FOR IMMEDIATE RELEASE
May 13, 2010
RNs concerned about patients facing major cuts in care
at St. Albert’s Youville Home
Edmonton – United Nurses of Alberta has written to W. John Brennan, Board Chair of the Covenant Health Board to express concerns for patients well-being after significant nursing reductions were announced for Youville Home recently.
Covenant Health told the nurses last week it is almost completely eliminating RNs from direct care positions at the facility, and RNs will be mainly in supervisory oversight positions. RN staffing for the Day and Evening shifts is dropping from a total of eight RNs to just two on Days and one on Evenings. Night shift will continue with just one RN. Even with the dramatically reduced RN numbers, the RNs are assigned extra non-nursing, non-patient care duties.
“As Registered Nurses it is our professional and ethical responsibility to draw your attention to the staffing changes that will result in Youville providing less skilled care to patients,” UNA says in its letter to Covenant.
“The almost complete elimination of Registered Nurses from direct care of patients at the facility directly compromises the care and the safety of the patients. We are concerned Covenant is reducing the qualification mix of skilled care providers to reduce costs in the care of patients. This is unacceptable,” the letter to Brennan says.
“We are concerned about the wisdom of drastically thinning Registered Nurse numbers because patient acuity is increasing, the residents are more seriously ill than before,” says Mary Roche, President of the UNA Local at Youville. “Adequate supervision of patient care cannot be provided under the proposed RN staffing configuration.”
Youville Home is a Covenant Health long-term care facility in St. Albert that provides accommodation and care for patients in 5 units for a total of over 220 beds. Previously a nursing home, just a few years ago it was designated as an auxiliary hospital.
Nursing takes a strong team of RNs, LPNs and aides – in an appropriate mix. Removing RNs almost completely from the equation is NOT the formula for best care for patients.
There are a number of specific issues with the reduced staffing:
• RNs will be back and forth across as many as 5 units spread over three floors in two separate buildings and and won’t be assessing each patient directly – there won’t be time.
• The RNs stress the importance of assessment and observation of patients. “I know what’s normal for my patients, and I can see when something’s wrong,” says one nurse.
• When staff are dealing with more than one patient crisis at a time, for example a fall, and a life-risk “code”, the RNs will not be able to be in two places at once. The result will be more 911 calls for outside help. Often it could mean a potentially unnecessary ambulance trip and a lengthy wait for a frail elderly patient to be assessed by a nurse in an emergency department.
• Patient medication reviews, lab test interpretation and physician consultation nursing work will be less effective.
Nurses say “helicopter nursing” where the nurse only lands when a patient has a problem, but without knowing the patient, or the patient’s backround, is a poor care model. Good nursing care is pre-emptive, seeing problems evolving and heading them off before a full-fledged crisis.
RNs also have formal mechanisms for addressing professional and safety concerns, through their union, right to the Youville governing board. Management nurses do not have this right.
“Professionally, I must have a way to raise concerns about care at the highest level and be sure they get addressed,” says Karen Kuprys, vice-president of the UNA Local. She is very concerned this professional accountability for RNs will be greatly eroded when RNs are removed from direct nursing care.
The Youville nurses worry that the changes will short-change the over 200 residents of the facility.
“They’re being treated by health care as not that important because they are at the end of their lives,” one said.
Youville, the latest example of deskilling
Cutting the numbers of RNs has been reducing levels of care in long-term care facilities across the province.
“Alberta has actively been trying to cut long-term care costs by reducing staffing qualifications,” says UNA President Heather Smith.
“Many frail seniors or handicapped individuals who formerly would be in full nursing home care are now relegated to lower care levels in assisted living with little or no RN on site staffing,” she notes.
The Nursing Home Act regulations specify a floor level of RN care in all nursing homes. By reclassifying facilities into auxiliary hospitals or into assisted living, the government is avoiding complying with legislated levels of nursing care.
“At the same time as the acuity of the patients is increasing, the skill mix of the nursing staff is being decreased,” Heather Smith says.
UNA also raises concerns that the proposed Alberta Health Act, apparently coming in the fall, will repeal the Nursing Home Act and eliminate all specific protections of levels and qualifications of care.
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