Hospital and the provincial government need to pay attention to a study showing health outcomes are affected by staffing shortages, says Linda Haslam-Stroud, president of the Ontario Nurses’ Association.
Hospital and the provincial government need to pay attention to a study showing health outcomes are affected by staffing shortages, says Linda Haslam-Stroud, president of the Ontario Nurses’ Association.
A major new study showing that surgical patients face a higher risk of death when nursing workloads increase should serve as a warning to cash-strapped Ontario hospitals that continue to cut RN positions, warn leaders in the profession.
“The hospitals and the government need to take notice of the health outcomes that are being detrimentally affected by staff,” said Linda Haslam-Stroud, president of the Ontario Nurses’ Association (ONA), the nurses’ union.
The study, published Tuesday in the Lancet, shows that patients are more likely to die after common surgical procedures in hospitals where registered nurses have heavier workloads.
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It looked at more than 420,000 patients in 300 European hospitals and found that for every patient added to a nurse’s average workload, the chances of a surgical patients dying within 30 days of admission jumps by 7 per cent.
The study was done to look at the impact of nursing cuts undertaken as austerity measures to cut hospital expenses across Europe.
Haslam-Stroud said similar cuts are happening here, and patient care is suffering.
“Without RNs providing care, near misses are becoming common,” she warned in a recent pre-budget submission to a provincial legislative committee.
According to the Canadian Institute for Health Information, Ontario has the second worst registered nurse-to-population ratio of all provinces, after British Columbia.
In 2012, the most recent year for which statistics are available, there were 6.99 nurses per 1,000 residents, down from 7.18 in 2008. During the same period of time, the number of nurses per 1,000 residents nationwide rose slightly to 8.3 from 8.29.
To catch up to the national average, Ontario would have to hire 17,600 RNs, according the Registered Nurses’ Association of Ontario (RNAO), the professional body representing nurses. It is urging the province to commit to hiring at least 9,000 more.
In a recent letters to Premier Kathleen Wynn and Health Minister Deb Matthews, Doris Grinspun, CEO of the RNAO, warned that “a dangerous downward spiral trend is in rapid progress” and noted that 12.9 per cent of new grads were unemployed in 2012.
“Sadly, the time has come for RNAO to publicly ring the alarm bell on how the declining number of RNs will negatively affect patient care in our province,” Grinspun said, adding that her organization has quietly been trying to work on the issue with the government for three years “to no avail.”
Both ONA and the RNAO say the shortage of RNs is particularly worrisome in hospitals, which are shrinking as community care expands. That leaves the sickest of the sick in hospitals, where highly trained professionals need to be to care for them, the organizations say.
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But they say that registered nurses are increasingly being replaced with registered practical nurses (RPNs) in hospitals in an attempt to save money.
RN’s have four-year university degrees, while RPNs have two-year college diplomas. According to ONA, RPNs make approximately $27.75 to $29.77 an hour, while RNs earn in the range of $30.17 to $42.85.
“It’s basically being done by stealth. When nurses retire, they are very quietly replaced with RPNs,” said Haslam-Stroud, adding that RPN’s are being replaced by personal support workers who are paid even less.
“It’s a race to the bottom, the cheapest labour,” Haslam-Stroud charged.
The Lancet study also found that patients have the highest risk of death after surgery in hospitals where nurses with lower levels of education care for more patients. It showed that a 10 per cent increase in the proportion of nurses with bachelor degrees is associated with a 7 per cent decrease in the risk of death.
“RNs should be the only ones looking after medically unstable patients, but that is not what is happening today, and that’s where you get into trouble,” Grinspun said, explaining that RPNs are sometimes assigned to emergency departments and critical care units where the sickest and most medically unstable patients are.
Grinspun emphasized that she is not calling for fewer RPNs to work in hospitals, just more RNs.
Because the study was under embargo until Tuesday evening, the Ontario Hospital Association was unable to look at it and offer comment.
An article in the online magazine HealthyDebate.ca says other studies have found that higher levels of RN staffing result in lower patient death rates, shorter lengths of stay and fewer complications.
“What has not been as well studied, however, is what happens when RNs are replaced with (RPNs). As such, decision makers and administrators balancing tight budgets have only limited evidence to turn to when trying to determine what is the right mix of RNs and (RPNs),” it states.
TB
Theresa Boyle Theresa Boyle is the Toronto Star's health reporter.
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