A “growing and enormous” $4.8-billion funding gap is to blame for
declining care in Ontario’s acute-care hospitals, says the president of
the Ontario Council of Hospital Unions.
The damage for Windsor amounts to 234 fewer hospital nurses, 696
fewer hospital staff and a $74-million funding shortfall, when you
compare Ontario’s per-capita hospital funding to the funding in the rest
of Canada’s provinces, according to the union.
“You are being cheated out of the equivalent of 234 nurses, RNs and
RPNs,” Michael Hurley said at a news conference Thursday at the Royal
Canadian Legion Branch 255 in Riverside. The funding for acute hospitals
has dropped so below other provinces that patients in Ontario receive
six fewer hours of nursing care, he said. And the result is fewer
hospital beds and higher rates of medical errors, hospital-sourced
infections, and readmission of patients who were sent home too early.
“People don’t get the attention they need when they’re in a health
crisis,” said Hurley. “All these things together are the explanation for
the backlogs and waits people experience when they go to the hospital.”
Hurley’s union, CUPE, represents about 600 staff at Windsor’s two
hospitals — non-acute Hotel-Dieu Grace Healthcare and acute care Windsor
Regional Hospital, which earlier this year cited a $20-million budget
shortfall as it announced the elimination of 166 full-time equivalent
positions, most of those RNs (169 full- and part-time positions
according to their union). However, 80 of those FTEs are being replaced
by 80 RPNs. Before the cuts, the hospital had about 1,550 RNs.
Hurley is travelling throughout the province, to explain how over the
last decade Ontario’s acute hospital funding has been on the slide
compared to other provinces. In 2005-06, Ontario was “in the ballpark,”
with per capita funding of $1,112 compared to $1,159 for the rest of
Canada, Hurley said, citing figures from the Canadian Institute for
Health Information. Ten years later, Ontario’s funding was $1,396
compared to $1,750 for the rest of Canada.
Michael Hurley, president of the Ontario Council of Hospital Unions, speaks to the media during a news conference at the Royal Canadian
Legion in Riverside on August 4, 2016. Dan Janisse /
Windsor Star
He said the numbers extrapolated for Windsor are conservative, taking
into account only the City of Windsor’s 211,000 population, even though
Windsor Regional’s patients come from all over the Windsor-Essex region
(population 389,000) and beyond.
Hurley said while Ontario did increase its funding for hospitals
during the last decade, it didn’t come close to accounting for
inflation, population growth and the aging population. This year,
hospitals received a one per cent increase, but their actual costs rose
4.5 per cent, he said. “So their budgets have been cut again.”
Windsor Regional declined to comment on Hurley’s assertions.
In a statement, Health Minister Eric Hoskins said his
government is is doing what citizens want — continuing to invest in a
health-care system that “puts patients first,” asserting that 94 per
cent of Ontarians now have a family doctor, and that wait times for some
procedures are among the shortest in the country.
This year, it’s increasing health funding by $1 billion,
a 2.1 per cent increase, and it’s increasing funding to hospitals by
$345 million this year. “In Windsor, (since 2003) we’ve increased
funding for local hospitals by more than $126 million — an increase of
almost 50 per cent,” said Hoskins.
He also said Ontario is investing additional millions into
home care, community health centres and home-based hospice and
palliative care, because people prefer to receive their health care at
home instead of a hospital.
Hurley said the province argues that while it has been
actively downsizing the acute care system, at the same time it’s
increasing investments in home care and long-term care, to “pick up the
slack.” But he said Ontario is actually spending less on long-term care
and home care than the rest of the provinces. He said Ontario’s high
readmission rates are a sign the system is suffering.
“So we have fewer beds, there’s tremendous pressure to get people out
of those beds and send them home, and often when they’re sent home they
haven’t been made well actually and they return to hospital for a more
lengthy and expensive readmission.”
Hurley said his council is calling on the government to fund
hospitals “at least” at a level that reflects their rising costs, to
stop reducing the number of beds and staffing, and to increase access to
the people who need it.
The people being hardest hit by this are elderly, he said, who often
have lived a long time without serious health problems, until they’re
hit with a health crisis that lands them at a hospital doorstep.
“First they queue up in an ER for hours, and if they’re going to be
admitted it’s likely a stretcher in a hallway,” he said. And once
admitted, there’s likely pressure to get them discharged before they’re
fully well, he added.
“For the elderly in particular they feel the brunt because there’s rationing going on, the beds are so scarce.” bcross@postmedia.com
The charges stemmed from a January 2014 incident where a patient
allegedly attacked a nurse at CAMH, dragging her, kicking her and
beating her.
