Sunday, March 20, 2016

RNs, NPs, RPNs – There's Room for all in Health Care

Last month, a Hamilton-based hospital announced more than 60 front-line Registered Nurse (RN) cuts to many departments and units, including in the Neonatal Intensive Care Unit. The hospital noted that within this unit, it was "testing" replacing RNs with Registered Practical Nurses (RPNs).

We were all deeply concerned about the introduction of RPNs into this unit considering it’s a critical care area for premature babies. These patients are unpredictable and require the advanced assessment and the clinical and critical thinking skills of RNs. ONA voiced our concerns and advocated to reconsider this very rash decision.

The good news is that the hospital listened and it has rescinded the layoff notices to the RNs in the Neonatal Intensive Care Unit. 

Our strong advocacy and speaking out about RN cuts has worked. This time. For now.
ONA believes there is a place for RNs and RPNs in the health-care system. However, the gutting of RN positions and forcing RPNs to care for unpredictable, complex patients is putting the RPNs’ nursing licenses at risk.

Strong evidence

It’s a fact that employers across Ontario are replacing RNs with practical nurses or personal support workers. Yet the evidence is clear.

For every extra patient added to an average RN's workload, the risk of death and disease increases by seven per cent. Patients experience more sepsis, pneumonia, blood clots, bedsores, cardiac events and failure to rescue.

Where is the evidence? Well, to note but a few sources: they're herehere, here and here. These studies were published in medical journals and the evidence speaks for itself. Our patients are at risk with employers balancing their budgets on the backs of RNs.

Room for all in healthcare
Let me be very clear: There is room for Registered Nurses, Registered Practical Nurses, Nurse Practitioners and personal support workers in Ontario’s health-care system.
The main issue is ensuring that the appropriate skilled nurse is caring for patients dependent upon their needs.

RNs can work in any setting and with any type of patient, resident and client. RNs can care for those with any complexity of needs in unpredictable situations, whether it be in intensive care, surgical units, emergency departments, long-term care or in home-care settings.

RPNs are more appropriately used for the care of patients, residents and clients with less complex needs and with stable and predictable outcomes. Forcing practical nurses to care for unstable patients with unpredictable outcomes puts both the patient and the nurse's license to practice at risk.

As the government moves its Patients First agenda forward and removes the stable and predictable patients from hospitals, the unstable, high acuity and complex patients need to be cared for in hospitals by RNs. We need to have an increase in RN care in hospitals, not having RN care gutted.  

When employers are cutting RNs in areas such as neonatal ICU, emergency departments, critical care, cardiology, medical, surgical, labour and delivery, etc. – it raises many red flags. Employers are not using the evidence – they are simply cutting what’s most convenient and what will hurt patients the most.

Nurses know. We know that RN cuts will negatively impact patient, resident and client care.
In Solidarity,
Linda Haslam-Stroud, RN