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Community nursing plays greater role in Ontario as hospitals and province strive to reduce costs

When people hear that Linda Keirl is a palliative care nurse, they automatically assume her job is depressing.

But the Windsor native, who works as a registered practical nurse for St. Elizabeth Health Care, says that couldn’t be further from the truth.

“Oh my gosh, it’s the best,” she says. “I have the best conversations with family and patients. They are amazing in the gifts they give, the wisdom and the courage.”

As Ontario hospitals continue to downsize, Keirl is among a growing contingent of registered practical nurses who work in the community. In 2012, there were 6,605 RPNs working in the community sector, up 26 per cent from 2011. They represented 16.5 per cent of RPNs employed in nursing in Ontario.

The simultaneous beefing up of the community sector and downsizing of the hospital sector has been far from smooth. Demands on both sectors are huge, leaving them both stretched. And taxpayer dollars are limited.

The ongoing rationalization of hospital services in Ontario has been a bumpy ride for health-care workers like Keirl.

She has been a nurse for 38 years, 30 of those in hospitals. She left in 2003, dissatisfied with her job. She had been transferred to the cardiology unit five years earlier, after the obstetrical unit where she had worked for 25 years was moved to another hospital.

“I wasn’t really happy with going to cardiology. I wasn’t really happy with getting a letter telling me I was redundant,” she says.

She spent the following two years helping care for her mother-in-law, who was dying of cancer — an experience that opened her eyes to the

“She wanted to be in her own home, around her own things, in an environment where her grandchildren could come in and out.” NURSE LINDA KEIRL, ON MOTHER-IN-LAW’S HOME CARE

value of home-care nursing. Interacting regularly with nurses who visited her mother-in-law, she got a first-hand look at their jobs. “They were awesome. They were my mentors,” she says, explaining that they inspired her to follow in their footsteps. She was particularly struck by how they made her mother-inlaw’s experience with death so much easier, by allowing her to die at home, as she wished. “She wanted to be in her own home, around her own things, in an environment where her grandchildren could come in and out,” Keirl says. The growth of community nursing has been fuelled by the need to cut hospital costs and by the fact many patients prefer to stay in their homes as long as possible. “Caring for people in their homes, when possible or appropriate, is desirable, firstly because so many of our patients prefer to be at home, but also because it is a cost-effective way of providing care,” says Dianne Martin, executive director of the Registered Practical Nurses Association of Ontario. “While obviously it is not always appropriate, and people do from time to time need the round-theclock acute care that hospitals provide, it is a great strategy to move everyone who can be at home, home.” After her mother-in-law died in 2005, Keirl began working in palliative care for St. Elizabeth Health Care. She finds immense satisfaction in helping bring peace and comfort to those in their final days.

Her job brings her into the most intimate moments of a family’s life.

Keirl talks to patients who are afraid of death and helps them deal with fears, such as pain or choking.

She also listens as they reflect on their lives.

“Those conversations happen a lot. What if I had done something a little different, what if I’d had a better time doing this or that.”

Her presence at the bedside is often as important to the family as it is to the patient. They are anxious about not being able to cope if something goes wrong and she isn’t there.

A big part of her job is educating family members on patient care. She teaches them how to give pain medication, how to turn patients regularly so they don’t get bed sores, how to wash them and even how to actively listen.

“Families can be pretty hesitant about having conversations at end of life,” she says.

“Sometimes you have to really listen to cue in about when they need to talk about walking through that door.”

She also gets satisfaction from the gratification patients and their families show her.

“There are lots of hugs and lots of people saying, ‘You did the best job in the whole world.’ ”