The Centre for
Mental Health and Addiction has been ordered to pay $80, 000 after
failing to ensure the safety of workers after the 2014 beating of a
nurse by a patient that reportedly left the victim “beyond recognition.”
(Brian B. Bettencourt / Toronto Star) |
The
Centre for Addiction and Mental Health pleaded guilty Monday to a
workplace safety charge related to the 2014 beating of a nurse by a
patient that reportedly left the victim “beyond recognition.”
Justice Robert Bigelow ordered the hospital to pay an $80,000 fine.
CAMH
pleaded guilty to violating the Occupational Health and Safety Act by
failing to develop, establish and put in place measures and procedures
to protect the health and safety of workers. The three other charges
were withdrawn by the ministry.
According
to an agreed statement of facts read out in court by Crown attorney Line
Forestier, the nurse was doing a round at 11 p.m. when a male patient
pushed her to the ground from behind and began kicking her.
The victim could not activate her body-worn alarm, a device known as a “screamer,” or a wall-mounted alarm during the attack.
Two
other nurses heard the commotion and went to investigate; one tried to
stop the patient while the other ran back to the nursing station to call
police. The nurse who stayed behind couldn’t stop the patient but got
the victim to her feet. Both ran towards the station, but the patient
caught up to them and continued the assault; the nurse fought him off
with a chair before she and the victim entered the safety of the nursing
station.
Toronto police arrived and
arrested the patient for assault. The Star was unable to learn whether
the patient was charged in the incident.
The
attack left the victim with a fractured eye socket, lacerations to the
face and head and wrist and back injuries, Forestier said. She was also
diagnosed with post-traumatic stress disorder and depression and has
been unable to return to work.
The nurse
who came to the victim’s aid suffered an injury that causes her chronic
back pain and has also been diagnosed with PTSD, Forestier added. She,
too, has been unable to return to work.
The
patient had previously attacked a nurse at another facility in 2010,
Forestier said. The nurse in that case required neural surgery. In 2013,
the patient reported hearing voices telling him to harm staff but
showed no intention of acting on the voices, and gave “no warning” the
day of the attack.
The layout of the unit,
which does not allow an unobstructed view, the dim lighting during
night shifts and that nurses are not required to do patrols in pairs all
hindered employee safety, Forestier said.
The
ministry requested a fine of $100,000 to send “a clear message” that
workplace violence, whether in the public or private sector, was not
acceptable.
Representing CAMH, attorney
Robert Little agreed that the attack was “very unfortunate” but said a
fine of $70,000 was more in line with other hospital fines. Little
pointed out that before the attack, the patient had scored zero out of
seven on a violence assessment scale and also said it was “entirely
speculative” to say paired patrols would have prevented the attack.
Following
the decision, Danielle Latulippe-Larmand, president of the Ontario
Nurses’ Association bargaining unit at CAMH, said she was happy that
CAMH pleaded guilty but was disappointed with the fine. She said the
hospital should be focusing on preventing violence instead of reacting
to it.
“We should be able to go to work and go back home the same way we looked when we walked into work,” she said.
Nancy
Pridham, president of the Ontario Public Service Employees Union
bargaining unit at CAMH, agreed. She criticized the use of “screamers,”
which depend on having someone around to hear the alarm going off, and
said better systems that immediately alert 911 need to be implemented.
“We
recognize that putting the kinds of measures we need in place is
expensive, but in order to ensure that there’s no staff that ends up the
way the staff have ended up at CAMH, we think the money is worth it,”
she said. “We think that our lives are worth it.”
Pridham
and Latulippe-Larmand both said they thought the hospital should have
been fined the maximum amount allowed by law — $500,000 per charge.
In
a statement, CAMH’s chief of nursing, Dr. Rani Srivastava, said the
hospital accepts the court’s decision and that the incident had a
“devastating impact” on “all of us at CAMH.”
“We deeply regret that we failed to meet our obligations for workplace safety, and that our valued staff members were injured.”
This
is not the first time CAMH has been fined for violating the
Occupational Health and Safety Act. In 2009, the hospital was fined
$70,000 after, in separate incidents, one nurse was punched by a patient
and another was molested.
Registered
nurses are invited to participate in an online survey and telephone
interview as part of a University of Ottawa study, "Initiation of
In-hospital CPR: An Examination of Nursing Behaviour within their Scope
of Practice." Click here for complete study details.
The
survey will take approximately 30-45 minutes to complete. The interview
will be conducted in person or by telephone in English only, and will
take approximately 60 minutes. All
interviews will be audio-recorded for transcription purposes. You may
be interviewed at any time deemed convenient and appropriate for you,
from July to September 2016.
