Enough is Enough!

https://www.facebook.com/OntarioNurses/photos/a.10150618932877394.442585.177990002393/10153841158062394/?type=3

HEADLINE: Patient Mortality and RN Staffing Levels

HEADLINE:			Patient Mortality and RN Staffing Levels
Program:	Windsor Morning		DATE:	2016-Jan-18 6:00AM	Time:	6:00AM - 8:30AM
Station:	CBC Radio 1 (Windsor) - CBEW FM		Network:	Canadian Broadcasting Corporation	City:	Windsor
CBC (Tony Doucette): Windsor Regional Hospital is going to lay off 166 staff members, about 120 of those will be registered nurses. Hospital CEO David Musyj says 80 of those RN positions will be replaced by cheaper registered practical nurses or RPNs. Musyj blames a $20 million budget shortfall because of decreased funding from the provincial government. In making the announcement last week, Musyj also said, and I'm quoting, quality outcomes are not diminished. Ann Tourangeau takes issue with that. She is an associate professor in the Faculty of Nursing at the University of Toronto. She has done two large studies that looked at the mix of nursing staffs at seventy-five Ontario hospitals, and she looked at the impact on patient mortality. Ann Tourangeau is on the telephone. Good morning. ANN TOURANGEAU (University of Toronto): Good morning Tony, how are you today? CBC: I'm well, thank you so much. What did your studies find? TOURANGEAU: Well, we found that overall, that the larger the proportion of registered nurses within the staff mix in acute care hospitals where patients are generally extremely ill, the lower are mortality rates. And we are very confident that mortality rates are certainly one of the most sensitive measures of quality of care in hospitals, and we know that some hospitals are better than others at preventing unnecessary deaths within these hospitals. CBC: Why the increase in patient mortality? TOURANGEAU: Because nurses really, our registered nurses are the surveillance system within a hospital. They are the people who are there twenty-four hours a day, seven days a week, observing patients, providing care to those patients, assessing them, contacting the rest of the health care team when they notice or observe that a patient is becoming ill with a complication or with their primary disease, and there are not as many other people in the health care circle of care of patients that can do that like registered nurses can. They're the ones who identify that particular issue quickly, gather around the health care team to intervene, and allay that complication so people don't die unnecessarily. CBC: In the hospitals you looked at, how great was the increase in patient mortality? TOURANGEAU: Well, for example, we found in our latest study that a ten percent increase in the proportion of registered nurses in a hospital's nursing staff mix was associated with six fewer deaths for every thousand patients discharged from that hospital. But even further, we looked at the preparation of the registered nurses, and now increasingly, since 2005, nurses in this province, registered nurses, have to have a baccalaureate degree to practice nursing, but not everybody does yet. Additionally, a ten percent increase in the proportion of baccalaureate educated registered nurses was associated with an additional nine fewer deaths per a thousand discharged patients. CBC: Baccalaureate educated nurses being those who get the four year bachelor of nursing degree. TOURANGEAU: Yes. Yeah. CBC: How can you draw a direct link between patient deaths and the nurses a hospital employees? TOURANGEAU: Well, what we do in our studies is we, well, we know for sure that most of the reasons people die within hospital or associated with their hospital care is related to their own health condition. So as a health services researcher, I'm less interested in their health condition, I'm more interested in the structure and processes of care. So I have to do things to adjust for or control for patients' own characteristics. So we adjust for or control for patients' own health conditions, and their characteristics. And we look, so that allows us to look at the structures and processes of health care. And when we look across these seventy-five hospitals, we see that there's a wide range of risk adjusted, already adjusted for patients' own health conditions, mortality rates. Some hospitals are much better than others across Ontario, that have lower mortality rates. I don't know about you, but I'd like to be at the hospital with the lower mortality rate. And so we look at the direct relationship, and the impact that staffing and those kinds of things have on mortality rates. We look at all kinds of different things. We also look at physician qualifications, et cetera. But consistently, it's the registered nurse staff mix that comes up as being the predictor of mortality. CBC: You say the mix of RNs and RPNs is much more important in a hospital today than it was twenty or twenty-five years ago. What do you mean by that? TOURANGEAU: Well, what I mean by that is that the patients in hospitals are quite different than they were ten years ago, fifteen years ago, twenty years ago, twenty-five years ago. Patients are much more ill. They're there for a much shorter period of time. They come in very ill. And they leave quite ill as well. And so it's only those very sick people that are usually admitted to hospital, and those are the kinds of patients that really need the clinical knowledge, the clinical judgment of registered nurses taking care of them. That doesn't mean there's not room for everybody in the health care system. There's more than enough room. But when patients are unstable and unpredictable, the person that you want caring for them is a baccalaureate prepared registered nurse. CBC: The CEO at Windsor Regional Hospital claims that the number of all RN hospitals has diminished drastically in Ontario, in other words hospitals staffed entirely by registered nurses. Is that something you've seen? TOURANGEAU: I can't say that I've been watching the statistics from year to year go up about the proportion of registered nurses in caring for patients in hospitals. But I would say that there's certainly quite a pull to do that because the outcome that is most visible to hospitals, and hospital executives, and they're really only doing their very best, they're trying to stay afloat, and do good things for patients, do good things for the communities. The most important thing that they have to take care of is budget. And when you have a budget that doesn't allow for... That you have to find things in to reduce, well, the most obvious thing is your employee budget, and the nurses take a huge part of the budget. The place to look for cuts is, of course, in your nursing pool. CBC: Is there such a thing as a good mix of registered nurses and registered practical nurses? TOURANGEAU: Well, it depends on the setting. So if Windsor Regional has not so sick patients, and has units where patients are predictable and stable, that's the kind of unit where you could have a lower mix of registered nurses. But in general, that's not what's in acute care hospitals now. Acute care hospitals, if you want the best outcomes for your patients, the best quality outcomes, including mortality, the evidence across Canada, the United States, Europe, is very clear--it's a registered nurse, baccalaureate prepared registered nurse, you know, highest proportion, even a hundred percent, that you can arrive at the best outcomes for your patients. CBC: To the best of your knowledge, are any Ontario hospitals solely staffed by registered nurses? TOURANGEAU: I believe there are some. And there are certainly many units within hospitals that are staffed entirely by registered nurses, and that's in recognition of the high intensity, acute needs of those patients. And remember, there are units in hospitals that may not need all registered nurse staff because they may not have highly unpredictable, unstable patients. There might be areas in those hospitals where patients are less... Are more predictable, more stable. And there can be a lower proportion of registered nurses in those areas. CBC: So deployment is a critical issue. TOURANGEAU: Absolutely. CBC: It's good to talk to you. Thank you very much. TOURANGEAU: Thank you very much. Bye Tony. CBC: Bye-bye. That is Ann Tourangeau, an associate professor in the Bloomberg Faculty of Nursing at the University of Toronto.

