Bedside view drives lobbying efforts [nursing & advocacy]

TheStar,com – News/healthzone.ca
May 10, 2010.   Judy Gerstel, SPECIAL TO THE STAR

Ontario’s registered nurses don’t want to just administer drugs, start intravenous lines and suture incisions, although they do all that and more.

They won’t even be satisfied with nurse practitioners being granted responsibility to admit and discharge patients to and from in-patient settings and to prescribe medication, though they are asking for that.

And while they continue to promote the hiring of 9,000 additional registered nurses by 2011, as promised by the Ontario government in the 2008 budget, even that now unlikely scenario won’t satisfy them.

The 29,000 members of the Registered Nurses’ Association of Ontario, observing its 85th anniversary, will be satisfied with nothing less than changing the world for the better.

And they want to start with Ontario.

“Nursing doesn’t work in a vacuum,” says Doris Grinspun, RNAO’s executive director.

“We’re not just nurses in terms of bedside care,” agrees Joseph Gajasan, a nurse in the cardiac unit of Toronto General Hospital. “It’s within our scope, our responsibility to the public we serve, to look beyond the issues of the profession.”

Even with the next provincial election more than a year away, RNAO presciently put forth a report in January titled “Creating Vibrant Communities,” a set of socially progressive policies it wants provincial political parties to adopt in their platforms.

Among them: increasing the minimum wage to $13.25, terminating all coal burning at Ontario power plants by 2012, introducing a carbon tax and rejecting the sale of publicly owned Crown corporations such as Hydro One and the LCBO.

“The issues that concern nurses are not narrowly defined,” emphasizes Wendy Fucile, who was RNAO president until recently and is interim director of Trent University’s school of nursing. “An enormous number of issues have huge potential impact on nurses in their work life and on the communities they serve.”

Foremost among them, she says, is poverty.

“You can’t work in any area in nursing, even teaching in a university setting, and not be exposed to people living in horrific poverty,” observes Fucile, who says she sees students struggling to pay for food.

She says nurses are aware of “the degree to which poverty and ill health walk hand in hand . . . they see things in their practice that lead them to ask for leadership in policy.”

Other issues command attention.

“We hear from front-line nurses every day,” says Fucile. “One issue that is at the top of their minds is what’s going in their workplaces and the quality of the work environment: How safe are you? Do you have the right equipment? Are there enough of the right kind of nurse to deliver proper care?”

An unstable, complex patient, she emphasizes, requires one registered nurse per shift to deliver sustained care, rather than being treated by a fragmented team.

“Full-time RNs, as compared with part-time and casual employees, are closely associated with lower mortality rates,” states the “Vibrant Communities” report.

It recommends each patient be assigned one nurse per shift. “RNs should be assigned the total nursing care for complex or unstable patients with unpredictable outcomes.”

Meanwhile, Fucile says some front-line nurses are concerned about how hospitals are dealing with the minimal 1.5-per-cent increase in funding provided by the province in its March budget.

“We hear and know there have been some layoffs around the province,” she says. “We’re watching it very carefully. We’ll see how much impact there is and we’ll be speaking out as the picture becomes clearer.”

“Unfortunately, the province, in the past, has had a bad track record of trying to balance budgets on the backs of nurses. . . It isn’t a good-value proposition to reduce the number of nurses because that only increases readmissions and reduces quality of outcomes.”

But Ontario Health Minister Deb Matthews denies that nursing jobs are being cut.

“While you have seen stories of layoff notices at hospitals in the news, in many cases, nurses will find employment within their own organization,” she says. “It should be noted also, with our commitment to our Aging at Home strategy, nursing resources are being shifted from the hospital to the community. . . We will be investing over $1 billion over four years to increase supports at home.”

Another reason for heightened vigilance: the province’s contract with nurses expires next March and a wage freeze for public employees was decreed in the recent budget.

Matthews says the salary freeze “will not affect the government’s commitment to support the creation of new nursing positions every year.”

Grinspun, who says she speaks from the historical perspective of being RNAO executive director since the 1990s, and experiencing the “Hula-Hoop time” of former premier Mike Harris, is very optimistic this time around.

“Both in numbers (of RNs employed) and full-time (positions), we have made tremendous gains. In the past 10 years, we’ve seen a decrease in part-time and casual nursing, alongside an increase in full-time. And that is critical, for patients, to have the continued care.”

She also cites a significant decrease in multiple employments — “nurses running from job to job, like chickens with their heads off, to make a living.”

“We used to have 18 per cent of nurses working for multiple employers, and now we have 8 per cent or less. We used to have barely 50 per cent working full time and now we have 66 per cent, and the Liberal government has committed to getting to 70 per cent.”

All this, she says, is important for retaining nurses in Canada.

“Whether the wage freeze will change things remains to be seen. Let’s let the negotiations happen.”

What fuels Grinspun’s optimism most is that “politicians are beginning to understand, not just politically, but policy-wise, the importance of nursing. I think we are getting there, finally.”

It wasn’t only about catheters and balloon pumps when nurse Joseph Gajasan invited MPP Rosario Marchese to visit the cardiac care unit at Toronto General Hospital last May for “Take Your MPP to Work Day,” an annual event organized by the Registered Nurses Association of Ontario.

Nursing accomplishments and the complexity of cardiac technology — showing it off, on the part of the nurses, and learning about it, on the part of Marchese — were undoubtedly the main events.

“He was asking a lot of questions,” says Gajasan. “He was very engaged and surprised by the technology and amount of work we do.”

But there was more going on, say both the nurse who issued the invitation and the NDP MPP.

Although Gajasan lives in Mississauga, he invited Marchese, the MPP for Trinity Spadina, because the hospitals are in his riding, so “his work will affect my work,” says the 28-year old RN. “Also, about 80 per cent of our practitioners live in his riding.”

That alone was a good reason for Marchese to accept the invitation.

“It was a good day,” he recalls, “good for me and good for the nurses. They lead a busy life and often don’t get to talk to politicians. It was good for me to go and learn about what they do — and they learned from me. What I told them is how we can be lobbied. If 10 or 20 or 30 nurses who live in my riding come to my office, talking about the same thing, it would be powerful lobby.”

Inevitably, there was talk was about jobs.

“They’re concerned about their jobs and losing their jobs,” says Marchese. “We hear of nurses being laid off. We were worried. They’re a big part of our health-care system. We need them.”

Gajasan agrees. “I get a little nervous when I hear about job loss but always think of it as a cycle. During the Harris years, there were a lot of job losses but I don’t think it will be that big. Canada is quite resilient compared to other countries.”

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