Hot! Ontario nurses say patient care is compromised by increasing workloads

TheStar.com – Life/Nursing Week – The addition of one patient to a nurse’s workload can increase mortality rates, says the Ontario Nurses’ Association.
May 07 2013.   By: , News reporter

Nurses across the province say increased workloads are threatening patient care.

“This is becoming a huge problem,” says Vicki McKenna, a vice-president 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 adding patients to a nurse’s workload can result in a rise in mortality rates.

Ontario has the second-lowest rate of registered nurses per capita in Canada (70.8 RNs for every 10,000 residents), and among the lowest rates of registered practical nurses (23.5), despite a slight rise in their overall numbers last year.

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, the number of acute-care beds in Ontario has decreased by 38 per cent over the past 20 years, which has resulted in “occupancy pressures in hospitals,” says Campbell. That means nurses must deal with high patient turnover and acute-care beds that are full all the time.

She explains the number of acute care beds has been reduced as hospitals move to less-invasive surgery, increased care on an outpatient basis, and improvements in community care that have resulted in shorter hospital stays.

But an average of 14 to 17 per cent of acute care beds are tied up by patients waiting to move into home care, long-term care or rehab centres.

“Our suggestion to the province is more funding for community-based services, because that’s where patients want to be,” says Campbell.

But McKenna says budget pressures have resulted in hospitals cutting nurses, or replacing RNs with lower-skilled, and lower-paid, RPNs.

According to the College of Nurses, the number of RNs employed in the province in 2012 fell by nearly a thousand, from a high of 93,916 in 2010. Most RNs have four-year university degrees.

But the number of RPNs employed in the province rose for the eighth year in a row, up by 1,400 to 32,858. Most RPNs have two-year college diplomas.

RNs earn about $21 to $44 per hour, while RPNs earn $20 to $25.

Campbell says there is no deliberate move to replace RNs with RPNs, but that the role of nursing is changing as the model of health-care 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 patient-care needs?”

McKenna says her association wants the province to prevent hospitals from laying off nurses while adding more patients to the workloads of those who remain.

“It’s a bad solution and short-sighted,” she says. “We’re dealing with people’s lives here. It doesn’t work for patients. And it doesn’t work for nurses.”

All nurses working in hospitals are feeling the pressure, says Dianne Martin, executive director of the Registered Practical Nurses Association of Ontario.

A recent survey by the association identified workload as a major reason RPNs are considering leaving the profession.

Martin says overworked nurses burn out and leave, because they’re overwhelmed by a feeling that they haven’t done enough for their patients.

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2 Comments

  1. This article seems to highlight some policy issues and structural changes that need to be made. RN’s cost more to employ than RPN’s but they also have a higher skill set due to their four years of university learning. When the RPN’s are brought in to take over or replace the RN’s thy are being over worked and possibly out of their skill level, this is an issue not only within hospitals but retirement residential living homes.

    RPN’s are overworked in residential homes, sometimes with up to ten elderly to one RPN. There is little attention in policy to the elderly persons care other than physical, not thought or policy around caring for their emotional health or spiritual health. The RPN’s know that these individuals they care for in the long term care homes deserve more attention but they are over worked and under paid and there just is not enough time in their shift to get what policy demands they get done and cater to emotions and spiritual needs. This leads to feelings of guilt, shame and resentment from both the elderly being cared for and the nurses themselves.
    This being said, policy around workloads and underpaying RPN’s while taking away jobs from RN’s needs to change in the form of new social policies. It is sad to think that the weakest stakeholder in long term residential care is the elderly person who is directly receiving the care, the second weakest stakeholder being their family members.

  2. Dear Editor,

    I completely agree with the nurses’ who believe that their ability to provide adequate care to patients is being compromised by their increasing workloads. I mean, how can someone be expected to provide the care a patient deserves when they are overloaded with work that requires them to provide care for too many patients at once?
    The wait times, especially for the administration of certain medications, in hospitals have become increasingly longer for patients who have to stay in ICU. As nurses become expected to handle more and more patients at a time, these wait times are only going to continue to increase. This can, and often does, lead patients to feel frustrated and as though their needs are not being met and that no one really cares about their wellbeing. This can even lead patients to take out their frustrations on the nurses, even though the nurses are truly trying their best to adequately meet patients’ needs throughout their long shifts. Not all patients are aware of the amount of work that nurses are expected to complete during their shifts, which only enhances their frustrations with the nurses. These overwhelming workloads, along with the voiced frustrations of hospital patients’, can lead to burnout and nurses quitting their jobs or resenting their jobs (thus inhibiting their ability to provide adequate care). As Canadian citizens, we pride ourselves in knowing that we have access to free health care, and therefore, we should be demanding that nurses receive lighter workloads (by hiring more trained RN’s and RPN’S), and demanding nurses receive more respect, as means to keep our health care system something to be proud of.

    Sincerely,
    Natalie

    BSW Student,
    Laurentian University

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