By Cynthia Johansen and Rob Calnan

Over the weekend, the College received messages from a number of nurses in B.C., and that message was clear: nurses are frustrated with the fee increase and decisions that led us to this point.

The Board of the College and staff work hard to limit fee increases. We had hoped to sell our building before the Board met at the start of December, so we could have announced a lower fee increase for registration renewal. Government requires the College to submit a fee increase ahead of the renewal date, which was done on December 1, 2017.

We are pleased to report that the building sale finalized on December 21, 2017. Due to this, registrants will pay an increase of $67.84, instead of $98.55 in 2018. CRNBC will cover the additional cost of professional liability insurance for the 2018 year, and are also reducing the cost of nurses’ professional liability protection over the next two years. We have more information about this on our website.

We know that this reduction doesn’t change the fact there is still a fee increase. And it doesn’t change the fact that many nurses have contacted us to register their concern. (If you haven’t read it, head over to the announcement on our website.)

As we reviewed these messages we noticed some consistent themes in the questions, comments and feedback, and we will to respond to these in this blog.

What have we heard from nurses?

Our decision to move to a new location in downtown Vancouver, the creation of a single nursing college, and our increased regulatory work plus the associated costs, received the most attention from nurses.

We’ll talk to each item separately, starting with the decision to move to downtown Vancouver. It was this decision that received the most feedback.

Moving to downtown Vancouver

The CRNBC building on Arbutus Street has served the organization well – and we are running out of space, as well as access to enough electricity, water and toilets to meet the needs of staff. The Arbutus building would require an expensive structural renovation, which would have meant an even larger fee increase. As a result, the option to stay in our current location was rejected by the Board.

We know that many nurses understand that the College needs to move, however you have questioned the location.

The decision to move from the current location included many considerations, cost being a key factor. In addition, the Board needed to consider accessibility to the location by staff and by stakeholders; the ability to collaborate with our partners, as directed within the Health Professions Act; sufficient space to enable the three colleges to come together as one organization; and the opportunity to enable multiple regulatory colleges to join the nursing college in the new space. While this last factor was not a key driver, CRNBC sees this as an opportunity to develop and enhance our regulatory work, and through this collaborative approach, we believe we will be able to reduce future fee increases.

So why downtown Vancouver? The three nursing Colleges worked with a real estate agent over the past 2 years to consider locations. When we started the exercise, there were many locations available. Many were not suitable (for example, no access by transit).

By the time the three colleges were ready to make a decision, our choices were very limited. The three colleges looked at a number of spaces, including other areas in Vancouver, and in Burnaby. The cost difference for the location downtown was not significantly different than the locations in Vancouver and Burnaby.

Our reality is that we have to move. The Board was faced with the choice of a costly upgrade of the old building, which would have required a more significant fee increase, or the sale of 2855 Arbutus Street.

The Board also took this opportunity to plan for the future. As regulatory costs go up, the Board decided on a long-term strategy to help smooth the increasing cost of regulating nurses in the public interest.

This brings us to the next point raised by nurses, namely the costs associated with co-creating a single nursing college.

One nursing regulator

A number of the messages we’ve received from nurses asked the leadership of the College to “tighten our belts, trim the fat and keep budgets in check.” This is a fair request, and one the Board and staff have been working to achieve for the past six years, during which time we have not raised our fees.

We acknowledge that registrants were asked to pay more last year, as ARNBC increased their fees which we collect on their behalf, but those are not our monies.

As the health care environment becomes increasingly complex, so do the challenges facing the regulator. The cost of regulation has, and will continue, to increase and the College is always searching for new ways to reduce the cost of regulation.

While the staff of the three colleges have collaborated on a number of areas over the years, the boards determined that co-creating a single nursing college in British Columbia was in the public interest. By co-creating a new college, nurses of all designations will contribute towards the one college, streamlining processes and creating a more efficient regulatory body for the public, stakeholders, government and registrants. This is one of our key strategies for reducing fee increases. While there is a cost increase now, co-locating with the other colleges and selling the Arbutus Street building is part of the long-term strategy to manage fees, and meet our strategic goals.

The work required to amalgamate the three colleges is large in scope. To harmonize standards while maintaining the distinct nursing designations is resource intensive, as are the logistics of relocating. These are critical factors resulting in the need for a fee increase; the increased costs of regulation have also had an impact.

Increasing costs of regulation

We’ve also heard from registrants over the last few weeks, asking for more clarity on what the extra fees are for.

There is really no one answer to this question. It is a combination of factors. The Board and the staff of the College have been working to control costs. What we cannot control is the increasing complexity of the health care environment in which nurses work – and that you experience every day. These complexities result in increased work for the regulator as we respond to changes in the environment.

The 2018-19 fee schedule was impacted by the significant increase in the complexity and the volume of complaints and other regulatory work needed to ensure we can fulfill our mandate to protect the public.

We described this in the original fee announcement, and it’s worth repeating. Here are the key regulatory reasons for the fee increase:

  • We have seen a 30% increase in the amount of complaints we’ve received, in the past year alone. Each complaint requires resources to investigate and, depending on the issue, conduct disciplinary hearings.
  • We have improved and expanded our quality assurance program to help support nurses with continuous professional improvement through multisource feedback. Quality assurance is a requirement within the Health Professions Act, which guides the work of the College.
  • The increased complexity of the regulatory work required to meet challenges such as the opioid crisis and medical assistance in dying legislation (amongst others).

If there is one thing we would like for you to take away from this blog, it’s this: there’s no single reason for the increase; rather, it is a combination of factors. Taken on their own they might seem to be easily overcome, but taken together they have exerted great pressure on CRNBC, and on the Board.

“Why didn’t we get a say in the matter?”

Lastly we want to touch on a recurring theme. “Why don’t we get a say in the fee increase? Why don’t we get a say in the location of the new college?”

It is the mandate of the College to protect the public, and by doing so, to help safeguard the public’s trust in the profession. And it is the Board’s responsibility to ensure the long-term viability of the College, whether that’s through the setting of fees, approving education programs, approving new or changing standards of practice, or determining how best to accommodate a growing work force, to name just a few.

Why don’t you, and your fellow nurses, have a direct say?

Your feedback, and the feedback of all nurses is important. That said, the governance structure of all colleges under the Health Professions Act is through decisions of a board made up of both registrants and appointed public members. The Board carefully considers all strategic matters of the College, and makes decisions to ensure the achievement of the mandate can continue. Nurses influence and make decisions about the work of the College through participation on the board, on committees, and through other forms of involvement such as participation in focus groups, contributions to changes in standards, responding to surveys, etc. The governance structure does not allow for individual votes by registrants on matters of running the College.


It is our responsibility to manage the cost of the regulatory work, and we have been able to keep CRNBC’s fees stable for the past six years. Unfortunately, and due to the reasons listed above, the College must increase the fee for the 2018 year.

As we stated at the beginning of this message, the board and staff work hard to control fees, and we will continue to do so. The sale of the CRNBC building will provide some needed relief against the current increase.

We also believe that the move to co-create a new regulatory college, and to continue to improve collaboration within the health care system will help reduce some of the costs of regulating nurses in B.C. These steps are all part of our vision to continue to protect the public, safeguard the public’s trust in the profession and strengthen our regulatory work, while working to minimize future fee increases.

Finally, we want to thank all the nurses who took the time to send us their questions and concerns. We are listening and we will continue to look for ways to innovate and collaborate to strengthen our role, while managing our costs.

Rob Calnan, Board Chair
Cynthia Johansen, CEO/Registrar