Behind the Front Lines · In an open letter, ... auxiliary nurse, between constant requests to work...
7
Behind the Front Lines A recap/critical look at health care news and the reality behind the reporting from the viewpoint of front-line Ontario registered nurses Volume 10, No. 1 March 2018 ONA President Vicki McKenna says Ontario hospitals are increasingly “industrializing” hospital care, which for RNs means working harder, faster, quicker, with fewer staff. Hospital Nurses’ Negotiations in the News The breakdown of negotiations between the Ontario Nurses’ Association (ONA) hospital nurses and the Ontario Health Association (OHA) dominated the news recently. Newly elected ONA President Vicki McKenna, RN, was all over both print and electronic media outlets following the news that ONA walked away from the table after 10 days of talks and two days of mediation. McKenna is proving to be an eloquent spokesperson, explain- ing to CFRA AM 580 Ottawa radio host Rob Snow that the hospitals are increasingly “industrializing” hospital care. Nurses are working excessive overtime, trying to meet their professional standards under the College of Nurses, she explained, “but most importantly…it is their concern around patient care…” Hospitals, McKenna says, are taking a new tact in trying to find “efficiencies” to assist them in balancing budgets after a number of years of inadequate funding. Some hospitals have taken to using assembly line methods, such as “just-in-time” staffing to avoid overstaffing. Registered nurses (RNs) have been warning for many years of the crisis in RN staffing. It has played a role in long wait times, and ONA has been vocal about the impact thousands of RN cuts have been having on patient care. As McKenna told Toronto Star reporter Moira Welsh, ONA heavily surveys its members and, in this round of negotiations, hospital RNs cited heavy workloads and the resulting professional issues – like job safety and patient care – as their top priorities in negotiations. The industrialization cited by McKenna is just another ex- pression for “work harder, faster, quicker with fewer” staff. INSIDE Private surgery centres killing patients in U.S. Nursing shortage impacting patient care in other provinces Hallway nursing: hospital overcrowding is not easing Overcapacity crisis: RN cuts come back to haunt CHEO
Transcript of Behind the Front Lines · In an open letter, ... auxiliary nurse, between constant requests to work...
Behind the Front LinesA recap critical look at health care news and the reality behind the reporting from the viewpoint of front-line Ontario registered nurses
Volume 10 No 1March 2018
ONA President Vicki McKenna says Ontario hospitals are increasingly ldquoindustrializingrdquo hospital care which for RNs means working harder faster quicker with fewer staff
Hospital Nursesrsquo Negotiations in the News
The breakdown of negotiations between the Ontario Nursesrsquo Association (ONA) hospital nurses and the Ontario Health Association (OHA) dominated the news recently
Newly elected ONA President Vicki McKenna RN was all over both print and electronic media outlets following the news that ONA walked away from the table after 10 days of talks and two days of mediation
McKenna is proving to be an eloquent spokesperson explain-ing to CFRA AM 580 Ottawa radio host Rob Snow that the hospitals are increasingly ldquoindustrializingrdquo hospital care
Nurses are working excessive overtime trying to meet their professional standards under the College of Nurses she explained ldquobut most importantlyhellipit is their concern around patient carehelliprdquo
Hospitals McKenna says are taking a new tact in trying to find ldquoefficienciesrdquo to assist them in balancing budgets after a number of years of inadequate funding
Some hospitals have taken to using assembly line methods such as ldquojust-in-timerdquo staffing to avoid overstaffing
Registered nurses (RNs) have been warning for many years of the crisis in RN staffing It has played a role in long wait times and ONA has been vocal about the impact thousands of RN cuts have been having on patient care
As McKenna told Toronto Star reporter Moira Welsh ONA heavily surveys its members and in this round of negotiations hospital RNs cited heavy workloads and the resulting professional issues ndash like job safety and patient care ndash as their top priorities in negotiations
The industrialization cited by McKenna is just another ex-pression for ldquowork harder faster quicker with fewerrdquo staff
INSIDEPrivate surgery centres killing patients in US
Nursing shortage impacting patient care in other provinces
Hallway nursing hospital overcrowding is not easing
Overcapacity crisis RN cuts come back to haunt CHEO
IN THE NEWS
continued on page 3
Nurse Shortage Impacting Patient Care in Other Provinces
While the ldquoindustrializationrdquo of health care in Ontario has had a negative impact on RNsrsquo working conditions nurses in other provinces have also experienced problems
In Manitoba a Winnipeg nurse says she is retiring because she ldquocanrsquot continue to workrdquo after government changes to health care will result in the loss of RNs and a decline in patient care
The unnamed RN says ldquothe changes have absolutely made me decide that I need to leave because itrsquos not working the way
Irsquom accustomed to doing my job and to taking care of patientsrdquo She added that the changes are ldquonot about the patient experience I think itrsquos about the numbersrdquo
Itrsquos no surprise to Ontario nurses to hear the RN describe that she canrsquot do her job properly with the staff shortages The nurses she says are constantly in fear that something bad will happen to a patient
In Quebec a Facebook post by nurse Emilie Ricard was shared tens of thousands of times after
Registered nurses in other provinces say they canrsquot do their jobs properly with the staff shortages Nurses are constantly in fear of making an error that will adversely affect their patient
OntarioNurses
What is ONAThe Ontario Nursesrsquo Association is the union representing 65000 registered nurses and health-care professionals as well as more than 16000 nursing student affiliates providing care in hospitals long-term care facilities public health clinics community and industry
Vicki McKenna RNONArsquos New PresidentONA President Vicki McKenna RN (pictured) is a registered nurse specializing in pediatric day surgery at London Health Sciences Centre Vicki is available for comment on a wide range of issues including pa-tient care health-care policy safe staffing workplace violence and much more To reach Vicki please contact Sheree Bond ONArsquos Media Relations Officer at shereebonaorg or (416) 964-8833 ext 2430 cell (416) 986-8240
How to reach usOntario Nursesrsquo Association 85 Grenville Street Suite 400Toronto ON M5S 3A2(416) 964-8833wwwonaorg
Visit us atwwwonaorg
Behind the Front Lines page 2
Behind the Front Lines page 3
What does the research sayAre registered nurses who say patient care is being compromised by short-staffing correct A large body of research says they are
Dozens of research studies have been done over the past two decades and most found similar results ndash more RN care results in lower rates of patient morbidity and mortality (about seven per cent)
For instance the Australian Health Review published a study that links higher nurse staffing to patient outcomes ndash and found a three to 12-per-cent reduction in ldquoadverse outcomes and 16-per- cent reduction in death for surgical patientsrdquo
The evidence says the study ldquoconfirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisorsrdquo The report concludes that policy makers must ensure there are sufficient registered nurses to provide patient safety
How bad is itIn Quebec doctors are calling for their planned raises to be cancelled and the money to flow to patient care and resources for ldquotheir underpaid and overworked colleagues insteadrdquo
In an open letter the group Meacutedecins Queacutebeacutecois pour le reacutegime public representing a group of doctors and medical students says that with many of Quebecrsquos nurses and other health-care workers ldquoat their witsrsquo endrdquo they want money to flow throughout the health-care system
The organizationrsquos president Dr Isabelle Leblanc explained to CBC that the news of her professionrsquos raises is coming at the same time that nurses are mobilizing in protest of their working conditions Physicians want to show their solidarity she said
The open letter was posted on the organizationrsquos website and within hours had 270 signatories
she described having to work a night shift during which she was responsible for the care of 70 patients ndash on her own
The post went viral and set off a media storm in which nurses debated which province had busier nurses and worse patient care
The Canadian Press reported that the province has instituted mandatory overtime shifts Nurse Veronique Brouillard told CP that while she loves being an auxiliary nurse between constant requests to work overtime and heavy and stressful workloads she is ldquoexhausted stressed ndash and furiousrdquo
