St. Joes backs off nursing plan for babies
‘We have listened and are pausing’: official
St. Joseph’s Healthcare is reassessing a cost-cutting plan to have lower-paid and less-educated nurses look after sick and premature babies in the special care nursery.
“In relation to some issues that have come forward, we have listened and are pausing,” said Winnie Doyle, vicepresident of clinical services and chief nursing executive. “We will review and see if there is anything we’ve missed or haven’t taken into account and we’ll make a decision.”
The Ontario Ministry of Health asked for the data behind the decision to replace four registered nurses certified in neonatal care with registered practical nurses without specialty training.
“Obviously there have been strong reactions,” said St. Joseph’s CEO Kevin Smith.
“We’re just making sure we’re doing all the right things.”
Concerns were raised by the Registered Nurses’ Association of Ontario, which is a professional body, and the Ontario Nurses’ Association, which is the union.
“We have to put a stop to things that are simply dangerous to patients,” said CEO Doris Grinspun of the RNAO. “There is a limit.”
Grinspun cut a vacation short when The Spectator reported that St. Joseph’s was believed to be the first hospital in Ontario to add RPNs to the staffing mix in its Level 2 nursery, which cares for babies born up to eight weeks early, need help breathing or require intravenous therapy.
“I saw the front page of The Hamilton Spectator and I went berserk,” she said. “We went to the ministry right away … It shocks me a nurse leader would support this or the CEO.”
She says RNAO was already voicing concerns to the ministry about Ontario hospitals balancing their budgets by replacing some RNs with RPNs on medical and surgical floors when St. Joseph’s “took it up another notch.”
“Here is where we draw the line in the sand,” she said. “Babies who need to be in a neonatal intensive care unit are very fragile. They can change in a minute. They can aspirate while feeding. They can have cardiac arrest.”
She says the association demanded immediate action because “we can’t wait even one day.”
Under Ontario regulations, RPNs have college diplomas and work with stable and predictable patients while RNs get university degrees and care for sicker and more complex patients.
The hospital planned to move from having five specialized nurses staff the unit at any one time to four certified RNs and one RPN in July. Doyle said the RPN would look after stable babies such as those apprehended by a children’s aid society or transferred from a Level 3 NICU. The Registered Practical Nurses Association of Ontario said it was appropriate as long as there is a “lower level of acuity with more predictable outcomes.”
But the nursing union argues there is no guarantee there will be enough stable babies in the nursery at any one time and points out their conditions can change rapidly. In addition, the nurses attend deliveries, leaving the nursery with fewer staff.
The final decision is expected to be made as close to the beginning of the fiscal year April 1 as possible.
“The clock is ticking,” said Smith about the need to find $26 million in cuts to balance the $550 million budget by March 31, 2017. Ontario’s hospitals got their first base funding increase in five years with a $345 million boost in February’s provincial budget. But it is not enough to stop planned cuts at St. Joseph’s and Hamilton Health Sciences.
RNs are much more expensive for the hospital making between $31.02 and $44.84 an hour while a job posting for an RPN at St. Joseph’s Hospital listed the pay as between $26.83 and $29.15 an hour.
“This is the tip of the iceberg,” said Grinspun. “You will see more coming.”