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
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hospital listened and it has rescinded the layoff notices to the RNs in the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.
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 here, here, 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
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
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
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.
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.
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
Nurses know. We know that
RN cuts will negatively impact patient, resident and client care.
Linda Haslam-Stroud, RN