Brouillard described having ldquono life One day off in a week and they call us four times [asking us] to come in for extra work Irsquove had enoughrdquo
Quebec nurses took to the streets of Montreal to express anger over staff shortages and working conditions They are seeing chal-lenges to care for patients
Meanwhile the head of the Feacutedeacuteration interprofessionnelle de la santeacute du Queacutebec blames government budget cuts for exacerbating the shortage
ldquoTheyrsquore always asking us to reorganize do more with less Wersquove hit a wall a level where we say we canrsquot go furtherrdquo said Nancy Bedard
Nurse Shortages Impacting Patient Care in Other Provinces continued from page 2
Behind the Front Lines page 4
Passionate Op Ed Calls for Better Care of Nurses
The controversies swirling in Quebec ndash including a group of physicians calling for their fee increases to be used instead to provide some relief to overworked nurses ndash have inspired a passionate opinion editorial in the Montreal Gazette
Allison Hanes wrote the piece which notes that anyone who has ever spent time in a hospital has benefited from the care of a nurse
Nurses she says ldquodonrsquot get much glory or credit Yet their often thankless work is the backbone of our health systemrdquo
The Gazette editorial points out that nurses say they are ldquocrumblingrdquo under the weight of the extraordinary demands being placed on themrdquo
The piece was sparked by coverage of the RNsrsquo too-heavy workloads stemming from a Facebook post of one nurse
Emilie Ricard posted a video in January noting that she was the only caregiver for 70 patients during her last shift She spoke of being so busy monitoring an
unstable patient that she had no time to help others and noting that she ldquowouldnrsquot want to see one of my own family members left in conditions like that I am broken by my profession I am ashamed of the pitiful care I am providing despite my best efforts My health system is broken and dyingrdquo she said
In a response that feels familiar to Ontariorsquos nurses Quebecrsquos health minister deflected blame Gaetan Barrette claimed that nurses are unwilling to fill vacant full-time positions for fear of being forced to work overtime This he claims has created a vicious circle where other nurses are forced to work mandatory overtime
In Ontario the outcry against heavy workloads for RNs has been met with a claim from
the province that it has hired thousands of new nurses since
2003 This leaves ONA wondering just where these thousands of
new nurses actually are
Ontario hospitals have cut more than 13000 RN positions in the
past five years alone Ontario has the worst RN-to-population ratio
in the country
Sexual Assault Clinic Canrsquot Keep Up As
MeToo Movement
Impacts Ottawa
Staff working at the sexual assault and partner abuse care program at The Ottawa Hospital canrsquot keep up with demand
The program has been around since the 1980s Patients see specially trained nurses ndash available 247 ndash and a nurse practitioner is there for a follow-up visit
Funding for the program has barely changed in the past decade yet demand has increased and close to 1000 patients were seen recently
Medical director Dr Kari Sampsel told the Ottawa Sun that demand has tripled in the past decade It operates on a $480000 budget that is meant to cover both staff and supplies
Sampsel believes this summer will be extra busy for the unit as the MeToo movement encourages people to talk about and seek help following sexual assault
Nurses says ONA President Vicki McKenna often put their own health needs last ndash well behind the health of their patients Thatrsquos what makes the fact that Quebec nurses speaking out about the
strain on their own health so extraordinary
Behind the Front Lines page 5
Ontariorsquos Hospital Overcrowding Is Not Easing
Readers of Behind the Front Lines first read about hospital over-crowding in Ontariorsquos hospitals more than a year ago
The intervening months have seen the issue regularly taking up space on new broadcasts and in printelectronic media
With an election approaching the NDP has kept the issue front and centre
NDP Leader Andrea Horwath and NDP Health Critic France Gelinas have been leading the attacks on the province finding stories of patients housed in ldquounconventional spacesrdquo such as a shower room
For front-line nurses and health-care professionals the news that patients are being cared for in hallways meeting rooms and other ldquounconventional spacesrdquo is no surprise The announcement of additional emergency funding to deal with the lack of lsquosurge cap-acityrsquo was welcome but without the funding to staff these extra beds front-line workers remain concerned about their patients
That concern was backed up by a report from Thomson Reuters indicating that patients are more likely to be misdiagnosed or ex-perience treatment delays when they become lsquohallwayrsquo patients
The report says that researchers surveyed 440 ER physicians attending a conference in Boston in 2015 The researchers found that these ldquonon-private encounters not only affect the accurate diagnosis of medical conditions but also of social and behavioural conditions such as domestic violence human trafficking suicidality and substance userdquo
Lead study author Dr Hanni Stoklosa an ER physician at Brigham and Womenrsquos Hospital and Harvard Medical School said ldquothis is quite concerning on many levels because emergency departments are on the front lines of caring for patients most vulnerable to these conditionsrdquo
Nurses have detailed the road-blocks to providing quality care to their patients in hallways and unconventional spaces this re-
port notes that 90 per cent of the physicians surveyed said they either changed or shortened how they took patient medical histor-ies in hallways and ldquosometimes often or always changing how they conducted physical examsrdquo
The physicians said that in 74 per cent of cases taking an abbreviated medical history had led them to fail to diagnose a social issue ndash such as suicidal thoughts or elder abuse ndash and 46 per cent said the changes in physical exam led them to miss these issues
Dr Bernard Chang a professor of emergency medicine at Columbia University Medical Center says the findings of the researchers add to the existing evidence that the environment in which patients are cared for may influence their treatment
For nurses hallway nursing has been a serious concern for well over a decade
The research evidence shows that hallway patients lack the access to privacy the quiet needed for rest the proper medical equipment and their exposure to others is an issue for proper infection control
ONA notes that patients are at greater risk if cared for in these ldquounconventional spacesrdquo
90 of the physicians surveyed said they either changed or
shortened how they took patient medical histories in hallways and ldquosometimes
often or always changed how they conducted
physical examsrdquo
Behind the Front Lines page 6
Childrenrsquos Hospital Transfers Pediatric Patients Elsewhere
ONA members vividly recall the CEO of the Childrenrsquos Hospital of Eastern Ontario (CHEO) telling local media that the closure of hospital beds and shedding 50 registered nurses would not impact care or services
Well that was then and this is now
When the cuts were announced in 2015 ONA noted that the cuts equated to a loss of 90000 hours of RN care per year
ONA predicted then that the neonatal intensive care unit the pediatric intensive care unit ambulatory care in-patient surgical and medical units would be hardest hit by the cuts
It now seems the cuts have impacted care as CHEO has been forced to send 19 critically ill pediatric patients out of town to receive care The Ottawa Citizen reports that the hospital is struggling with overcrowding in its intensive care units
The hospital ndash like so many others in Ontario ndash has been overcapacity for several months In February the pediatric intensive care unit transferred 15 patients to Kingston Toronto Hamilton or Montreal for care Two newborns needing neonatal intensive care were sent to Kingston and two were sent to Montreal
Tellingly the remarks of CHEOrsquos chief of staff Dr Lindy Samson
mentioned nurses ldquoWe only consider sending children ndash either babies or older kids ndash out of town once we have exhausted all our usual strategies That includes calling in nurses for extra shifts and overtime and opening extra beds Itrsquos not the first second or third approach that we take We only do it when we have no more nurses to callrdquo
The hospital acknowledged that the number of nursing hours worked in the pediatric intensive care unit had ldquoskyrocketedrdquo in 2018 with CHEO nurses working more than 14000 hours ndash or 50 per cent more than what hospital officials had predicted would be required
