that you are planning. I hope this list of resources is helpful to you in your work.

Nursing Competencies in Canada

CASN identified competencies and indicators for educating Registered Nurses in their document, Palliative and End-of-Life Care: Entry to Practice Competencies and Indicators for Registered Nurses. Their goal is for Canadian colleges and universities to use the “ … competencies may provide direction to curricula development; indicators may be used by nurse educators and students as a guide for assessing the development and integration of a competency.” 2

In Alberta, Canada, the College of License Practical Nurses of Alberta wrote that a “profession has strength when their contribution is clearly articulated. For the Licensed Practical Nurse profession in Alberta, this articulation is seen in competencies and education that outline the knowledge, skill, behaviors, judgments and attitudes that are expected of the profession.” They updated and launched their hospice palliative and end of life competencies in 2015. These competencies are clear and concise and may be very helpful as you prepare and evaluate education for practical and vocational nurses.

Personal Support Workers in Canada

The Canadian Association of Continuing Care Educators launched the Canadian Educational Standards for Personal Care Providers in 2012. The Ontario Ministry of Training, Colleges and Universities published the Personal Support Worker Program Standards in 2014, which includes learning outcomes related to palliative and end-of-life care, and accompanying performance objectives.

In a Canadian research study, a group of Personal Support Workers serving as palliative care champions in their facilities developed the Quality Palliative Care in Long Term Care Alliance Personal Support Workers Competencies. These more advanced competencies may be most useful in developing continuing education for experienced PSWs.

Jackie McDonald who helped create the PSW competencies

On the right is the fabulous Personal Support Worker, Jackie McDonald, who helped to write the PSW competencies associated with the Quality Palliative Care in Long Term Care.

Nursing Competencies in the United States

The American Association of Colleges of Nursing approved the end-of-life care competencies developed by ELNEC, that are available in the 2017 document, Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care. ELNEC identified entry level competencies for Registered Nurses. In this same article, they identify content areas where the competencies can be taught in a nursing program.

Nurses and Nursing Assistant in the United States

The Hospice Palliative Nurses Association provide advanced certification for Nursing Assistants, Practical/Vocational Nurses and Registered Nurses and Registered Nurses working with children. Competency documents and study guides are available for each of these groups.

Interprofessional Competencies in Ireland

The Irish interprofessional team identified competencies that the entire health care team share as well as identifying those that are profession specific in Palliative Care Competence Framework. Currently there is a team in Canada that is finalizing their interprofessional competencies. I will add them to this list when they are approved.

Now, my question for you: What competency resources do you use to guide your work?


  1. The literature has found that educators have been attempting to accurately define the notion of competence for several decades and have not yet reached agreement. Many authors argue that this confusion in what actually constitutes competence is what has slowed down the progression to competency-based education. … what makes matters even more confusing is that it is difficult to separate a competency from what have been called goals and objectives, and in fact many competencies that have been developed tend to be a combination of what others may call goals and objectives.” Palliative Care and End of Life Working Group (2009). Competency-Based Education Approaches in Palliative and End-of-Life Care in Cancer, Canadian Partnership Against Cancer, pp 15.
  2. Canadian Association of Schools of Nursing (2011). Palliative and End-of-Life Care Entry-to-Practice Competencies and Indicators for Registered Nurses.

Canadian Association of Practical Nurse Educators – Conference

What was news at CAPNE Conference?

We returned Wednesday from PEI where we attended the conference for the Canadian Association of Practical Nurse Educators (CAPNE). We saw the Anne of Green Gables Musical which was superb, and walked the streets and paths of Charlottetown.

Eighty CAPNE educators from across Canada came together to discuss education, and to enhance their abilities to provide excellent education for the students in the Practical Nursing programs.

The role of the LPN has changed, the scope has expanded! The colleges are tasked with helping students develop skills, behaviours and knowledge that once was covered in two and three year RN programs.

Elaine Leclerc spoke about generational differences, (the Traditionalists, Baby Boomers, Generation X, and the Millenials) and how these differences play out in the classroom setting and in the workforce. It was fascinating. I reflected on the many times we talk about multicultural issues, but neglect to contemplate the multi-generational conflicts… stemming from individuals coming from such different cultures within the same apparently homogeneous community.

Barb Fry ( had us hooting about challenges in the workplace while reflecting on our behaviours and attitudes and how they impact patient care, workplace relationships and quality of worklife. Barb discussed ideas for working with toxic characters such as the “workplace queens” and “negaholics”. What was most impressive to me was her resilience when her job was cut due to the merger of several hospitals, and how she was able to turn that into a wonderful time of growth and new opportunities. Years ago I came upon a quote that read

“Prepare then for opportunity disguised as loss.”

Barb has done a good job of doing just that!

It was a privilege to present the “Essentials in Hospice Palliative Care” resources at the conference, and I hope we can continue to provide support and resources to educators in the future.