Stepping up care in nursing homes
NURSE PRACTITIONERS COULD BE THE ANSWER TO WHAT AILS ONTARIO’S LONG-TERM CARE
Following a year of tragedy in Ontario’s long-term care sector, the Registered Nurses’ Association of Ontario (RNAO) is marking National Nursing Week by calling for action from the province.
The association, which represents registered nurses, nurse practitioners and nursing students in Ontario, wants the government to finally implement calls to expand and enhance the role of nurse practitioners in the province — a move they say will better deliver quality care in long-term care homes.
An April report from Ontario’s LongTerm Care Commission detailed how the sector wasn’t prepared when the pandemic’s deadly first wave hit Ontario in early March 2020. The virus spread like wildfire among residents and staff, and a slow response from the province only hampered efforts to fight the spread.
To date, more than 3,700 residents and 11 staff have lost their lives, according to the report.
“It’s been awful,” says Wendy Dunn, an attending nurse practitioner working in two long-term care facilities in southwestern Ontario. She describes how one of the homes went into outbreak in March 2020.
“We were right at the front of that wave,” she says. “We worked for years and years at making them homes, not institutions — in one fell swoop, that all got yanked away.
“They put this iron ring around us, and not even physicians could come in — they were told not to because of the risks they would bring in. And then no physiotherapists, no dieticians, none of that team we relied on.”
That’s when nurse practitioners like
Dunn stepped up.
Nurse practitioners have additional education and experience, which allow them to autonomously diagnose and treat illnesses and perform certain medical procedures. In nursing homes, attending nurse practitioners assisted with managing outbreaks and infection prevention, while compensating for gaps in staffing.
“There’s no way they would have got through the outbreak without somebody like me. It wouldn’t have had to be me, but a nurse practitioner,” Dunn says.
The RNAO says the failings outlined in the Long-Term Care Commission echo issues the association has raised for more than two decades.
Even before COVID-19 devastated the fragile sector, the RNAO began developing a set of recommendations to optimize the nurse practitioner role in Ontario. Among the proposals in the Vision For Tomorrow task force report: beef up supply.
“When you look at Canada overall, we are shamefully short of nurse practitioners compared to the U.S., where they have been used extensively,” says Doris Grinspun, CEO of the RNAO.
While the number of nurse practitioners in the U.S. is rapidly growing — more than doubling between 2010 and 2017 — the workforce in Canada is strikingly low. Fewer than 6,000 such nurses are practising in settings like primary and long-term care, based on 2019 data from an RNAO task force report.
The Long-Term Care Commission says it heard overwhelming evidence of both an overall shortage of staff, along with a staffing mix that couldn’t meet residents’ increasingly complex health-care needs.
“The staffing situation in long-term care is untenable,” the Commission reads. “Immediate steps must be taken to address it.”
The RNAO suggests a target of one nurse practitioner per 120 long-term care residents — with a staffing mix comprised of registered nurses, registered practical nurses and personal support workers to ensure the number of hours of direct hands-on care is increased to an average of four hours per day per resident.
“During the pandemic, those nursing homes that had nurse practitioners performed significantly better,” Grinspun says. “So we are not saying one NP for every 120 residents just because we want to increase the number. We’re saying that’s the ratio if we want to have better health outcomes in nursing homes.”
Expanding the nurse practitioner practice in Ontario would result in improving access to acute and primary care, lead to more comprehensive care for vulnerable and underserved populations, and improve health-care cost outcomes across all sectors, according to the RNAO.
The report also recommends expanding the scope of practice for nurse practitioners, investing in research to support the practice and ensuring all insurance benefit carriers accept nurse practitioner services.
Meanwhile, Grinspun has penned a letter to Ontario Premier Doug Ford, asking the government to recognize Nursing Week by announcing 100 additional attending nurse practitioners be made available over the course of 2021 to long-term care homes that are most in need.
“We are actually demanding. Not urging, not asking,” Grinspun says. “We have been on record for saying one NP for every 120 residents for a long time. The tragedy is that it hasn’t moved fast enough.”