In the pediatric intensive care unit CHEO nurses worked 50 more hours than what hospital officials had predicted would be required
Behind the Front Lines page 7
UNDER THE RADARNews the Media is Missing
Private Surgery Centres Killing Patients
ONA has frequently spoken out against the further privatization of medicare in Ontario
Not only do private providers have to find savings to carve out profit from funds that otherwise would go to public hospitals and health-care providers but even the US has noted that ldquoas surgery centers boom patients are paying with their livesrdquo
A recent joint Kaiser Health News-USA TODAY report found that 260 patients have died follow-ing ldquoin-and-outrdquo procedures at these centers since 2013 In addition dozens of patients some as young as two years of age have died after routine operations such as colonoscopies and tonsillectomies
The centers are intended to be low-cost alternatives for patients
who require minor procedures They have been around in the US for nearly 50 years but now out-number hospitals as federal regu-lators have okayed an expanding list of outpatient procedures as they struggle to cut federal fund-ing of health-care costs
ONA believes this is a cautionary tale for Ontario As ONA has spoken out about there has been creeping privatization in our system with lsquoroutinersquo procedures such as cataract surgeries and colonoscopies
being performed by for-profit clinics
As this USA TODAY-Kaiser report shows these kinds of private surgical centers call
9-1-1 when patients experience complications shifting the
burden of caring for seriously ill patients back onto the
public system
Nursesrsquo Contract Will Expire Soon
After it Takes Effect
The Windsor Starrsquos Brian Cross found an arbitration decision for 26 registered nurses who work at the city-owned long-term care facility Huron Lodge and was astounded to see that the four-year deal expired 44 days after it was handed down
As ONA President Vicki McKenna RN told the Star ldquoItrsquos absolutely unusual ndash itrsquos not unheard of but itrsquos unusualrdquo
The Ontario Nursesrsquo Association members had been working without a contract since April 1 2014 The new contract runs to March 31 2018
Cross attempted to interview management of Huron Lodge but was not successful his report notes that RNs in hospital and long-term care are considered an essential service and cannot strike Arbitration was the last resort
As for ONA McKenna said that while no dates have been set for the next round of bargaining she is hoping it wonrsquot be a repeat of this one
wwwonaorg
Sheree Bond Media Relations Officer (416) 964-8833 ext 2430 or cell (416) 986-8240
shereebonaorg
ONA members work in hospitals long-term care public health the community and industry and can answer your questions as health care continues to evolve in this province
Previous Issues of Behind the Front Lines
Need a reliable and informed source Speak to front-line nurses
Behind the Front Lines ndash an electronic newsletter that takes a look at the stories behind the stories
continued on page 3
Nurse Shortage Impacting Patient Care in Other Provinces
While the ldquoindustrializationrdquo of health care in Ontario has had a negative impact on RNsrsquo working conditions nurses in other provinces have also experienced problems
In Manitoba a Winnipeg nurse says she is retiring because she ldquocanrsquot continue to workrdquo after government changes to health care will result in the loss of RNs and a decline in patient care
The unnamed RN says ldquothe changes have absolutely made me decide that I need to leave because itrsquos not working the way
Irsquom accustomed to doing my job and to taking care of patientsrdquo She added that the changes are ldquonot about the patient experience I think itrsquos about the numbersrdquo
Itrsquos no surprise to Ontario nurses to hear the RN describe that she canrsquot do her job properly with the staff shortages The nurses she says are constantly in fear that something bad will happen to a patient
In Quebec a Facebook post by nurse Emilie Ricard was shared tens of thousands of times after
Registered nurses in other provinces say they canrsquot do their jobs properly with the staff shortages Nurses are constantly in fear of making an error that will adversely affect their patient
OntarioNurses
What is ONAThe Ontario Nursesrsquo Association is the union representing 65000 registered nurses and health-care professionals as well as more than 16000 nursing student affiliates providing care in hospitals long-term care facilities public health clinics community and industry
Vicki McKenna RNONArsquos New PresidentONA President Vicki McKenna RN (pictured) is a registered nurse specializing in pediatric day surgery at London Health Sciences Centre Vicki is available for comment on a wide range of issues including pa-tient care health-care policy safe staffing workplace violence and much more To reach Vicki please contact Sheree Bond ONArsquos Media Relations Officer at shereebonaorg or (416) 964-8833 ext 2430 cell (416) 986-8240
How to reach usOntario Nursesrsquo Association 85 Grenville Street Suite 400Toronto ON M5S 3A2(416) 964-8833wwwonaorg
Visit us atwwwonaorg
Behind the Front Lines page 2
Behind the Front Lines page 3
What does the research sayAre registered nurses who say patient care is being compromised by short-staffing correct A large body of research says they are
Dozens of research studies have been done over the past two decades and most found similar results ndash more RN care results in lower rates of patient morbidity and mortality (about seven per cent)
For instance the Australian Health Review published a study that links higher nurse staffing to patient outcomes ndash and found a three to 12-per-cent reduction in ldquoadverse outcomes and 16-per- cent reduction in death for surgical patientsrdquo
The evidence says the study ldquoconfirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisorsrdquo The report concludes that policy makers must ensure there are sufficient registered nurses to provide patient safety
How bad is itIn Quebec doctors are calling for their planned raises to be cancelled and the money to flow to patient care and resources for ldquotheir underpaid and overworked colleagues insteadrdquo
In an open letter the group Meacutedecins Queacutebeacutecois pour le reacutegime public representing a group of doctors and medical students says that with many of Quebecrsquos nurses and other health-care workers ldquoat their witsrsquo endrdquo they want money to flow throughout the health-care system
The organizationrsquos president Dr Isabelle Leblanc explained to CBC that the news of her professionrsquos raises is coming at the same time that nurses are mobilizing in protest of their working conditions Physicians want to show their solidarity she said
The open letter was posted on the organizationrsquos website and within hours had 270 signatories
she described having to work a night shift during which she was responsible for the care of 70 patients ndash on her own
The post went viral and set off a media storm in which nurses debated which province had busier nurses and worse patient care
The Canadian Press reported that the province has instituted mandatory overtime shifts Nurse Veronique Brouillard told CP that while she loves being an auxiliary nurse between constant requests to work overtime and heavy and stressful workloads she is ldquoexhausted stressed ndash and furiousrdquo
Brouillard described having ldquono life One day off in a week and they call us four times [asking us] to come in for extra work Irsquove had enoughrdquo
Quebec nurses took to the streets of Montreal to express anger over staff shortages and working conditions They are seeing chal-lenges to care for patients
Meanwhile the head of the Feacutedeacuteration interprofessionnelle de la santeacute du Queacutebec blames government budget cuts for exacerbating the shortage
ldquoTheyrsquore always asking us to reorganize do more with less Wersquove hit a wall a level where we say we canrsquot go furtherrdquo said Nancy Bedard
Nurse Shortages Impacting Patient Care in Other Provinces continued from page 2
Behind the Front Lines page 4
Passionate Op Ed Calls for Better Care of Nurses
The controversies swirling in Quebec ndash including a group of physicians calling for their fee increases to be used instead to provide some relief to overworked nurses ndash have inspired a passionate opinion editorial in the Montreal Gazette
Allison Hanes wrote the piece which notes that anyone who has ever spent time in a hospital has benefited from the care of a nurse
Nurses she says ldquodonrsquot get much glory or credit Yet their often thankless work is the backbone of our health systemrdquo
The Gazette editorial points out that nurses say they are ldquocrumblingrdquo under the weight of the extraordinary demands being placed on themrdquo
The piece was sparked by coverage of the RNsrsquo too-heavy workloads stemming from a Facebook post of one nurse
