Nurses must play key role in 'workforce redesign,' UBC professor tells UNA members

If you want to have health care that’s safe for patients and health-care workers alike, you need to ensure nurses have a voice in all health care decisions, says University of British Columbia professor Maura MacPhee.

Dr. MacPhee, of the UBC School of Nursing, addressed United Nurses of Alberta’s annual general meeting yesterday afternoon on safe staffing lessons that have been learned in the workplace.

The key lesson she cited: Nurses and other health care workers need to be wary of various schemes for “workforce redesign” put forward by health care managers and politicians, which often advocate changing the mix of nurses and other front-line workers in the system.

“As nurses, we have to be the watchdogs,” MacPhee said, arguing that for health care to be truly safe and effective, “nurses need a voice at every level.”

This is not to say there’s not a role for all kinds of health care workers in a properly functioning system, she cautioned. But professional nurses need to be on guard against “scope creep” in redesigned workplaces, especially among non-regulated aides.

“It’s important to know the scope of practice of team members,” MacPhee stated. “Scope of practice blurring is dangerous, and creates a lot of tension in the workplace.

“We need to be advocating for very clearly defined scope of practice,” she said.

In other words, “like for like is a policy that belongs within workforce redesign,” she explained. “If an RN is deemed necessary to the needs of a patient, then only an RN should replace an RN.”

If an RN is not available, she argued – for example, in the event of an unplanned absence by an RN – schedulers must consider how replacement with a non-RN will influence the workload and safety for patients and other staff members.

Among her recommendations for any workforce redesign program: 

-       Use real-time patient needs assessment tools to determine patient needs – remembering that patients must come first

-       Once patient needs are known, nurses should be assigned based on nurse competencies

-       Nursing scopes of practice should clearly distinguish among regulated groups based on formal educational attainment

-       Education must take place within approved and accredited programs

-       Staff replacement policies must ensure like replaces like

-       Establish mandatory time periods for review and action on professional responsibility forms and critical incident reports

Canadian Federation of Nurses Unions President Linda Silas, who spoke after MacPhee, touched on the same topics, telling delegates that “what employers are often really doing is pitting workers against workers.”

 “We need every health care worker,” Silas said. “There are not too many of us. There are too little of us!”

30