Registered Nurse Cuts Hit Toronto Hospitals: ONA President says "enough is enough"

FOR IMMEDIATE RELEASE                                                                                            February 4, 2016

Registered Nurse Cuts Hit Toronto Hospitals:

ONA President says "enough is enough"

TORONTO — Barely into 2016, registered nurse (RN) positions are being cut in increasing numbers as Ontario hospitals gut positions to balance budgets. Linda Haslam-Stroud, RN, President of the Ontario Nurses’ Association (ONA) says that 2016 is turning into a "disaster" for patient care and it's now hitting Toronto hospitals.

"We saw 61 RN cuts at Joseph's Healthcare Hamilton on Monday, now the University Health Network's Toronto General and Toronto Western sites have cut 51 RN positions, Mount Sinai Hospital has cut 59 RNs and the Centre for Addictions and Mental Health (CAMH) has just announced RN cuts," she says.

"Enough is enough," said Haslam-Stroud. "Our patients simply can't tolerate any more cuts to the front-line registered nurses who provide bedside care for the unstable and unpredictable patients who rely on us. Hospitals are cutting RNs out of units where their care is vital, including neonatal intensive care units, ORs, cardiology, oncology units...I am particularly outraged that critical care areas, where patients require the advanced assessment and clinical skills of RNs, are gutting RNs and putting other health-care providers into areas where their licenses to practice are at risk when they are forced to care for unstable patients."

In the past four weeks alone, 406 RN positions have been cut from hospitals in the province. In 2015, 775 RNs were cut, equivalent to the loss of close to one million hours of front-line RN care for patients. Last fall, Runnymede Health Care in Toronto cut fully half of its RN staff, despite showing a budget surplus.

"Unless there is a public backlash now, RN cuts for 2016 will far outnumber last year's," said Haslam-Stroud. "It's painfully clear that our hospitals can no longer cope with frozen base hospital funding. Patient health outcomes are far more important than fiscal austerity, yet our policy-makers are choosing to risk patients' health for the bottom line. Unless people speak out against the cuts, they will continue and patients will pay the price. How much longer will we allow the government to sit silently by as our patients' health is being put at risk?"

The University Health Network, Mount Sinai Hospital and CAMH cuts follow RN cuts at Windsor Regional Hospital, Grand River Hospital, Northumberland Hills Hospital, St. Joseph's Healthcare Hamilton and Quinte Health Care.