Emilie Ricard posted a video in January noting that she was the only caregiver for 70 patients during her last shift She spoke of being so busy monitoring an
unstable patient that she had no time to help others and noting that she ldquowouldnrsquot want to see one of my own family members left in conditions like that I am broken by my profession I am ashamed of the pitiful care I am providing despite my best efforts My health system is broken and dyingrdquo she said
In a response that feels familiar to Ontariorsquos nurses Quebecrsquos health minister deflected blame Gaetan Barrette claimed that nurses are unwilling to fill vacant full-time positions for fear of being forced to work overtime This he claims has created a vicious circle where other nurses are forced to work mandatory overtime
In Ontario the outcry against heavy workloads for RNs has been met with a claim from
the province that it has hired thousands of new nurses since
2003 This leaves ONA wondering just where these thousands of
new nurses actually are
Ontario hospitals have cut more than 13000 RN positions in the
past five years alone Ontario has the worst RN-to-population ratio
in the country
Sexual Assault Clinic Canrsquot Keep Up As
MeToo Movement
Impacts Ottawa
Staff working at the sexual assault and partner abuse care program at The Ottawa Hospital canrsquot keep up with demand
The program has been around since the 1980s Patients see specially trained nurses ndash available 247 ndash and a nurse practitioner is there for a follow-up visit
Funding for the program has barely changed in the past decade yet demand has increased and close to 1000 patients were seen recently
Medical director Dr Kari Sampsel told the Ottawa Sun that demand has tripled in the past decade It operates on a $480000 budget that is meant to cover both staff and supplies
Sampsel believes this summer will be extra busy for the unit as the MeToo movement encourages people to talk about and seek help following sexual assault
Nurses says ONA President Vicki McKenna often put their own health needs last ndash well behind the health of their patients Thatrsquos what makes the fact that Quebec nurses speaking out about the
strain on their own health so extraordinary
Behind the Front Lines page 5
Ontariorsquos Hospital Overcrowding Is Not Easing
Readers of Behind the Front Lines first read about hospital over-crowding in Ontariorsquos hospitals more than a year ago
The intervening months have seen the issue regularly taking up space on new broadcasts and in printelectronic media
With an election approaching the NDP has kept the issue front and centre
NDP Leader Andrea Horwath and NDP Health Critic France Gelinas have been leading the attacks on the province finding stories of patients housed in ldquounconventional spacesrdquo such as a shower room
For front-line nurses and health-care professionals the news that patients are being cared for in hallways meeting rooms and other ldquounconventional spacesrdquo is no surprise The announcement of additional emergency funding to deal with the lack of lsquosurge cap-acityrsquo was welcome but without the funding to staff these extra beds front-line workers remain concerned about their patients
That concern was backed up by a report from Thomson Reuters indicating that patients are more likely to be misdiagnosed or ex-perience treatment delays when they become lsquohallwayrsquo patients
The report says that researchers surveyed 440 ER physicians attending a conference in Boston in 2015 The researchers found that these ldquonon-private encounters not only affect the accurate diagnosis of medical conditions but also of social and behavioural conditions such as domestic violence human trafficking suicidality and substance userdquo
Lead study author Dr Hanni Stoklosa an ER physician at Brigham and Womenrsquos Hospital and Harvard Medical School said ldquothis is quite concerning on many levels because emergency departments are on the front lines of caring for patients most vulnerable to these conditionsrdquo
Nurses have detailed the road-blocks to providing quality care to their patients in hallways and unconventional spaces this re-
port notes that 90 per cent of the physicians surveyed said they either changed or shortened how they took patient medical histor-ies in hallways and ldquosometimes often or always changing how they conducted physical examsrdquo
The physicians said that in 74 per cent of cases taking an abbreviated medical history had led them to fail to diagnose a social issue ndash such as suicidal thoughts or elder abuse ndash and 46 per cent said the changes in physical exam led them to miss these issues
Dr Bernard Chang a professor of emergency medicine at Columbia University Medical Center says the findings of the researchers add to the existing evidence that the environment in which patients are cared for may influence their treatment
For nurses hallway nursing has been a serious concern for well over a decade
The research evidence shows that hallway patients lack the access to privacy the quiet needed for rest the proper medical equipment and their exposure to others is an issue for proper infection control
ONA notes that patients are at greater risk if cared for in these ldquounconventional spacesrdquo
90 of the physicians surveyed said they either changed or
shortened how they took patient medical histories in hallways and ldquosometimes
often or always changed how they conducted
physical examsrdquo
Behind the Front Lines page 6
Childrenrsquos Hospital Transfers Pediatric Patients Elsewhere
ONA members vividly recall the CEO of the Childrenrsquos Hospital of Eastern Ontario (CHEO) telling local media that the closure of hospital beds and shedding 50 registered nurses would not impact care or services
Well that was then and this is now
When the cuts were announced in 2015 ONA noted that the cuts equated to a loss of 90000 hours of RN care per year
ONA predicted then that the neonatal intensive care unit the pediatric intensive care unit ambulatory care in-patient surgical and medical units would be hardest hit by the cuts
It now seems the cuts have impacted care as CHEO has been forced to send 19 critically ill pediatric patients out of town to receive care The Ottawa Citizen reports that the hospital is struggling with overcrowding in its intensive care units
The hospital ndash like so many others in Ontario ndash has been overcapacity for several months In February the pediatric intensive care unit transferred 15 patients to Kingston Toronto Hamilton or Montreal for care Two newborns needing neonatal intensive care were sent to Kingston and two were sent to Montreal
Tellingly the remarks of CHEOrsquos chief of staff Dr Lindy Samson
mentioned nurses ldquoWe only consider sending children ndash either babies or older kids ndash out of town once we have exhausted all our usual strategies That includes calling in nurses for extra shifts and overtime and opening extra beds Itrsquos not the first second or third approach that we take We only do it when we have no more nurses to callrdquo
The hospital acknowledged that the number of nursing hours worked in the pediatric intensive care unit had ldquoskyrocketedrdquo in 2018 with CHEO nurses working more than 14000 hours ndash or 50 per cent more than what hospital officials had predicted would be required
In the pediatric intensive care unit CHEO nurses worked 50 more hours than what hospital officials had predicted would be required
Behind the Front Lines page 7
UNDER THE RADARNews the Media is Missing
Private Surgery Centres Killing Patients
ONA has frequently spoken out against the further privatization of medicare in Ontario
Not only do private providers have to find savings to carve out profit from funds that otherwise would go to public hospitals and health-care providers but even the US has noted that ldquoas surgery centers boom patients are paying with their livesrdquo
A recent joint Kaiser Health News-USA TODAY report found that 260 patients have died follow-ing ldquoin-and-outrdquo procedures at these centers since 2013 In addition dozens of patients some as young as two years of age have died after routine operations such as colonoscopies and tonsillectomies
The centers are intended to be low-cost alternatives for patients
who require minor procedures They have been around in the US for nearly 50 years but now out-number hospitals as federal regu-lators have okayed an expanding list of outpatient procedures as they struggle to cut federal fund-ing of health-care costs
ONA believes this is a cautionary tale for Ontario As ONA has spoken out about there has been creeping privatization in our system with lsquoroutinersquo procedures such as cataract surgeries and colonoscopies
being performed by for-profit clinics
As this USA TODAY-Kaiser report shows these kinds of private surgical centers call
9-1-1 when patients experience complications shifting the
burden of caring for seriously ill patients back onto the
