Who best to care for patients on a one-on-one basis in hospital?
The answer varies depending on whether it's a registered nurse or a registered practical nurse, but while many are uncomfortable with the shift from the former to the latter, still others see it as a good solution to staffing and money shortfalls.
A shortage of registered nurses has seen QHC embark on a plan to shore up the RN vacancies by inserting more registered practical nurses into patient care scenarios that had previously been the area serviced by RNs. This also accomplishes another goal -- to help reduce QHC's burgeoning deficit, predicted to reach $15.1 million by March 31, 2010 -- since RPNs make about half the annual amount of RNs.
At the same time, personal support workers (PSWs) -- roughly the equivalent of the old orderlies who were a hospital staple for years but were phased out a few decades ago -- have been hired to fill the gap left by RPNs who are assuming a larger nursing role. The change was recommended in the Murphy Walsh consultant's report, also known as the self-improving system for hospitals.
The shuffle was not palatable to all concerned.
"There was a lot of controversy," admitted Kim Hennessy, an eight-year RPN who worked on the 58-bed acute-care floor (Quinte 5) at Belleville hospital until moving recently to Trenton Memorial.
But during an interview, she said the controversy was overblown because RNs and RPNs were too busy to do all the things necessary to improve a patient's stay in hospital. Now, PSWs can spend time with patients, talking, washing them -- doing the tasks needed for daily living, Hennessy said, while nurses can tend to the medical care of patients. The system was installed on Q5 this past June. The change has been remarkable, she said.
"Quality of care drastically improved," Hennessy said. "We were being pulled in so many directions. We were doing it all. It was burning us out. We didn't feel good about the care."
Hennessy was blunt in her assessment.
"They are balancing the budget on our backs," Hennessy said, but added that doesn't change the fact that the Murphy Walsh provisions have improved nurses' work lives and patient care.
But the fallout -- as many as 45 RN positions have received layoff notices to take effect April 30 (about 30 per cent of the positions are already vacant) -- came as a surprise to some. The Murphy Walsh report was to improve the work life of nurses, but it also recommended replacing RNs for tasks that could be done by RPNs and PSWs as a cost-saving measure. Other departments were given layoff notices, too, including five at the lab at Picton hospital
Kelly Pound, a 27-year RN who is the team leader on Q5, agreed the changes improved the situation -- for awhile.
That was when alternate level of care patients (ALC) filled almost half the beds on the floor. Those patients are usually elderly who are ready for discharge from hospital but there are no nursing home beds available. They require less care, so cutting RNs to six from 10, bringing the RPN complement up to six from five and adding four PSWs during the day when things are more hectic, worked fine. No one lost their jobs, either, because the RN positions were vacant due to the nursing shortage, said QHC spokeswoman Susan Rowe.
But in September, the ALC numbers dropped to about 10 from 24, and the beds were filled with acute-care patients, many with a high degree of medical problems, Pound said.
Vice-president of patient services and chief nursing officer Katherine Stansfield said the staff changes regarding nurses was given to the Ontario College of Nurses and the college saw no problem with the plan.
Several studies conducted by the Ontario Nursing Association -- the nursing union -- have shown that mortality rates go down when RNs are the primary care nurses.source
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