Volume 3, No. 2March 2011

A recap /critical look at health care news and the reality behind the reporting from the viewpoint of front-line Ontario registered nurses

Behind the Front Lines

1. Don’t pick on nurses – your readers will protest

2. RN statistics show nursing shortage still an issue – go

3. Home Care: both sides in chaos – go and go

4. More on the Sault’s “War of Words” – go

Four ThingsYou’ll Learn in This

Issue:

continued on page 2

RN cuts, cancelled surgeries and six-figure hospital CEO salaries didn’t generate as much reader feedback as a recent story in The Ottawa Citizen (source).

The case of the cartoon scrubs dominated the front pages and letters to the editor section of the Citizen in early February, as The Ottawa Hospital’s human resources and executive teams announced a new dress code that would ban nurses from wearing scrubs or uniforms that are colourful or feature cartoon characters.

Saying the change in policy was part of the push to make nurses easier for patients to identify, the hospital banned colourful scrubs and said nurses would also have to wear white lab coats while away from their units.

Nurses, however, say they are already identifiable and that many patients suffer from “white coat syndrome,” becoming tense and anxious when surrounded by people wearing the lab coats.

Readers have objected to RNs being told not to wear colourful scrubs.

Flap Over Colourful Scrubs: Ottawa Hospital Reverses Policy

Vaccine Safety in Question

Media coverage of a link between the H1N1 vaccine and narcolepsy in children is surprisingly sparse.

The Globe and Mail’s André Picard covered the story (source) but was one of the few to report on a new National Institute for Health and Welfare study that found the link.

The Finnish study showed that children who’d been vaccinated were nine times more likely to develop narcolepsy than those who did not receive the vaccine.

Coming in the wake of reports that a researcher who’d linked childhood vaccines with autism faked the data, the lack of coverage of this study may not be such a mystery.

Behind the Front Lines page 2

What is ONA?The Ontario Nurses’ Association (ONA) is the union representing 55,000 front-line RNs and allied health professionals and more than 12,000 nursing student affiliates providing care in Ontario hospitals, long-term care facilities, public health, the community, industry and clinics.

Who is Linda Haslam-Stroud, RN?

ONA President Linda Haslam-Stroud, RN (pictured), is a veteran renal transplant nurse who is an expert spokesperson on a range of issues. Linda is available to com-ment on everything from workplace violence, patient care, health care policy in Ontario, the flu pandemic, nursing cuts, public health and much more. Simply contact ONA’s media relations officer, Sheree Bond, at (416) 964-8833, ext. 2430 if you would like to interview Linda on a health-related issue.

How to reach us:Ontario Nurses’ Association85 Grenville Street, Suite 400Toronto, ON M5S 3A2(416) 964-8833www.ona.org

Colourful Scrubscont’d

ONA representative and intensive care nurse Frances Smith says that often, the only colourful or cheerful thing her patients see in a day is her colourful scrubs. In addition, she expressed concern about the cost to the hospital to purchase the extra lab coats while simultaneously grappling with a tight budget.

A deluge of on-line comments and letters to the editor showed overwhelming disapproval of the policy by the public. As one reader said, while undergoing 30 chemotherapy treatments, there was never a problem identifying the nurses because “they’re the ones run off their feet, tending to patients and providing the most professional and compassionate care I’ve ever encountered.”

Similarly, another reader said the nurses should wear whatever they want and he’s never had trouble identifying a nurse because they’re the “ones who actually care.” Readers urged the hospital to stop “attacking these workhorses of the medical system” and questioned whether the “suits” at The Ottawa Hospital “have become unglued.”

Five days after announcing the policy, The Ottawa Hospital rescinded it, announcing that nurses could wear whatever scrubs they wanted after all, but still insisting that they must wear white lab coats on top of the scrubs.

Ironically, the lab coats can not be worn while caring for patients as they pose an infection hazard.

Follow-up to “War of Words”In the December issue of Behind the Front Lines, we brought to you a war of words that had broken out in Sault Ste. Marie between nurses at Sault Area Hospital and a Sault Star columnist.

The Sault Star ’s coverage of the independent assessment committee (IAC) hearing that has now heard three days of submissions on the subject was – in contrast to a series of opinion columns – quite fact-based.