The term of office for all positions is two (2) years, commencing January 1, 2017 to December 31, 2018.
If you are interested in allowing your name to stand, you must complete the nomination form and return it to my attention via email to chiefelectoralofficer@ona.org by 4:00pm, on Friday, September 2, 2016. Failure to submit a complete nomination as above will render your nomination null and void.
Voting will commence upon receipt of the Ticket of Nominations and conclude at 4:00 pm on November 1, 2016. Results will be available November 2, 2016.
Posted: Jun 20, 2016 5:04 PM ETLast Updated: Jun 21, 2016 5:42 PM ET
Linda Haslam-Stroud, RN, President, Ontario Nurses' Association. (John Maclennan/Canadian Press)
The firing of the head nurse at London Health Sciences Centre
illustrates a larger systemic problem of hospital bosses trying to
muzzle their staff, says the president of the Ontario Nurses
Association.
Vanessa Burkoski, the former chief nursing executive at London Health
Sciences was fired earlier this month after the Registered Nurses
Association of Ontario released a report critical of the province's plan
to replace registered nurses with cheaper, less educated health care
workers.
Burkoski, who is also president of the association that produced the
report, was offered a cash settlement to resign on three separate
occasions, but she refused. Then the hospital's CEO Murray Glendining
fired her.
"This is not uncommon," said Linda Haslam-Stroud, president of the
Ontario Nurses Association. "We are seeing this across the province
where nurses at many levels are being forced to be muzzled for fear of
losing their positions."
Glendining did not accept a request for an interview with CBC News. Instead, he issued a written statement.
"We can confirm that Vanessa Burkoski is no longer an employee at
London Health Sciences Centre," he wrote, "LHSC does not comment on any
personnel matters."
Replacing RNs
Rising healthcare costs, coupled with minimal or no government
funding increases, in recent years, have put pressure on hospitals to
slash budgets, Haslam-Stroud said.
To cut costs, several hospitals have opted to replace registered
nurses with less expensive registered practical nurses. Nurses have been
protesting the moves, saying much of the nurse swapping is occurring in
acute care hospitals, where patients have critical and complex needs.
"Even our front line nurses are concerned now about speaking out for
fear of having even something such as not getting the schedule they
requested or not getting the job they posted into," Haslam-Stroud said.
Mind the Safety Gap in Health System Transformation: Stop RN Replacement
Nineteen thousand respondents completed RNAO’s action alert to stop
RN replacement and fragmented models of nursing care delivery. Now, we
are moving to the second phase of our advocacy to #StopRNreplacement.
In 2015, the Ministry of Health and Long-Term Care (MOHLTC) released
three policy proposals aimed at improving patient and family-centred
care across the health system. RNAO supports re-orienting the health
system within community-based care; increasing public transparency;
providing co-ordinated and integrated services that match population
health needs; and monitoring health system performance and improving
accountability. As Ontario’s largest regulated health profession,
nursing will be instrumental in implementing the visionary plans to
transform the health system.
It is critical that effective nursing skill-mix and organizational
models of nursing care delivery are in place across the health system.
RNAO has spent the last year conducting a comprehensive analysis of the
MOHLTC’s plan and comparing it to nursing human resource trends and the
evidence on organizational models of nursing care delivery. We have
identified a shocking gap. Bold health system transformation ideas are
presented, but an interprofessional health human resource (HHR) plan to
fuel these changes is nowhere to be found. As a result, some
organizations are depleting their RN workforce as a short-sighted answer
to balance budgets. At a time when the health system is shifting to
provide care for only the sickest of the sick in hospitals, and when
people in the community have more complex health needs, it is simply
wrong to replace RNs with less qualified health-care providers or revert
back to outdated organizational models of nursing care delivery that
fragment patient care.
RNAO is calling for a moratorium on nursing skill mix changes until a
comprehensive interprofessional HHR plan is completed and an outright
stop to fragmented organizational models of nursing care delivery. These
are just some of the recommendations RNAO has presented in the report.
We ask you to urge Premier Kathleen Wynne and Health Minister
Eric Hoskins to accept the recommendations presented in the report: Mind the Safety Gap in Health System Transformation: Reclaiming the Role of the RN.
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.
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
The MOHLTC and Local Health Integration Networks (LHIN) issue a
moratorium on nursing skill mix changes until a comprehensive
interprofessional HHR plan is completed
LHINs mandate the use of organizational models of nursing care delivery that advance care continuity and avoid fragmented care
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)
LHINs require that all first home health-care visits be completed by an RN
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
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
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.