ONA is the union representing 60,000 registered nurses and allied health professionals, as well as more than 14,000 nursing student affiliates, providing care in hospitals, long-term care facilities, public health, the community, clinics and industry.

http://www.cbc.ca/news/canada/windsor/nursing-shortage-to-hit-windsor-essex-in-next-5-years-1.3431219

Nursing shortage to hit Windsor-Essex in next 5 years

A fifth of nurses with Erie St. Clair LHIN are over the age of 55

By Lisa Xing, CBC News Posted: Feb 04, 2016 6:00 AM ET Last Updated: Feb 04, 2016 6:00 AM ET

 

Windsor-Essex will experience a shortage of nurses within the next five years, local experts say. There will be more jobs than officials can fill.
That's despite recent layoffs at Windsor Regional Hospital, where management will eliminate 126 registered nurse positions to make up for a $20-million budget shortfall. The hospital will, instead, hire 80 new registered practical nurses.
The looming shortage will be caused by combination of retirements, fewer students getting into the profession and nursing graduates leaving the region.
Janice Kaffer, CEO of Hôtel-Dieu Grace Healthcare, acknowledged the potential shortage.
"It concerns me as an administrator; it concerns me as a consumer of health care services, as a grandmother, as a mother," she said. "We want to have a healthy system."

Aging nurses

At 22 per cent, more than a fifth of the Erie St. Clair LHIN's nurses are over the age of 55. At Hôtel-Dieu Grace Healthcare, 9.3 per cent of its registered nurses and 11.5 per cent of the registered practical nurses are over the age of 60.
"That's not a small number," said Kaffer. "There will be opportunities locally for those nurses who can hang in a little bit."
Kaffer acknowledges her biggest concern is a skills gap that will happen when older, more experienced nurses retire before the younger crop fill those roles.
"I don't know if any of us have it all figured out yet, to be honest with you," she said. "We're still working through how that will look and how to manage that.
"Many nurses who retire at 55, they don't necessarily want to stop working entirely. Perhaps they could be coaxed back into the system on part time or casual basis to provide that mentorship."
However, Kaffer said the health care system is changing. She predicts there will be more opportunities in community-based care, as opposed to hospital-based care, and that's also where graduates should look for jobs.

Casual, part-time work

Meanwhile, Kaffer said younger, newer nurses should be looking for casual or part-time work.
"It really is almost next to impossible for an external candidate to get a full time job right out of nursing," she said. "That's a reality we all need to get comfortable talking about."
However, some nurses eager to work often leave the area rather than wait or work part-time.
Debbie Kane, a registered nurse and professor in the Faculty of Nursing at the University of Windsor, told CBC News that, in her experience, many graduates who do end up leaving, do not return.
"You're losing that qualified group of new grads who are going elsewhere. Some of them are leaving nursing if they can't get a full time position," Kane said.

'Other places are welcoming'

Kane said there was a shortage of nurses back in the 1990s. She claims the Ontario Ministry of Health and the Registered Nurses Association of Ontario made an effort to recruit nurses.
"The ministry put out money," Kane said. "RNA put out the energy to recruit, mostly [Canadian nurses] from the U.S., and they brought six nurses back.
"So, it's evidence once the nurses establish themselves in other areas, they're much less likely to come back to work in our area, and that's problematic."
Anthony Valeri is a fourth-year nursing student at the University of Windsor, who was born and raised in Tecumseh. He is one of about 300 nursing students who graduate from the University of Windsor each year.
"It is frustrating because, ultimately, we'd like to stay within Canada to work," Valeri said. "It's not that we want to leave here. It's just that opportunity calls. As a young person coming out of school, I want to work. The U.S. and other places in Canada are welcoming us."

By the numbers

Age of nurses employed in Erie St. Clair LHIN:

• 18-29: 17.5 per cent
• 30-54: 60.3 per cent
• 55-plus: 22.2 per cent

Hôtel-Dieu Grace Healthcare breakdown:

• RNs over 55: 22.5 per cent
• RPNs over 55: 17 per cent
• RN average age: 43.76 years
• RPN average : 41.76 years

Windsor Regional Hospital breakdown:

• RNs over 55: 15.95 per cent
• RPNs over 55: not provided
• RN average age: 45 years
• RPN average age: 39.6 years (but, 11 per cent of total RPNs average 55 years old)

RNs mount campaign to protest 169 job cuts at Windsor Regional

http://windsorstar.com/news/local-news/rns-mount-campaign-to-protest-169-job-cuts-at-windsor-regional