public system
Nursesrsquo Contract Will Expire Soon
After it Takes Effect
The Windsor Starrsquos Brian Cross found an arbitration decision for 26 registered nurses who work at the city-owned long-term care facility Huron Lodge and was astounded to see that the four-year deal expired 44 days after it was handed down
As ONA President Vicki McKenna RN told the Star ldquoItrsquos absolutely unusual ndash itrsquos not unheard of but itrsquos unusualrdquo
The Ontario Nursesrsquo Association members had been working without a contract since April 1 2014 The new contract runs to March 31 2018
Cross attempted to interview management of Huron Lodge but was not successful his report notes that RNs in hospital and long-term care are considered an essential service and cannot strike Arbitration was the last resort
As for ONA McKenna said that while no dates have been set for the next round of bargaining she is hoping it wonrsquot be a repeat of this one
wwwonaorg
Sheree Bond Media Relations Officer (416) 964-8833 ext 2430 or cell (416) 986-8240
shereebonaorg
ONA members work in hospitals long-term care public health the community and industry and can answer your questions as health care continues to evolve in this province
Previous Issues of Behind the Front Lines
Need a reliable and informed source Speak to front-line nurses
Behind the Front Lines ndash an electronic newsletter that takes a look at the stories behind the stories
Behind the Front Lines page 3
What does the research sayAre registered nurses who say patient care is being compromised by short-staffing correct A large body of research says they are
Dozens of research studies have been done over the past two decades and most found similar results ndash more RN care results in lower rates of patient morbidity and mortality (about seven per cent)
For instance the Australian Health Review published a study that links higher nurse staffing to patient outcomes ndash and found a three to 12-per-cent reduction in ldquoadverse outcomes and 16-per- cent reduction in death for surgical patientsrdquo
The evidence says the study ldquoconfirms that improvements in nurse staffing is a cost-effective investment for the health system but this is not fully appreciated by health policy advisorsrdquo The report concludes that policy makers must ensure there are sufficient registered nurses to provide patient safety
How bad is itIn Quebec doctors are calling for their planned raises to be cancelled and the money to flow to patient care and resources for ldquotheir underpaid and overworked colleagues insteadrdquo
In an open letter the group Meacutedecins Queacutebeacutecois pour le reacutegime public representing a group of doctors and medical students says that with many of Quebecrsquos nurses and other health-care workers ldquoat their witsrsquo endrdquo they want money to flow throughout the health-care system
The organizationrsquos president Dr Isabelle Leblanc explained to CBC that the news of her professionrsquos raises is coming at the same time that nurses are mobilizing in protest of their working conditions Physicians want to show their solidarity she said
The open letter was posted on the organizationrsquos website and within hours had 270 signatories
she described having to work a night shift during which she was responsible for the care of 70 patients ndash on her own
The post went viral and set off a media storm in which nurses debated which province had busier nurses and worse patient care
The Canadian Press reported that the province has instituted mandatory overtime shifts Nurse Veronique Brouillard told CP that while she loves being an auxiliary nurse between constant requests to work overtime and heavy and stressful workloads she is ldquoexhausted stressed ndash and furiousrdquo
Brouillard described having ldquono life One day off in a week and they call us four times [asking us] to come in for extra work Irsquove had enoughrdquo
Quebec nurses took to the streets of Montreal to express anger over staff shortages and working conditions They are seeing chal-lenges to care for patients
Meanwhile the head of the Feacutedeacuteration interprofessionnelle de la santeacute du Queacutebec blames government budget cuts for exacerbating the shortage
ldquoTheyrsquore always asking us to reorganize do more with less Wersquove hit a wall a level where we say we canrsquot go furtherrdquo said Nancy Bedard
Nurse Shortages Impacting Patient Care in Other Provinces continued from page 2
Behind the Front Lines page 4
Passionate Op Ed Calls for Better Care of Nurses
The controversies swirling in Quebec ndash including a group of physicians calling for their fee increases to be used instead to provide some relief to overworked nurses ndash have inspired a passionate opinion editorial in the Montreal Gazette
Allison Hanes wrote the piece which notes that anyone who has ever spent time in a hospital has benefited from the care of a nurse
Nurses she says ldquodonrsquot get much glory or credit Yet their often thankless work is the backbone of our health systemrdquo
The Gazette editorial points out that nurses say they are ldquocrumblingrdquo under the weight of the extraordinary demands being placed on themrdquo
The piece was sparked by coverage of the RNsrsquo too-heavy workloads stemming from a Facebook post of one nurse
Emilie Ricard posted a video in January noting that she was the only caregiver for 70 patients during her last shift She spoke of being so busy monitoring an
unstable patient that she had no time to help others and noting that she ldquowouldnrsquot want to see one of my own family members left in conditions like that I am broken by my profession I am ashamed of the pitiful care I am providing despite my best efforts My health system is broken and dyingrdquo she said
In a response that feels familiar to Ontariorsquos nurses Quebecrsquos health minister deflected blame Gaetan Barrette claimed that nurses are unwilling to fill vacant full-time positions for fear of being forced to work overtime This he claims has created a vicious circle where other nurses are forced to work mandatory overtime
In Ontario the outcry against heavy workloads for RNs has been met with a claim from
the province that it has hired thousands of new nurses since
2003 This leaves ONA wondering just where these thousands of
new nurses actually are
Ontario hospitals have cut more than 13000 RN positions in the
past five years alone Ontario has the worst RN-to-population ratio
in the country
Sexual Assault Clinic Canrsquot Keep Up As
MeToo Movement
Impacts Ottawa
Staff working at the sexual assault and partner abuse care program at The Ottawa Hospital canrsquot keep up with demand
The program has been around since the 1980s Patients see specially trained nurses ndash available 247 ndash and a nurse practitioner is there for a follow-up visit
Funding for the program has barely changed in the past decade yet demand has increased and close to 1000 patients were seen recently
Medical director Dr Kari Sampsel told the Ottawa Sun that demand has tripled in the past decade It operates on a $480000 budget that is meant to cover both staff and supplies
Sampsel believes this summer will be extra busy for the unit as the MeToo movement encourages people to talk about and seek help following sexual assault
Nurses says ONA President Vicki McKenna often put their own health needs last ndash well behind the health of their patients Thatrsquos what makes the fact that Quebec nurses speaking out about the
strain on their own health so extraordinary
Behind the Front Lines page 5
Ontariorsquos Hospital Overcrowding Is Not Easing
Readers of Behind the Front Lines first read about hospital over-crowding in Ontariorsquos hospitals more than a year ago
The intervening months have seen the issue regularly taking up space on new broadcasts and in printelectronic media
With an election approaching the NDP has kept the issue front and centre
NDP Leader Andrea Horwath and NDP Health Critic France Gelinas have been leading the attacks on the province finding stories of patients housed in ldquounconventional spacesrdquo such as a shower room
For front-line nurses and health-care professionals the news that patients are being cared for in hallways meeting rooms and other ldquounconventional spacesrdquo is no surprise The announcement of additional emergency funding to deal with the lack of lsquosurge cap-acityrsquo was welcome but without the funding to staff these extra beds front-line workers remain concerned about their patients
That concern was backed up by a report from Thomson Reuters indicating that patients are more likely to be misdiagnosed or ex-perience treatment delays when they become lsquohallwayrsquo patients
The report says that researchers surveyed 440 ER physicians attending a conference in Boston in 2015 The researchers found that these ldquonon-private encounters not only affect the accurate diagnosis of medical conditions but also of social and behavioural conditions such as domestic violence human trafficking suicidality and substance userdquo
