Nursing week is an annual opportunity to honour the dedication of nurses and acknowledge their contribution to the health care profession. But this year, the otherwise celebratory tone of the event started on a sour note.
On May 9, 2016 the Registered Nurses’ Association of Ontario (RNAO) came out with a position paper about “reclaiming the role of the RN.” Essentially, the RNAO called for eliminating registered practical nurses (RPNs) in acute care settings.
In Mind the safety gap in health system transformation: Reclaiming the role of the RN, the RNAO argues for an “interprofessional health human resources plan” for Ontario. The association says their proposals would result in improved patient safety and health outcomes.
The report lays out eight recommendations. Among them, the RNAO calls on the Ministry of Health and Long-Term Care to “legislate an all-RN workforce in acute care effective within two years for tertiary, quaternary and cancer centres… and within five years for large community hospitals.” It also calls for all first home health care visits to be completed by an RN, and for minimum RN staffing standards in long-term care homes.
The RNAO argues that cuts in health care have resulted in a nursing mix that favours RPNs over RNs. It says hospitals are replacing RNs with RPNs because they can pay them less, but are not taking into account the better patient outcomes that registered nurses afford.
There is no conclusive evidence that proves that a hospital that only employs RNs will have better health outcomes for patients. There is a vital role for both RNs and RPNs in delivering a high standard of care.
RPNs must complete a focused two and a half year study of nursing and are governed by the College of Nurses of Ontario (CNO). The Registered Practical Nurses Association of Ontario (RPNAO) says, “RPNs work anywhere that health care is provided: in hospitals, homes for the aged, nursing homes, retirement homes, public health units, community nursing agencies, clinics, private practice, industry, schools, child care centres, and children’s camps.” Some of them go on to complete post-graduate studies to practice in specialized areas such as gerontology, obstetrics, surgery and mental health.
The Canadian Institute for Health Information lists RPNs as being among 30 allied health professionals considered to be the greatest assets of our health care system. They are on the same list as doctors, registered nurses, social workers, occupational therapists and psychologists. These professionals all work together in a team that varies according to the needs of individual patients.
Patient care is multi-faceted and dependent on the contributions of many workers who also provide indirect care. These “hidden” health care workers include filing clerks, records managers, receptionists, cooks, cleaners, maintenance staff and security personnel. Sadly, their work is often only recognized when it does not get done.
According to a paper published by Women and Health Care Reform called Hidden Health Care Work and Women, “to plan for and deliver good quality health care, we need to consider the whole health care workforce, not just a part of it.”
Let’s put this in perspective. A doctor can diagnose and set a course for treatment when a patient is admitted into the hospital. But that’s just one part of the patient’s health care journey. Before the doctor came to the diagnosis, a medical lab technologist was probably involved. While the patient is in the hospital, a nurse will monitor his/her condition; the records manager will ensure the patient’s history is up to date; the cook will prepare healthy food while taking into account dietary restrictions; the cleaner will follow protocols to minimize the spread of infection; the social worker will visit to talk about how the patient is coping; and the occupational therapist will try to make it easier for the patient to get around, once they are feeling better.
Health care cuts in Ontario have placed a huge burden on hospitals to do more with less and as a result, there are fewer people doing more work. RNs, RPNs and other health professionals need to band together to convince the government that this is unacceptable. The Ministry of Health and Long-Term Care has clearly indicated its intention to put patients first. But in order to do that, we need more funding to ensure adequate staffing and the full range of health care professionals who can work together to offer the best care possible.
Health care is a team effort. Every member of that team has the potential to influence patient outcomes. Instead of arguing that one health care professional is better than the other, we should be acknowledging the value of all health care workers.