PrintNurses' patient safety concerns too often originate in workforce changes unsupported by evidence, professional responsibility advisor says
Many of the patient-safety concerns raised by Registered Nurses and other health care workers in Alberta’s hospitals and care facilities are the symptoms of larger workforce changes that have been taking place in the province for 20 years, United Nurses of Alberta professional responsibility advisor Joshua Bergman told the union’s annual general meeting this morning.
The workforce changes tend to have the effect of diluting the number of Registered Nurses and Registered Psychiatric Nurses in the workforce and replacing them with workers who have a mix of skills in health care facilities across Alberta, Bergman said.
“Unfortunately, a number of these changes don’t appear to be based on any obvious evidence and appear largely driven by the goal of saving money, or ‘bending the cost curve,’ as they call it now,” Bergman told the more than 900 members, observers, staff members and guests attending the second day of UNA’s 39th AGM at the Edmonton EXPO Centre.
On the contrary, said Bergman, strong evidence from generations of Canadian and international research consistently demonstrated a clear relationship between inadequate nurse staffing and poor patient outcomes, including higher mortality rates, hospital-acquired infections, cardiac arrest, falls, medication errors and longer hospital stays.
So while it’s important for governments to be responsible stewards of Alberta tax dollars, observed Bergman, who is a Registered Nurse and holds a Masters Degree in Public Health, “this approach must be balanced with evidence and the obligation to promote and protect the health of Albertans.”
If this isn’t done, he warned, “this approach truly becomes an experiment that may put the health of Albertans at risk.”
And that is what the two-decade emphasis on cost-cutting that began under the premiership of Ralph Klein has become, Bergman emphasized – an extended experiment unsupported by evidence and based on the narrative by governments and health executives that health-care spending in unsustainable.
In fact, he said, “since 2011, health spending in Canada has decreased by an average 0.6 per cent a year.
“The continued claim that Alberta has the highest per capita spending on health care in Canada also isn’t true,” he added. “Alberta ranks fourth among all provinces and territories for per capita spending in 2015, and had the second lowest growth in per capita spending growth in Canada in 2015 at just 0.1 per cent.”
But the lack of evidence has not stopped the “insidious and elusive” stream of “short-sighted cost-savings measures” in Alberta care facilities using a variety of different names and running counter to “the mountain of peer-reviewed evidence on the relationship between RN staffing and patient, staff, and organizational outcomes.”
The effect is insidious and elusive, Bergman said, because the changes while similar are called by so many different names – service delivery models, care transformation initiatives, provider mix changes, scheduling optimization, rotation optimization, patient-centred care, workforce optimization, CoACT, benchmarking and, lately, operational best practices, just to mention a few.
“All were used with little explanation of how they are the same or different, or how they relate to each other,” he said, walking delegates through the history of the staffing approaches that have been tried since Klein was premier right up to the present government.
“How does an employee possibly keep up with this?”
Bergman urged delegates to continue to use the Professional Responsibility Concern (PRC) process embedded in UNA’s collective agreements to immediately raise patient safety concerns as soon as they are apparent.
“The professional responsibility process in our collective agreement is one of the most substantial and robust patient-hazard identification systems in Alberta and Canada,” he stated. “PRCs prevent adverse events and save lives.”
He also called on nurses to reinvigorate their “Wear White Wednesdays” campaign to raise the visibility of RNs and RPNs in the health care system for patients, families, and the public generally and illustrate “the unique and critical role they plan in delivering safe and high quality care to Albertans.”
