With less money to go around, HSN is changing the duties it assigns to registered nurses and registered practical nurses to help cut costs.
This move prompted the RNAO to say evidence suggests giving the duties of an RN to an RPN can be risky for patients. When pressed by NorthernLife.ca, the association shared its evidence — nine studies looking into the issue.
Perhaps the most compelling is a study published in the BMC Health Services Research medical journal in August 2012. Researchers in the United States found that a one-per-cent increase in licensed practical nurse (the American equivalent to registered practical nurses) time in trauma centres was associated with a four-per-cent increase in the odds of mortality, and a six-per-cent increase in the odds of sepsis.
The study used data from a sample of 70,142 patients in 77 trauma centres across the United States.
Casas said in her letter that registered nurses and registered practical nurses should be assigned based on the complexity of a patient's care needs, with the former group responsible for patients who have the greatest needs.
“Rolling back the clock to outdated models of care delivery results in fragmented care and is detrimental to both patients and to nurses,” Casas said.
But in an email to NorthernLife.ca, hospital spokesperson Dan Lessard said the hospital is being careful about how it will be assigning RPNs and RNs, based on the complexity of patient needs and the skillset of the staff. It's about providing the appropriate level of care for the appropriate treatment required.
“For example, ALC (alternate level of care) patients likely won’t need a level of care that is beyond the scope and skill of a team of RPNs and personal support workers,” he said. “And on the other side, we’ve gone to a complete RN staff complement in oncology because those patients have more complex needs. Previously, we had a mix of RNs and RPNs in that unit.”
What's the hospital's plan?Health Sciences North says new staff mixes in some units – replacing registered nurses with personal support workers and registered practical nurses in some cases – won't compromise patient care.
To save $5.2 million, Health Sciences North will cut just over 35 full-time equivalent non-management positions, or about one per cent of unionized positions at the hospital.
The hospital is also cutting 6.4 full-time equivalent management positions, or around three per cent of total management employees.
Nearly 26 full-time equivalent position reductions are Ontario Nurses' Association members; just over three are staff with the Canadian Union of Public Employees; 4.5 full-time equivalents are with the Ontario Public Services Employees Union; and two are non-union and non-management.
“To minimize the impact on patients and employees, HSN has focused its efforts on finding efficiencies using such measures as not filling existing vacancies, attrition, and reductions in scheduled hours,” the hospital said when it announced the cuts.
In some units, Health Sciences North plans to replace part of its registered nurse compliment with less expensive personal support workers and registered practical nurses.
Health Sciences North will change the staff mix in the medical program, with a registered practical nurse, personal support worker and activity worker model for alternate level of care patients, but will switch to an all-registered nurse model for oncology.
In the emergency and ambulatory care program, Health Sciences North will move to an all-registered practical nurse model for the emergency department green zone – for less intensive care, and will see no reductions in its registered nurse complement.