ONA filed a professional responsibilities complaint last November, saying that RNs in the renal unit “have been assigned more work than is appropriate for patient care.”

The hospital has reduced RN care hours for hemodialysis patients – increasing morbidity and mortality rates for patients in this unit. A Star columnist had painted the issue as a labour relations disagreement rather than a professional matter in a series of opinion pieces.

The IAC will make recommendations to resolve the issues, likely by early- to mid-April.

Surgical nurses at Lakeridge Health Oshawa have filed for an IAC hearing.

Behind the Front Lines page 3

Toronto Star Home Care

ExposéGets It Right

Kudos to the Toronto Star for its exposé on Ontario’s home care system.

The ‘Begging for Care’ series (source) brings the challenges faced by those relying on Com-munity Care Access Services to life, telling the stories of aging or ill Ontarians who find inadequate supports in the community.

The personal stories of those who’ve been desperate to receive care in the community make real the challenges our health system and those who depend on it.

While the series brilliantly illustrates the inadequacies and failures of the “Aging at Home” strategy introduced by the provincial gov-ernment, it doesn’t shed a lot of light on the experiences of those trying to provide the care and the challenges they face.

One installment does talk about the difficulty recruiting and retaining personal support workers, noting that they are paid by the visit ($13) no matter how long the visit takes, and are not paid for time they spend travelling between clients.

The challenges faced by the case workers and case managers of the province’s 14 CCACs responsible for arranging that care are little known. In “Under the Radar,” read about the story of what’s happened to those working in this beleaguered system here.

2010Registered Nursing Statistics

ReleasedAs the Liberal government touts its progress in hiring nurses, the College of Nurses of Ontario has released its 2010 RN statistics (source).

The statistics show changes in the numbers of registered nurses newly working in Ontario by health care sector:

ONA has been advocating for an increase of 12,000 full-time registered nursing positions. However, the statistics show that when combined, Ontario has a net increase in new RNs working of just 745 during 2010. ONA has tracked more than 2,500 RN position cuts in a little more than a one-year time period.

Of the RNs working in 2010, 27,258 of them (or 29 per cent) were aged 55 and older – of retirement age.

On the other hand, Registered Practical Nurses (RPNs) have seen their numbers increase by 1,642. RPNs are paid less than RNs – they have a two-year college diploma education and are qualified to care for stable, less complex patients. RNs require a four-year baccalaureate degree and care for more complex patients with less predictable health outcomes.

Status Sector 2009 2010 Change

Full-time Hospital 40,749 41,030 +281

Long-Term Care 4,723 4,851 +128

Community 10,677 10,947 +270

Other 4,086 4,135 +49

Unspecified 672 521 -151

Total Full Time 60,907 61,484 +577

Part-time Hospital 15,486 15,576 +90

Long-Term Care 2,166 2,201 +35

Community 4,753 4,757 +4

Other 1,774 1,697 -77

Unspecified 447 355 -92

Total Part Time 24,626 24,586 -40

Casual Hospital 4,374 4,352 -32

Long-Term Care 528 552 +35

Community 1,967 2,134 +167

Other 588 651 +63

Unspecified 181 147 -24

Total Casual 7,638 7,846 +208

As detailed in the Toronto Star ’s excellent series ‘Begging for Care’, Ontario’s community care/home care system faces multiple challenges.

What has happened to the goal of getting people out of hospitals and receiving home care, or keeping them out of nursing homes and aging at home with proper supports? A number of changes have occurred in the system over the past five years.

In 2006, the government passed legislation that created Ontario’s 14 Local Health Integrated Networks (LHINs). That necessitated that the province’s 42 Community Care Access Centres (CCACs) – the bodies that arrange home care for those who need it – would have to be amalgamated from 42 to 14 to align with the LHIN boundaries.

The CCACs are funded by the government, and in recent years, funding has failed to keep up with the rate of inflation – just as it has for hospitals and public health units.

In contrast to the public’s perception, the RNs employed by CCACs are unionized public sector workers and have not been immune to layoffs. As budgets shrank, these RNs who serve as case managers and care coordinators, determining client needs, priorities and the type of service – have either been laid off or are now facing demands for a two-year wage freeze.

