Island Health CEO Dr. Brendan Carr would have us believe that a shortage of trained nurses is both the cause of an unhealthy amount of paid overtime worked by hospital nurses and a key factor driving the health authority to adopt “care delivery model redesign,” a new patient care model (“New patient care model will improve outcomes,” May 3).
Neither claim is credible because there’s no real shortage of nurses. This is proven by the fact that many part-time nurses wait years for any full-time positions to be posted and that Island Health is hiring few graduating nurses. If there were a real shortage, there would be numerous posted positions going unfilled and all those graduates would be snapped up.
I agree that hospital nurses have to work too much overtime and that this isn’t good for nurses or patient care. This is due largely to short-staffing by management, either because positions are being left empty or because nurses aren’t replaced when they’re on vacation, sick or on leave.
Carr says an aging patient population with higher-acuity illness justifies moving to CDMR, which he claims better addresses individual care needs.
Higher-acuity patients do deserve better care, but CDMR certainly won’t give them that. By moving nurses further from the bedside, CDMR denies timely access to the very type of care these patients need most. Gravely ill patients need more professional nursing care to recover, not less.
Carr implies that care aides are being added to teams and that no nursing positions are being cut. Nurses would welcome care aides being added to existing teams to help patients with their daily needs. The truth is, nurses are being replaced by care aides. There are more care aides on the ward, but fewer nurses providing care at the bedside.
Carr refuses to acknowledge that reducing the number of nurses can harm patient safety.
The price of replacing nurses with care aides is less access to the nursing skills central to full recovery. In Victoria, 187,000 annual nursing-care hours are being cut (more than 100 positions), while in Nanaimo 48,620 annual hours have been cut (26 positions). That’s a lot of lost care.
The truth is that CDMR sharply increases the number of patients nurses are responsible for. Where previously, nurses were fully occupied looking after the needs of four or five patients, under CDMR they now have seven, eight or more.
The potential for errors, adverse outcomes, failures to rescue and mortality rises when nurses have too many patients to look after. With more patients, proper surveillance and assessment of changing conditions is less likely, as is timely administration of medications and other vital care. Rather than giving timely care to all patients, nurses are forced to triage and only focus on the sickest because they have too many patients.
The negative effects of rising patient ratios are well documented in studies over decades. As recently as February 2014, a study of 300 European hospitals showed that for every additional patient an RN looks after, the risk of mortality after surgery rises by seven per cent.
For Island Health to ignore such studies and the many ill-fated experiments in replacing professional nurses with unlicensed caregivers is unconscionable. There’s just as much obligation to practise evidence-based management in health care as there is in evidence-based medicine.
CDMR isn’t about improving patient outcomes or about better care — it’s about cutting costs by reducing nursing care.
Not only will our patients suffer (whether self-monitoring by hospitals captures that or obscures it), but unacceptable working conditions will make it more likely that nurses decline to work on these units. That negative spiral is already occurring in Nanaimo.
Carr wants us to believe that CDMR frees up nursing time. The exact opposite is happening at Nanaimo Regional General Hospital. Nursing time is being spread across more and more patients, diminishing what’s available to each.
Nurses struggling with CDMR and its impossible patient load are physically exhausted and say they live in moral distress because they can’t deliver safe care for which they are educated and licensed. In these circumstances, nurses face the choices of going numb, leaving hospital nursing or speaking out for safer patient care.
Carr and Island Health management need to start listening to nurses. They could begin by providing the public with the long-sought-after independent evidence to prove this new care model is safe for patients.
Debra McPherson is president of the B.C. Nurses’ Union.
