@SUNnurses President's Message

The time for action is now  #ptsafety  #nursing  #skpoli

[April 20, 2016] I’ll start my address in a different way to usual. I’ll ask all of you to please join me in a small visualization exercise.

First, I’d like you to take a moment to think about your individual workplaces – close your eyes if you have to – picture yourself at work, at the bedside, going about your day, caring for your patients.

What changes have you seen in the past year? – Or even in the past three or four years? Think about the biggest challenges affecting how you as a registered nurse are able to deliver care?

What’s having the biggest impact on your professional practice?

Now, build a picture in your mind of what it means to you personally to be a registered nurse – why did you choose this career in the first place? How does your original ideal compare to today’s reality? How has your practice changed over the years?

I imagine many of you are thinking about the exact same things – you are being asked to care for more and more patients at a time and there simply aren’t enough staff to give you the support you need to your job; your workloads continue to grow; you are forced to focus on tasks rather than using your knowledge; often if feels like there aren’t enough hours in a shift to give your patients the care you know they deserve; you’re tired; and many of you may even be starting to feel burnt out.   

Now think about the effect all of this is having on the safety and quality of patient care on your unit or in your facility, and try to envision what the future might look if these troubling trends continue – what will the next one year, five years or even 10 years look like?

Unfortunately short-staffing is nothing new to registered nurses. For years we have been working under increasing pressure, many of us at the breaking point, but we have always showed up and got the job done because we know that being a registered nurse has never been about us. We know that our patients always come first – they depend on us and at the end of the day it’s them that make this incredibly rewarding career worthwhile.

The problem is that it’s not getting any easier. When you listen to what direct care registered nurses are saying everywhere in the system; there is no question that patient safety is increasingly at risk in this province.

This past year, SUN members filed a total of 995 work situation reports and a staggering 827, or 83%, of those were related to staffing concerns.

Even more worrisome were the findings of the 2016 SUN member survey – of the close to 1,500 members from all corners of the province and health system who responded, over 85% said that they are aware of times patients have been put at risk due to short-staffing; and, 45% of those said that this occurs “frequently”. I’m sure you agree – these numbers are both sobering and extremely concerning.

I think it’s important to note, when looking at these numbers, that short-staffing isn’t a stand-alone concept that simply refers to “not enough bodies on the floor” or “too few registered nurses in the system” – it’s far more complex than that.

We have to start acknowledging short-staffing’s link to having the appropriate staffing mix on the nursing team, and ensuring that the right providers, who have the right education, are matched with the right patients based on their acuity and complexity.

There is no question that nursing role clarity is inextricably connected to short-staffing and patient safety.

When employers set policies that fill registered nurse positions with LPNs as a first choice to cover sick calls or vacation time; or when retired registered nurses are no longer replaced with registered nurses but LPNs instead, there is a direct impact on the workloads of the team and even the ability of new graduates to find full time placements.

Staffing policies such as these change the skill mix and dynamic of the nursing team, further compounding the effects of growing patient numbers and increasing patient acuity – the links between the erosion of the registered nurse’s role at the bedside and short-staffing are clear – These are the new causes of declining registered nurse numbers on the unit.

Some of you may be thinking that you have not experienced these changes first-hand yet. You might be wondering if your personal area of practice is even at risk. This isn’t entirely surprising as it would be fair to say that registered nurse replacement has been relatively gradual and insidious thus far. But make no mistake this is set to accelerate in the very near future.

Government, employers and SALPN have been strategically laying the groundwork that would advance an expanded role for LPNs going forward – and unfortunately they are nearing the completion of this work.  

Think of this groundwork in terms of building a new house. Before you start erecting walls and putting a roof on you need to build a solid foundation upon which the house will sit.

This is precisely what has been happening these past few years. SALPN and government have been working to develop the foundation they need to legitimize LPN practices that are currently not supported through their basic practical nursing education.

This foundation consists of new bylaws that expand the LPN scope of practice. The Minister of Health signed-off on these bylaws and they were consequently gazetted in January 2016.