Facing an 11 per cent slash in their numbers at Windsor Regional Hospital, registered nurses are embarking on a campaign to protest hospital funding cuts they say are bad for the people of Windsor and Essex County.
“If the government really cared about our health, they wouldn’t be doing this,” says Sue Sommerdyk, the Ontario Nurses’ Association local president who represents 1,550 RNs at Windsor Regional’s two locations. She said ONA has launched a petition and a letter writing campaign, and is planning information pickets to protest the government cuts.
The hospital talked three weeks ago about a total of 166 full-time-equivalent (FTE) jobs being cut from its 3,800-person workforce to cope with a $20-million budget shortfall, but added that it was hiring 80 registered practical nurse FTEs to replace 80 RN FTEs. But the impact on RNs amounts to 169 fewer full- and part-time RNs, Sommerdyk said Monday.
She noted that the normal attrition rate at the hospital — people who retire or quit in a year — is five per cent.
“I have 1,550 members, this is more than 10 per cent of my members, so I’m not really sure the attrition rate will actually work here,” Sommerdyk said.
She said the cuts are going to be felt throughout the hospital, citing hospital intentions to close or downsize its diabetes clinic, an obstetrician clinic and its HIV clinic.
“All of them, I guess it’s your interpretation what the impact’s going to be on the community,”  Sommerdyk said.
Hospital CEO David Musyj said that the hospital has to look at all the outpatient clinics it offers because the new hospital funding formula doesn’t provide proper funds for them. The diabetes clinic will be kept open for only a small percentage of patients with the most severe problems, and the rest will have to go to clinics in the community — Musyj said there are seven diabetes clinics in Windsor and the county — offering the same service.
The obstetrics clinic is a service provided so that obstetricians on call in the hospital can see their office patients at the hospital. Only four of the hospital’s 12 OBGYNs use the service, Musyj said. He said the OB triage — where pregnant women can bypass the emergency and go straight to the obstetrics department for medical help — will continue.
The HIV clinic — located in a separate building on the Met property — will probably have its pharmacy merged with the cancer centre pharmacy and its hours will be reduced as staff retire, he said.
Musyj said that due to the lack of funding, the hospital needs to get out of areas where patients can get the same service outside the hospital or at their doctor’s office.
Other hospitals in the province are in the same boat. London Health Sciences announced last week it would replace its cleaning staff with lower-paid contract workers and Bluewater Health in Sarnia announced it would be cutting 12 staff.
He said it’s too early to tell whether all the job cuts announced at Windsor Regional will be achieved through attrition. While natural attrition is five per cent a year, he said other factors could raise that number, including an early retirement package that provides nine months of pay and the lure of Michigan hospitals and their high-value U.S. paycheques. Maternal and parental leaves can also offset the job losses, he said.
“So there are a lot of factors,” Musyj said. “We’re not in any way guaranteeing it, but we’ve got to let it play out and see what happens.”

Nurses strike avoided at Harrow Health Centre

http://www.cbc.ca/news/canada/windsor/nurses-strike-avoided-at-harrow-health-centre-1.3421944

Five nurse practitioners and three registered practical nurses providing patient care at Harrow Health Centre have reached a tentative collective agreement with management there.
Harrow Health Centre executive director Margo Reilly and the Ontario Nurses Association say the agreement was reached late Tuesday. It has not been ratified. Details have not been released.
The nurses would have been in a strike position Wednesday had the deal not been reached.
The Ontario Nurses Association recommends the nurses accept the deal.
Reilly hopes it will be voted on it by the end of the week.

ON behalf of Local 8 congratulations on your first collective agreement!!

WRH nurses consider early retirement packages

http://www.am800cklw.com/News/Headlines/WRH-nurses-consider-early-retirement-packages

Local members of the Ontario Nurses Association have been meeting with ONA officials the past 2 days to address impending layoffs at Windsor Regional Hospital.
The hospital has announced about 160 full time equivalent Registered Nursing positions will be eliminated because of budget constraints in provincial funding.
By the end of next week early retirement packages should be out for those nurses who are eligible.
Susan Summerdyke is the local bargaining unit president of the 1500 nurses at the 2 campuses of WRH.
Summerdyke says the job losses are in a number of different areas of the hospital operations.
She says this is very difficult, particularly for those who are new to the profession:  "jobs are few and far between for nurses. We don't have a lot of places to go and I think this is a very sad time that a lot of our young nurses, who will be our future nurses, are probably going to cross the border or leave the city to find work"
Summerdyke adds the loss of the nursing experience in the system should be a concern because senior highly skilled nurse who take the package won't be there to mentor the new nurses.
Summerdyke says the formal notices will have to be issued by the hospital by February 15th.