Health minister, nursing college square off over qualifications

Manitoba’s health minister and the province’s nursing authority are at odds over qualifications after a disciplinary panel stripped a licence because of “shocking” misconduct that nearly ended a patient’s life.

The College of Registered Nurses of Manitoba issued a 41-page decision on Nipaben Patel Thursday about her actions at Lynn Lake Hospital’s emergency department in 2024.

“This was not a single mistake or a simple medication error — it was a series of demonstrable failures of judgment by the registrant,” the decision said.

Registrar Deb Elias called on the province to reconsider a 2022 order to license RNs from other provinces who don’t have recent Canadian experience, arguing it has left the college in an “impossible position” because it can’t ensure that registered nurses from other jurisdictions are experienced and competent.

Health Minister Uzoma Asagwara responded later in the day, calling the misconduct in the case rare and telling the college it has to establish registration requirements while, at the same time, abiding by free trade labour mobility rules.

Thursday’s call-and-response resumed a long-simmering disagreement between the authority and the health minister, who has been dealing with a chronic shortage of nurses in the province and mixed results with recruitment and retention efforts.

In 2022, the province issued a compliance order and subsequent ministerial directives that the college — the profession’s regulator in Manitoba — may not require proof of recent nursing practice in a Canadian jurisdiction from an applicant currently registered as an RN in another province or territory.

The latest directive from Asagwara in June said labour mobility obligations under internal trade agreements — the Canadian Free Trade Agreement and New West Trade Partnership Agreement — required the province to register a nurse registered in another province.

At the time, the minister called the college “a barrier to nurses successfully joining the front lines and they’re leaving Manitoba as a result, or not considering Manitoba as an option.”

The registrar responded by saying that the province was putting labour mobility and its support for interprovincial free trade ahead of patient safety and lives.

“Professional regulatory bodies like the college are put in an impossible position when we are directed to only apply substantial regulatory oversight after professional misconduct has occurred.”

On Thursday, Elias repeated her concern.

Patel, a former midwife who hadn’t worked as a registered nurse since leaving India 13 years earlier, was able to take an exam in New York state in 2023 that enabled her to register in Ontario, and then Manitoba. She ended up working for private nursing agencies on contract and took shifts at the Lynn Lake nursing station in 2024.

When paramedics arrived with an unconscious 55-year-old man on Nov. 6, 2024, Patel didn’t know what she was doing when, without a doctor’s orders, she administered a paralytic and fentanyl and intubated the patient, whose vitals crashed, the agreed statement of facts said.

It said she lacked the knowledge, skill and judgment to make the right choices and conduct herself “in a manner consistent with the requirements of competent registered nursing practice.

“This resulted in an outcome that would have caused the patient’s death if they had not been resuscitated by the paramedic present in the trauma bay,” the decision said.

Patel’s registration was taken away and she was fined $10,000 to cover the costs of the investigation and proceedings.

“Incidents like the one documented in the Patel decision are generally preventable through the application of reasonable, appropriate standards and requirements for registration,” Elias, the registrar, said in a prepared statement.

“The tragic events (in Patel’s case)… drive to the core of the college’s concerns regarding the Manitoba government’s continuing directive that the college may not require or set a standard for currency of practice for labour mobility applicants seeking registration in Manitoba.”

Elias asked for a meeting with the province.

“Professional regulatory bodies like the college are put in an impossible position when we are directed to only apply substantial regulatory oversight after professional misconduct has occurred.”

The panel that ruled to remove Patel’s registration agreed.

“With hindsight, had the registrant been subject to a (critical competency assessment) before being endorsed as a registrant with the college in 2023, these tragic events and this proceeding might have been avoided in their entirety.”

It appears the nurse was “set up to fail,” said Manitoba Nurses Union president Darlene Jackson.

“Not allowing the college to actually assess and do education with these individuals is not helping them and it certainly isn’t helping our public health-care system,” Jackson said Thursday.

Such cases “do not reflect the everyday care provided by nurses across Manitoba, who show professionalism and compassion in their work every day.”

 

Asagwara said such cases “do not reflect the everyday care provided by nurses across Manitoba, who show professionalism and compassion in their work every day.”

The college says it received 215 complaints in 2025, up from 148 in 2024 and from the previous record number of 189 complaints in 2023. It’s seeing a rise in employer reports involving “serious and complex concerns and, like the Patel matter, have required urgent referral to the complaints investigation committee.”

Asagwara said that registration standards and disciplinary decisions are set by the college “within the legal framework established by legislation.”

“When policies need to be adjusted to align with the law, regulators update them accordingly. The government does not make individual licensing decisions.”

When it comes to oversight of nursing agencies, “we have been clear about patient safety expectations and have taken action when concerns were raised. This includes direction to agencies to ensure nurses meet appropriate requirements around recent practice hours and readiness for the roles they are placed into,” the minister’s statement said.

Asagwara said the province is open to recommendations from the college “in the interest of safe, high-quality care for Manitobans in every community.”

Premier Wab Kinew said he wants to see more nurses working in Manitoba, internal trade barriers removed and for patients to be safe.

“I think it is a wake-up call and a reminder of the fact that when people are asking for trade barriers to be brought down, well, we need to take the time to get those right.”

Tory health critic Kathleen Cook called for Asagwara to meet with the college and determine “how best to ensure Manitoba is a competitive environment for nursing recruitment while ensuring patient safety is paramount.”

-With files from Tyler Searle

carol.sanders@freepress.mb.ca