Evidence-based, long-term solutions needed to address growing system challenges

A first round of cuts to frontline staff happened on Thursday in the Saskatoon Health Region. About 70 staff, including 12 RNs, will be losing their jobs as a result of the region’s attempt to save $34 million to balance their budget.

Unfortunately we know that the Saskatoon Health Region isn’t the only region struggling with looming budget deficits. While this has been the most public and official layoff announcement, there has been a gradual but steady erosion of registered nurses at the bedside through the abolishment of positions and not filling vacancies for quite some time now. Registered nurses are acutely aware of the fact that decisions like these will likely have a negative impact on patient care.

Reducing the numbers of registered nurses providing direct patient care in response to budget shortfalls is not a long term solution to addressing the realities of today’s healthcare challenges.

Research consistently shows that appropriate registered nurse staffing has a direct positive impact on patient outcomes and safety, including reduced hospital complications and infections, shortened hospital stays and fewer readmissions – all of this has been shown to have a direct impact on the bottom line, ultimately resulting in cost-savings to the system.  

According to the recently released 2015-2016 Saskatchewan Ministry of Health Annual Report, the number of Critical Incidents reported in Saskatchewan rose significantly last year – 249, up from 194 in each of the last 2 years. That’s an increase of more than 28 percent. This includes a record number of Critical Incidents in the “Care Management” category, which are incidents that occur during the provision of patient care.

These worsening critical incident numbers certainly appear to be linked to what registered nurses are telling us from the frontlines:    

  • Of the close to 1500 registered nurses surveyed earlier this year, 85 per cent said they are aware of times patients have been put at risk due to short-staffing; and 45% of those said this occurs “frequently”. 
  • In 2015, registered nurses filed 995 work situation reports with the health regions and SUN, and a staggering 827, or 83%, of those were related to staffing concerns. Work situation reports are an important tool for employers and the union to track issues of concern on the frontlines.
  • Registered nurses also continue to work large amounts of overtime. This is often out of necessity and not by choice; leading to high levels of stress and burnout.

The fact is patient volumes are up; placing increased demand on the system and direct care providers, and ultimately this puts a significant strain on patient care delivery.

Saskatchewan has record high population numbers and, in spite of a recent economic downturn, we still have one of the fastest rates of population growth across the country. This means more patients are requiring care in our province than ever before. But it’s not just more patients; patients are also requiring more of the system and those who work in it.

People are now living longer and with multiple illnesses or comorbidities thanks to advancements in modern medicine. They are presenting in our facilities with not just one condition, but multiple, often serious, underlying chronic conditions. This is what health professionals mean when they talk about the ever increasing acuity and complexity of our province’s patient population. These patients require a different level of care, attention and expertise, which places increased demands on the heath care team.

If we look at the Saskatoon Health Region for example, they are reporting an overall “5% increase in inpatient volumes” (September 7, 2016 memo to all staff and physicians), while their emergency rooms and base hospitals frequently reach critical overcapacity levels. It was just this past 2016 flu season the region stated they were only “one patient away from a code orange” or major disaster at Royal University and St Paul’s Hospitals, and they were shipping patients to other regional facilities while contemplating surgery postponements. Unfortunately challenges such as these are not localized to the Saskatoon Health Region. SUN members have been reporting overcapacity and safe staffing concerns from all corners of the system for quite some time. 

Given all that we know, it is clearly evident that reductions in the number of direct care providers in response to current-year budget deficits is simply a sort-term fix for a much larger systemic problem that needs a more long-term and evidence-based solution – a solution registered nurses want to be a part of. 

Tracy Zambory, RN
SUN President