Saturday, June 18, 2016

Mind the Safety Gap in Health System Transformation: Reclaiming the Role of the RN

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Ontario's health system is at a critical juncture. With its Patients First initiative, the Ministry of Health and Long-Term Care (MOHLTC) has indicated major changes are on the horizon that will shift health care into the community, and provide more co-ordinated health services. This bold strategy proposes to create the kind of system Ontarians want and deserve, but RNAO's research suggests the province may not currently have the health human resources (HHR) to make it a reality.

For the groundbreaking Mind the Safety Gap in Health System Transformation: Reclaiming the Role of the RN report, RNAO analyzed recent trends in nursing skill mix utilization and models of care delivery. We found the current state of nursing -- the largest workforce in the Ontario health system -- is at odds with the government's Patients First goals. In an effort to cut costs, health organizations across the province are replacing registered nurses (RN) with less qualified care providers, and resorting to task-oriented models of nursing that fragment care delivery. As a result, the RN share of the nursing work force has dropped significantly in recent years. This has left Ontario's health system unprepared to meet rising levels of acuity in hospitals and in the community, and put the safety of Ontarians at risk.

This report is an urgent call for an interprofessional HHR plan for Ontario that would follow a transparent, evidence-based, and engaged process. We focus our report on nursing, and see it as an installment for the broader made-in-Ontario HHR plan.

Thankfully, these dangerous trends are reversible. In this report, RNAO delivers eight evidence-based recommendations across all health sectors to reclaim the role of the RN, and help government achieve its goal of putting patients first.
  1. The MOHLTC develop a provincial evidence-based interprofessional HHR plan to align population health needs and the full and expanded scopes of practice of all regulated health professions with system priorities
  2. The MOHLTC and Local Health Integration Networks (LHIN) issue a moratorium on nursing skill mix changes until a comprehensive interprofessional HHR plan is completed
  3. LHINs mandate the use of organizational models of nursing care delivery that advance care continuity and avoid fragmented care
  4. The MOHLTC legislate an all-RN nursing workforce in acute care effective within two years for tertiary, quaternary and cancer centres (Group A and D) and within five years for large community hospitals (Group B)
  5. LHINs require that all first home health-care visits be completed by an RN
  6. The MOHLTC, LHINs and employers eliminate all barriers, and enable NPs to practise to full scope, including: prescribing controlled substances; acting as most responsible provider (MRP) in all sectors; implementing their legislated authority to admit, treat, transfer and discharge hospital in-patients; and utilizing fully the NP-anaesthesia role inclusive of intra-operative care
  7. The MOHLTC legislate minimum staffing standards in LTC homes: one attending NP per 120 residents, 20 per cent RNs, 25 per cent RPNs and 55 per cent personal support workers
  8. LHINs locate the 3,500 CCAC care co-ordinators within primary care to provide health system care co-ordination and navigation, which are core functions of interprofessional primary care
Learn more about RNAO's research and recommendations by reading the full report and checking out the resources below.