Silas comments on new CIHI numbers
The latest Canadian Institute for Health Information data shows that the total number of RNs and LPNs in the country continues to rise. Hopefully, this trend will continue or even accelerate so that we can reclaim the nurse to population ratio we had in the early 1990s. This becomes all the more important as the average age of nurses continues to increase and more and more of us approach retirement.
The value of nurses
A large volume of literature over the past 10 years now makes an incontrovertible case for the value of nursing. Increasing the number of nurses is known to decrease mortality (including respiratory failure, and cardiac arrest in ICUs, and failure to rescue in surgical patients), to decrease morbidity (including the odds of hospital acquired pneumonia or of unplanned extubation), and to decrease patient length of stay (by 24% in ICUs and by 31% in surgical patients, according to one study). Employers, governments the public and nurses need to appreciate this point.
These findings are not particular to acute care. Residents in long-term care facilities that provide higher nursing hours per resident day have better outcomes, including lower mortality rates, improved nutritional status, better physical and cognitive functioning, lower urinary tract infection rates, fewer incidents of pressure sores, and fewer hospital admissions.
Importantly, we can often increase the number of nurses without incurring increased costs. According to one study, decreasing the length of stay alone recuperates 72% of increased labour costs, and on top of this we can add the significant cost benefits of reduced morbidity and the economic value of lower liability and reduced staff turnover.
Concerns over nurse workload have been rising, despite the modest increases in the workforce population. Excessive workloads create significant challenges for nurses, negatively affecting the quality of their work environment and, ultimately, the quality of patient care they are able to deliver.
Nurses are constantly telling me: ‘I’ve reached my limit. Something must be done!’ And yet they continue working because they love being nurses and because they will not let patients down. Polls of nurse union members across the country show that workload is becoming an increasingly important issue, often cited as the most important bargaining priority. Workload and overtime are increasing and, more than ever, nurses are working below normal staffing levels.
So what gives? Shouldn’t the situation be getting better, not worse, as more nurses enter the workplace? The short answer is that the numbers only tell a part of the story. Several other factors play into the problem of nurse workload.
In the first place, there is an increase in the complexity of care. Canadians are living longer and demanding more complicated and labour-intensive interventions. Second, despite the promises following the 2003-2004 Health Accord and 10-year Plan, there has been little advancement in primary care reform such that too many patients receive care in the costliest and most labour-intensive place, the hospital. Unfortunately, in the absence of reform, it is often nurses who must bear the brunt to ensure the highest standards of patient care. In a recent survey of 158 Canadian emergency department directors, 62% reported overcrowding as a major problem during the preceding year, and 82% reported that overcrowding was a major source of stress for nurses.
But this is only part of the problem. Nurses spend much of their time doing non-nursing work (i.e. work not directly related to patient care), they deal with frequent interruptions due to hectic work environments, and they often work with outdated, inadequate staffing plans that give them little influence over staffing decisions.
There is no need to revoice old complaints here. What we do need is to move on to solutions. In the first place, this means giving nurses at the bedside a mechanism to say ‘enough is enough’ when workload reaches a level that is unsafe for the health of patients and nurses alike. In the longer term, we need a staffing model that is flexible, sensitive to the characteristics of the patient and nursing population, adaptable on a shift-by-shift basis, and receptive to the input of front-line nurses.
The CFNU is currently preparing a report on nurse workload. The goal is a solution-oriented policy document with specific ideas to help alleviate the stress on nurses so they can provide safe, quality care to patients. We want to give voice to nurses on the front line who face excessive workloads on a daily basis.
We applaud the growth in the nursing workforce and encourage governments to continue investing in this area. At the same time, let’s recognize that the health of our nursing workforce, and the quality of patient care, depend on real solutions to the problem of excessive workload.