Meanwhile, the registered nurses who work for home care agencies that provide the care arranged by the CCAC have also faced massive job losses. The organizations that employ them have once again fallen under the competitive bidding system that was first introduced by the former Mike Harris government.

While it sounds good, what it means is that each time a contract with the CCAC comes up for renewal, the

agencies – many of them private – that employ RNs, RPNs and personal support workers to care for those in the community – face the loss of the contract.

For the clients, this means that the knowledge and skills of their caregivers can be lost, as is continuity of care.

For the workers, it means the loss of their job, their seniority, their benefits and the prospect

of starting anew with another agency or leaving the sector altogether.

The RNs who work in home care are committed to their patients and worry about the effects of a change in caregiver for long-time clients. But they also despair when they face such insecurity in their jobs – which pay them a fair bit less than their colleagues in the hospital sector are paid. Many have simply left home care and gone to work in local hospitals or long-term care facilities rather than face another round of cuts.

The CCAC nurses – who determine what their clients need and arrange for the hands-on care – are suffering from obscenely heavy case loads as the demand for home care has risen. Many service 10,000 or more clients per year and are suffering burnout.

Many of the clients requiring home care services are “more complex” than ever before. This means their health care needs are more serious and require the skills of health care professionals that used to be provided only in hospitals.

Retaining nurses who are of retirement age will continue to be more challenging. As pressures increase, demands for wage freezes continue and job cuts or incentive packages become common, more RNs will leave the profession, leading to even more severe wait times for badly needed services.

Home Care Challenges From the Other Side

UNDER THE RADARNews the Media is Missing

Behind the Front Lines page 4

ONA members spoke out to the public and media about changes to home care that threatened

quality patient services.The ONA members here are at a 2008 home care

public forum and rally in Hamilton.

Behind the Front Lines page 5

Nurses Under Attack by Public Health Unit

Local media in Grey-Bruce county dutifully reported accusations by the Medical Officer of Health that the lower-than-usual annual vaccination rates for health care workers was the cause of nine deaths from influenza (source).

Now officials are admitting that they haven’t actually kept track of how many health care workers have received their flu shots (source). In a media release, Chief Medical Officer of Health for Grey-Bruce, Dr. Hazel Lynn, cited three-month-old health care worker vaccination uptake rates, blaming health care workers for contributing to an outbreak of flu in several area facilities. The statistics cited were from November 15, 2010.

The flu outbreak is now easing. Lynn told the media that she believes the drop off is in part due to “fatigue” from last year’s H1N1 pandemic. She has vowed that there will be a “vigorous” campaign in place by next fall and says studies have proven over and over that the best way to prevent outbreaks is to have 100% staff immunization.

Nurses Calling for More Independent AssessmentsOntario Nurses’ Association members have an important professional clause in their contracts that enables them to take action should they believe that workload or other issues are interfering with their ability to provide safe patient care.

The “professional responsibility clause” (PRC) was won initially by nurses at Toronto’s Mount Sinai Hospital when they believed their nursing licenses were at risk because of the demand that they care for too many patients to do so safely.

As the nursing shortage has worsened, nursing position cuts have continued and the “acuity” (or severity of illness) of patients has worsened, ONA members are increasingly using the PRC to advocate for adequate RN staffing levels in specific units in order to safely meet patient care needs.

The nurses at Lakeridge Health’s Oshawa site surgical unit are the latest to file for an Independent Assessment Committee hearing, which is scheduled to be held in early April.

RNs in the unit have been filing improper workload forms with the employer for five years but the issue has not been addressed. RNs continue to be concerned about the safety of patient care in this unit.

At an Independent Assessment Committee hearing, a panel hears the RNs and the employer discuss the issues and present each side of the case. The panel consists of three experts who will conduct a hearing into the unit in question and make recommendations to resolve the issues.

After hearing both sides, the panel meets and develops recommendations to address the issues.

Health care workers have been criticized in parts of the province by medical officers of health.

www.ona.org

Need a reliable and informed source? The Ontario Nurses’ Association has a whole host of experts in health care.ONA members work in hospitals, long-term care, public health,the community and industry and can answer your questionsas health continues to evolve in this province. Contact ONA.

Sheree Bond, Media Relations Officer,(416) 964-8833, ext. 2430 or cell (416) 986-8240

shereeb@ona.org