It also includes the development of on-the-job training and workshops in spite of the SRNA’s explicit instruction to employers and nurse educators not to teach LPNs tasks and functions that are beyond their scope of practice and basic education, and in contravention of the RN Act of 1988.

The final building-block in laying this foundation is perhaps of greatest concern and is something you are going to be hearing a lot about over the course of this annual meeting. SALPN is currently developing a new LPN competency profile which could result in significant duplication of RN practice across the entire continuum of care.

They have stated that this new competency profile will be modelled on that of Alberta’s and that it will be based on a scan of activities and functions LPNs are currently performing in Saskatchewan. Many of these activities, which are unauthorized according to Saskatchewan’s Licenced Practical Nurses Act, will now be considered LPN practice regardless of the lack of supporting evidence, research, or foundational education LPNs receive.

We are talking about LPNs providing care in highly complex situations with highly unstable patients – scenarios such as caring for women with post partem hemorrhage, monitoring and managing symptoms of arrhythmia and cardiac tamponade, resuscitation of newborns, and managing post anesthetic clients for recovery in the post-anesthesia care unit.    

So what does it look like when employers are finally able to build on this foundation?

Well, SALPN are already in the process of conducting education sessions for employers, nurse managers and clinical educators on these new competencies – and SUN members who have been in attendance have reported some extremely troubling comments from SALPN representatives such as – “The only thing that differs between RNs and LPNs is the employer policy’”

Unfortunately, we also know polices that allow LPNs to work outside of their scope of practice already exist – and we can be sure that expanded policies enabling the replacement of RNs with LPNs based on the training they receive at work will be developed once the new competency profile is completed.

These new policies will translate into increased registered nurse vacancies or replacement with other care providers, fewer registered nurses on the floor leading the nursing team, and ultimately a decline in patient safety.

You’re probably all wondering why government would endorse a strategy when all the research and evidence points to it not being in the best interest of patient safety.

Registered nurses make up the largest group of health care providers in the system. This unfortunately means that government decision-makers too often view us as an “operating cost” and overlook the gains and returns on investment that would be achieved with safe registered nurse staffing levels.

Decades of Canadian and international research has consistently demonstrated that with safe registered nurse numbers patient outcomes improve, hospital death rates and infection rates decline, hospital stays are shortened – and in stark contrast to viewing us as a “cost to the system”, the evidence shows that when you increase patient access to registered nursing care we actually save the system money in the long run.

The long and short of it is that there is no substitute for a registered nurse, nobody does what you all do – and when you are not constantly working short-staffed everyone benefits – patients, workers and the system.

This drive to change LPN functioning is the latest attempt to cut costs contrary to all this evidence.

I would argue that right now, in April 2016, we have reached a critical juncture for patient care in this province – a threat to our registered nursing profession represents a threat to the safety and quality of care for all patients in Saskatchewan.

We have an opportunity, as individual registered nurses, to turn the tides on April 29th at a special meeting of the SRNA. Unfortunately, the reality is, this may be one of our last opportunities before the new competency profile for LPNs is finalized. 

We must seize this opportunity to stand up for our patients and their safety by compelling our regulatory body to uphold their mandate to protect the public by protecting our profession.

It’s up to us to ensure that our legislated role and critical knowledge on the nursing team is respected and valued. We cannot fix problems such as short-staffing and high workloads if we do not speak out for nursing role clarity. If we do not stand together now, the erosion of our profession and patient safety in Saskatchewan will continue.

Now is the time to stand united. I have witnessed unparalleled solidarity among SUN members these past 12 months and today I am asking you to once again demonstrate that same strength on April 29th at the SRNA special meeting. This is so important.   

In closing I’ll ask you to return to the visualization exercise I began this address with – as we move through each agenda item over the next two days try take yourself back to what you personally envisioned for yourself when you first embarked on your career as a registered nurse – and then try to imagine what you can do now to get that ideal back on track. The time for action is now.

Thank you. 

Tracy Zambory, RN
SUN Presidents