Lead study author Dr Hanni Stoklosa an ER physician at Brigham and Womenrsquos Hospital and Harvard Medical School said ldquothis is quite concerning on many levels because emergency departments are on the front lines of caring for patients most vulnerable to these conditionsrdquo
Nurses have detailed the road-blocks to providing quality care to their patients in hallways and unconventional spaces this re-
port notes that 90 per cent of the physicians surveyed said they either changed or shortened how they took patient medical histor-ies in hallways and ldquosometimes often or always changing how they conducted physical examsrdquo
The physicians said that in 74 per cent of cases taking an abbreviated medical history had led them to fail to diagnose a social issue ndash such as suicidal thoughts or elder abuse ndash and 46 per cent said the changes in physical exam led them to miss these issues
Dr Bernard Chang a professor of emergency medicine at Columbia University Medical Center says the findings of the researchers add to the existing evidence that the environment in which patients are cared for may influence their treatment
For nurses hallway nursing has been a serious concern for well over a decade
The research evidence shows that hallway patients lack the access to privacy the quiet needed for rest the proper medical equipment and their exposure to others is an issue for proper infection control
ONA notes that patients are at greater risk if cared for in these ldquounconventional spacesrdquo
90 of the physicians surveyed said they either changed or
shortened how they took patient medical histories in hallways and ldquosometimes
often or always changed how they conducted
physical examsrdquo
Behind the Front Lines page 6
Childrenrsquos Hospital Transfers Pediatric Patients Elsewhere
ONA members vividly recall the CEO of the Childrenrsquos Hospital of Eastern Ontario (CHEO) telling local media that the closure of hospital beds and shedding 50 registered nurses would not impact care or services
Well that was then and this is now
When the cuts were announced in 2015 ONA noted that the cuts equated to a loss of 90000 hours of RN care per year
ONA predicted then that the neonatal intensive care unit the pediatric intensive care unit ambulatory care in-patient surgical and medical units would be hardest hit by the cuts
It now seems the cuts have impacted care as CHEO has been forced to send 19 critically ill pediatric patients out of town to receive care The Ottawa Citizen reports that the hospital is struggling with overcrowding in its intensive care units
The hospital ndash like so many others in Ontario ndash has been overcapacity for several months In February the pediatric intensive care unit transferred 15 patients to Kingston Toronto Hamilton or Montreal for care Two newborns needing neonatal intensive care were sent to Kingston and two were sent to Montreal
Tellingly the remarks of CHEOrsquos chief of staff Dr Lindy Samson
mentioned nurses ldquoWe only consider sending children ndash either babies or older kids ndash out of town once we have exhausted all our usual strategies That includes calling in nurses for extra shifts and overtime and opening extra beds Itrsquos not the first second or third approach that we take We only do it when we have no more nurses to callrdquo
The hospital acknowledged that the number of nursing hours worked in the pediatric intensive care unit had ldquoskyrocketedrdquo in 2018 with CHEO nurses working more than 14000 hours ndash or 50 per cent more than what hospital officials had predicted would be required
In the pediatric intensive care unit CHEO nurses worked 50 more hours than what hospital officials had predicted would be required
Behind the Front Lines page 7
UNDER THE RADARNews the Media is Missing
Private Surgery Centres Killing Patients
ONA has frequently spoken out against the further privatization of medicare in Ontario
Not only do private providers have to find savings to carve out profit from funds that otherwise would go to public hospitals and health-care providers but even the US has noted that ldquoas surgery centers boom patients are paying with their livesrdquo
A recent joint Kaiser Health News-USA TODAY report found that 260 patients have died follow-ing ldquoin-and-outrdquo procedures at these centers since 2013 In addition dozens of patients some as young as two years of age have died after routine operations such as colonoscopies and tonsillectomies
The centers are intended to be low-cost alternatives for patients
who require minor procedures They have been around in the US for nearly 50 years but now out-number hospitals as federal regu-lators have okayed an expanding list of outpatient procedures as they struggle to cut federal fund-ing of health-care costs
ONA believes this is a cautionary tale for Ontario As ONA has spoken out about there has been creeping privatization in our system with lsquoroutinersquo procedures such as cataract surgeries and colonoscopies
being performed by for-profit clinics
As this USA TODAY-Kaiser report shows these kinds of private surgical centers call
9-1-1 when patients experience complications shifting the
burden of caring for seriously ill patients back onto the
public system
Nursesrsquo Contract Will Expire Soon
After it Takes Effect
The Windsor Starrsquos Brian Cross found an arbitration decision for 26 registered nurses who work at the city-owned long-term care facility Huron Lodge and was astounded to see that the four-year deal expired 44 days after it was handed down
As ONA President Vicki McKenna RN told the Star ldquoItrsquos absolutely unusual ndash itrsquos not unheard of but itrsquos unusualrdquo
The Ontario Nursesrsquo Association members had been working without a contract since April 1 2014 The new contract runs to March 31 2018
Cross attempted to interview management of Huron Lodge but was not successful his report notes that RNs in hospital and long-term care are considered an essential service and cannot strike Arbitration was the last resort
As for ONA McKenna said that while no dates have been set for the next round of bargaining she is hoping it wonrsquot be a repeat of this one
wwwonaorg
Sheree Bond Media Relations Officer (416) 964-8833 ext 2430 or cell (416) 986-8240
shereebonaorg
ONA members work in hospitals long-term care public health the community and industry and can answer your questions as health care continues to evolve in this province
Previous Issues of Behind the Front Lines
Need a reliable and informed source Speak to front-line nurses
Behind the Front Lines ndash an electronic newsletter that takes a look at the stories behind the stories
Behind the Front Lines page 4
Passionate Op Ed Calls for Better Care of Nurses
The controversies swirling in Quebec ndash including a group of physicians calling for their fee increases to be used instead to provide some relief to overworked nurses ndash have inspired a passionate opinion editorial in the Montreal Gazette
Allison Hanes wrote the piece which notes that anyone who has ever spent time in a hospital has benefited from the care of a nurse
Nurses she says ldquodonrsquot get much glory or credit Yet their often thankless work is the backbone of our health systemrdquo
The Gazette editorial points out that nurses say they are ldquocrumblingrdquo under the weight of the extraordinary demands being placed on themrdquo
The piece was sparked by coverage of the RNsrsquo too-heavy workloads stemming from a Facebook post of one nurse
Emilie Ricard posted a video in January noting that she was the only caregiver for 70 patients during her last shift She spoke of being so busy monitoring an
unstable patient that she had no time to help others and noting that she ldquowouldnrsquot want to see one of my own family members left in conditions like that I am broken by my profession I am ashamed of the pitiful care I am providing despite my best efforts My health system is broken and dyingrdquo she said
In a response that feels familiar to Ontariorsquos nurses Quebecrsquos health minister deflected blame Gaetan Barrette claimed that nurses are unwilling to fill vacant full-time positions for fear of being forced to work overtime This he claims has created a vicious circle where other nurses are forced to work mandatory overtime
In Ontario the outcry against heavy workloads for RNs has been met with a claim from
the province that it has hired thousands of new nurses since
2003 This leaves ONA wondering just where these thousands of
new nurses actually are
Ontario hospitals have cut more than 13000 RN positions in the
past five years alone Ontario has the worst RN-to-population ratio
in the country
Sexual Assault Clinic Canrsquot Keep Up As
MeToo Movement
Impacts Ottawa
Staff working at the sexual assault and partner abuse care program at The Ottawa Hospital canrsquot keep up with demand
The program has been around since the 1980s Patients see specially trained nurses ndash available 247 ndash and a nurse practitioner is there for a follow-up visit
