Workloads compromise care: nurses
As patient volumes continue to rise in Ontario hospitals, the search for efficient health care sharpens
Nurses across the province say an increase in workload is threatening patient care.
“This is becoming a huge problem,” says Vicki McKenna, a vicepresident with the Ontario Nurses’ Association, who says nurses in hospitals are being asked to take on more patients. For example, “instead of having one patient in ICU, they’ll have two.”
McKenna says studies show that one additional patient added to a nurse’s workload can result in a 7 per cent rise in mortality rates.
Ontario has the second lowest per capita rate of registered nurses, and one of the lowest rates of registered practical nurses, in the country, despite a slight rise in their numbers overall from 2011 to 2012.
One reason for the increased workload is that patient volumes in Ontario hospitals continue to rise, especially in emergency departments, says Pat Campbell, president and CEO of the Ontario Hospital Association.
As well, acute care beds in the province have gone down 38 per cent, which has resulted in “occupancy pressures in hospitals,” says Campbell.
Nurses are dealing with higher patient turnover and acute-care beds that are full all the time.
“Our suggestion to the province is more funding for communitybased services, because that’s where patients want to be,” says Campbell.
The number of acute care beds has fallen as hospitals move to a model of care that includes less invasive surgery, increased care on an outpatient basis and additional investments by the province in community care that have resulted in shorter hospital stays, says Campbell. But there is still not enough capacity and 14 per cent to 17 per cent of acute care beds have patients waiting to move because of a lack of services such as home care, longterm care or rehabilitation. The reduction in beds also results in intense circumstances for nurses who are working with high-needs patients in shorter periods of time, says Dianne Martin, executive director of the Registered Practical Nurses Association of Ontario. And the reduction in beds means the majority are filled all the time, she says. A recent survey by the association identified workload as a major reason RPNs would leave the profession. Overworked nurses burn out and leave, because they’re overwhelmed by a feeling that they haven’t done enough for their pa- tients, says Martin, who worked in obstetrics for 34 years.
McKenna says budget pressures have resulted in hospitals replacing nurses with lesser skilled nurses, or, in some cases, none at all, and adding patients to each nurse’s workload.
The number of registered nurses employed in the province in 2012 was down nearly a thousand from a high of 93,916 in 2010, according to the College of Nurses of Ontario.
But the number of registered practical nurses (RPNs), who have a two-year diploma, not the four-year degree RNs have, made up the loss as the number employed in the province rose for the eighth year in a row.
There were 32,858 employed in 2012, up 1,400 from the year before. RPNs work with patients who have more reliable outcomes or alongside other healthcare professionals, such as RNs, when they don’t. Salaries can start in the low $20-per-hour range.
Campbell says there is no move to replace RNs with lesser-paid RPNs, but that nursing is changing as the model of healthcare delivery continues to change.
“There’s certainly pressure to focus on value — so that you don’t have too many overqualified people, if you can provide a service effectively,” she says. “And that’s the big question: What are the patientcare needs?”
Full-time RNs generally work 1,950 hours a year with a starting hourly wage in the mid-$20 range. A senior nurse would make $43.61 per hour.
McKenna says her association wants the province to stop allowing hospitals to lay off nurses and add more patients to their workloads.
“It’s a bad solution and shortsighted,” she said. “We’re dealing with people’s lives here. It doesn’t work for patients. And it doesn’t work for nurses.”
More and more, disputes about workplace issues between nurses and hospitals are going to an outside independent nursing committee for resolution, because the two groups can’t solve the problem, says McKenna.