Funding for the program has barely changed in the past decade yet demand has increased and close to 1000 patients were seen recently
Medical director Dr Kari Sampsel told the Ottawa Sun that demand has tripled in the past decade It operates on a $480000 budget that is meant to cover both staff and supplies
Sampsel believes this summer will be extra busy for the unit as the MeToo movement encourages people to talk about and seek help following sexual assault
Nurses says ONA President Vicki McKenna often put their own health needs last ndash well behind the health of their patients Thatrsquos what makes the fact that Quebec nurses speaking out about the
strain on their own health so extraordinary
Behind the Front Lines page 5
Ontariorsquos Hospital Overcrowding Is Not Easing
Readers of Behind the Front Lines first read about hospital over-crowding in Ontariorsquos hospitals more than a year ago
The intervening months have seen the issue regularly taking up space on new broadcasts and in printelectronic media
With an election approaching the NDP has kept the issue front and centre
NDP Leader Andrea Horwath and NDP Health Critic France Gelinas have been leading the attacks on the province finding stories of patients housed in ldquounconventional spacesrdquo such as a shower room
For front-line nurses and health-care professionals the news that patients are being cared for in hallways meeting rooms and other ldquounconventional spacesrdquo is no surprise The announcement of additional emergency funding to deal with the lack of lsquosurge cap-acityrsquo was welcome but without the funding to staff these extra beds front-line workers remain concerned about their patients
That concern was backed up by a report from Thomson Reuters indicating that patients are more likely to be misdiagnosed or ex-perience treatment delays when they become lsquohallwayrsquo patients
The report says that researchers surveyed 440 ER physicians attending a conference in Boston in 2015 The researchers found that these ldquonon-private encounters not only affect the accurate diagnosis of medical conditions but also of social and behavioural conditions such as domestic violence human trafficking suicidality and substance userdquo
Lead study author Dr Hanni Stoklosa an ER physician at Brigham and Womenrsquos Hospital and Harvard Medical School said ldquothis is quite concerning on many levels because emergency departments are on the front lines of caring for patients most vulnerable to these conditionsrdquo
Nurses have detailed the road-blocks to providing quality care to their patients in hallways and unconventional spaces this re-
port notes that 90 per cent of the physicians surveyed said they either changed or shortened how they took patient medical histor-ies in hallways and ldquosometimes often or always changing how they conducted physical examsrdquo
The physicians said that in 74 per cent of cases taking an abbreviated medical history had led them to fail to diagnose a social issue ndash such as suicidal thoughts or elder abuse ndash and 46 per cent said the changes in physical exam led them to miss these issues
Dr Bernard Chang a professor of emergency medicine at Columbia University Medical Center says the findings of the researchers add to the existing evidence that the environment in which patients are cared for may influence their treatment
For nurses hallway nursing has been a serious concern for well over a decade
The research evidence shows that hallway patients lack the access to privacy the quiet needed for rest the proper medical equipment and their exposure to others is an issue for proper infection control
ONA notes that patients are at greater risk if cared for in these ldquounconventional spacesrdquo
90 of the physicians surveyed said they either changed or
shortened how they took patient medical histories in hallways and ldquosometimes
often or always changed how they conducted
physical examsrdquo
Behind the Front Lines page 6
Childrenrsquos Hospital Transfers Pediatric Patients Elsewhere
ONA members vividly recall the CEO of the Childrenrsquos Hospital of Eastern Ontario (CHEO) telling local media that the closure of hospital beds and shedding 50 registered nurses would not impact care or services
Well that was then and this is now
When the cuts were announced in 2015 ONA noted that the cuts equated to a loss of 90000 hours of RN care per year
ONA predicted then that the neonatal intensive care unit the pediatric intensive care unit ambulatory care in-patient surgical and medical units would be hardest hit by the cuts
It now seems the cuts have impacted care as CHEO has been forced to send 19 critically ill pediatric patients out of town to receive care The Ottawa Citizen reports that the hospital is struggling with overcrowding in its intensive care units
The hospital ndash like so many others in Ontario ndash has been overcapacity for several months In February the pediatric intensive care unit transferred 15 patients to Kingston Toronto Hamilton or Montreal for care Two newborns needing neonatal intensive care were sent to Kingston and two were sent to Montreal
Tellingly the remarks of CHEOrsquos chief of staff Dr Lindy Samson
mentioned nurses ldquoWe only consider sending children ndash either babies or older kids ndash out of town once we have exhausted all our usual strategies That includes calling in nurses for extra shifts and overtime and opening extra beds Itrsquos not the first second or third approach that we take We only do it when we have no more nurses to callrdquo
The hospital acknowledged that the number of nursing hours worked in the pediatric intensive care unit had ldquoskyrocketedrdquo in 2018 with CHEO nurses working more than 14000 hours ndash or 50 per cent more than what hospital officials had predicted would be required
In the pediatric intensive care unit CHEO nurses worked 50 more hours than what hospital officials had predicted would be required
Behind the Front Lines page 7
UNDER THE RADARNews the Media is Missing
Private Surgery Centres Killing Patients
ONA has frequently spoken out against the further privatization of medicare in Ontario
Not only do private providers have to find savings to carve out profit from funds that otherwise would go to public hospitals and health-care providers but even the US has noted that ldquoas surgery centers boom patients are paying with their livesrdquo
A recent joint Kaiser Health News-USA TODAY report found that 260 patients have died follow-ing ldquoin-and-outrdquo procedures at these centers since 2013 In addition dozens of patients some as young as two years of age have died after routine operations such as colonoscopies and tonsillectomies
The centers are intended to be low-cost alternatives for patients
who require minor procedures They have been around in the US for nearly 50 years but now out-number hospitals as federal regu-lators have okayed an expanding list of outpatient procedures as they struggle to cut federal fund-ing of health-care costs
ONA believes this is a cautionary tale for Ontario As ONA has spoken out about there has been creeping privatization in our system with lsquoroutinersquo procedures such as cataract surgeries and colonoscopies
being performed by for-profit clinics
As this USA TODAY-Kaiser report shows these kinds of private surgical centers call
9-1-1 when patients experience complications shifting the
burden of caring for seriously ill patients back onto the
public system
Nursesrsquo Contract Will Expire Soon
After it Takes Effect
The Windsor Starrsquos Brian Cross found an arbitration decision for 26 registered nurses who work at the city-owned long-term care facility Huron Lodge and was astounded to see that the four-year deal expired 44 days after it was handed down
As ONA President Vicki McKenna RN told the Star ldquoItrsquos absolutely unusual ndash itrsquos not unheard of but itrsquos unusualrdquo
The Ontario Nursesrsquo Association members had been working without a contract since April 1 2014 The new contract runs to March 31 2018
Cross attempted to interview management of Huron Lodge but was not successful his report notes that RNs in hospital and long-term care are considered an essential service and cannot strike Arbitration was the last resort
As for ONA McKenna said that while no dates have been set for the next round of bargaining she is hoping it wonrsquot be a repeat of this one
wwwonaorg
Sheree Bond Media Relations Officer (416) 964-8833 ext 2430 or cell (416) 986-8240
shereebonaorg
ONA members work in hospitals long-term care public health the community and industry and can answer your questions as health care continues to evolve in this province
Previous Issues of Behind the Front Lines
Need a reliable and informed source Speak to front-line nurses
Behind the Front Lines ndash an electronic newsletter that takes a look at the stories behind the stories
Behind the Front Lines page 5
Ontariorsquos Hospital Overcrowding Is Not Easing
Readers of Behind the Front Lines first read about hospital over-crowding in Ontariorsquos hospitals more than a year ago
The intervening months have seen the issue regularly taking up space on new broadcasts and in printelectronic media
With an election approaching the NDP has kept the issue front and centre
NDP Leader Andrea Horwath and NDP Health Critic France Gelinas have been leading the attacks on the province finding stories of patients housed in ldquounconventional spacesrdquo such as a shower room
For front-line nurses and health-care professionals the news that patients are being cared for in hallways meeting rooms and other ldquounconventional spacesrdquo is no surprise The announcement of additional emergency funding to deal with the lack of lsquosurge cap-acityrsquo was welcome but without the funding to staff these extra beds front-line workers remain concerned about their patients
That concern was backed up by a report from Thomson Reuters indicating that patients are more likely to be misdiagnosed or ex-perience treatment delays when they become lsquohallwayrsquo patients
The report says that researchers surveyed 440 ER physicians attending a conference in Boston in 2015 The researchers found that these ldquonon-private encounters not only affect the accurate diagnosis of medical conditions but also of social and behavioural conditions such as domestic violence human trafficking suicidality and substance userdquo
Lead study author Dr Hanni Stoklosa an ER physician at Brigham and Womenrsquos Hospital and Harvard Medical School said ldquothis is quite concerning on many levels because emergency departments are on the front lines of caring for patients most vulnerable to these conditionsrdquo
Nurses have detailed the road-blocks to providing quality care to their patients in hallways and unconventional spaces this re-
port notes that 90 per cent of the physicians surveyed said they either changed or shortened how they took patient medical histor-ies in hallways and ldquosometimes often or always changing how they conducted physical examsrdquo
The physicians said that in 74 per cent of cases taking an abbreviated medical history had led them to fail to diagnose a social issue ndash such as suicidal thoughts or elder abuse ndash and 46 per cent said the changes in physical exam led them to miss these issues
Dr Bernard Chang a professor of emergency medicine at Columbia University Medical Center says the findings of the researchers add to the existing evidence that the environment in which patients are cared for may influence their treatment
For nurses hallway nursing has been a serious concern for well over a decade
The research evidence shows that hallway patients lack the access to privacy the quiet needed for rest the proper medical equipment and their exposure to others is an issue for proper infection control
ONA notes that patients are at greater risk if cared for in these ldquounconventional spacesrdquo
90 of the physicians surveyed said they either changed or
shortened how they took patient medical histories in hallways and ldquosometimes
often or always changed how they conducted
physical examsrdquo
Behind the Front Lines page 6
Childrenrsquos Hospital Transfers Pediatric Patients Elsewhere
ONA members vividly recall the CEO of the Childrenrsquos Hospital of Eastern Ontario (CHEO) telling local media that the closure of hospital beds and shedding 50 registered nurses would not impact care or services
Well that was then and this is now
When the cuts were announced in 2015 ONA noted that the cuts equated to a loss of 90000 hours of RN care per year
ONA predicted then that the neonatal intensive care unit the pediatric intensive care unit ambulatory care in-patient surgical and medical units would be hardest hit by the cuts
It now seems the cuts have impacted care as CHEO has been forced to send 19 critically ill pediatric patients out of town to receive care The Ottawa Citizen reports that the hospital is struggling with overcrowding in its intensive care units
The hospital ndash like so many others in Ontario ndash has been overcapacity for several months In February the pediatric intensive care unit transferred 15 patients to Kingston Toronto Hamilton or Montreal for care Two newborns needing neonatal intensive care were sent to Kingston and two were sent to Montreal
Tellingly the remarks of CHEOrsquos chief of staff Dr Lindy Samson
mentioned nurses ldquoWe only consider sending children ndash either babies or older kids ndash out of town once we have exhausted all our usual strategies That includes calling in nurses for extra shifts and overtime and opening extra beds Itrsquos not the first second or third approach that we take We only do it when we have no more nurses to callrdquo
The hospital acknowledged that the number of nursing hours worked in the pediatric intensive care unit had ldquoskyrocketedrdquo in 2018 with CHEO nurses working more than 14000 hours ndash or 50 per cent more than what hospital officials had predicted would be required
In the pediatric intensive care unit CHEO nurses worked 50 more hours than what hospital officials had predicted would be required
Behind the Front Lines page 7
UNDER THE RADARNews the Media is Missing
Private Surgery Centres Killing Patients
ONA has frequently spoken out against the further privatization of medicare in Ontario
Not only do private providers have to find savings to carve out profit from funds that otherwise would go to public hospitals and health-care providers but even the US has noted that ldquoas surgery centers boom patients are paying with their livesrdquo
A recent joint Kaiser Health News-USA TODAY report found that 260 patients have died follow-ing ldquoin-and-outrdquo procedures at these centers since 2013 In addition dozens of patients some as young as two years of age have died after routine operations such as colonoscopies and tonsillectomies
The centers are intended to be low-cost alternatives for patients
who require minor procedures They have been around in the US for nearly 50 years but now out-number hospitals as federal regu-lators have okayed an expanding list of outpatient procedures as they struggle to cut federal fund-ing of health-care costs
ONA believes this is a cautionary tale for Ontario As ONA has spoken out about there has been creeping privatization in our system with lsquoroutinersquo procedures such as cataract surgeries and colonoscopies
being performed by for-profit clinics
As this USA TODAY-Kaiser report shows these kinds of private surgical centers call
9-1-1 when patients experience complications shifting the
burden of caring for seriously ill patients back onto the
public system
Nursesrsquo Contract Will Expire Soon
After it Takes Effect
The Windsor Starrsquos Brian Cross found an arbitration decision for 26 registered nurses who work at the city-owned long-term care facility Huron Lodge and was astounded to see that the four-year deal expired 44 days after it was handed down
As ONA President Vicki McKenna RN told the Star ldquoItrsquos absolutely unusual ndash itrsquos not unheard of but itrsquos unusualrdquo
The Ontario Nursesrsquo Association members had been working without a contract since April 1 2014 The new contract runs to March 31 2018
Cross attempted to interview management of Huron Lodge but was not successful his report notes that RNs in hospital and long-term care are considered an essential service and cannot strike Arbitration was the last resort
As for ONA McKenna said that while no dates have been set for the next round of bargaining she is hoping it wonrsquot be a repeat of this one
wwwonaorg
Sheree Bond Media Relations Officer (416) 964-8833 ext 2430 or cell (416) 986-8240
shereebonaorg
ONA members work in hospitals long-term care public health the community and industry and can answer your questions as health care continues to evolve in this province
Previous Issues of Behind the Front Lines
Need a reliable and informed source Speak to front-line nurses
Behind the Front Lines ndash an electronic newsletter that takes a look at the stories behind the stories
Behind the Front Lines page 6
Childrenrsquos Hospital Transfers Pediatric Patients Elsewhere
ONA members vividly recall the CEO of the Childrenrsquos Hospital of Eastern Ontario (CHEO) telling local media that the closure of hospital beds and shedding 50 registered nurses would not impact care or services
Well that was then and this is now
When the cuts were announced in 2015 ONA noted that the cuts equated to a loss of 90000 hours of RN care per year
ONA predicted then that the neonatal intensive care unit the pediatric intensive care unit ambulatory care in-patient surgical and medical units would be hardest hit by the cuts
It now seems the cuts have impacted care as CHEO has been forced to send 19 critically ill pediatric patients out of town to receive care The Ottawa Citizen reports that the hospital is struggling with overcrowding in its intensive care units
The hospital ndash like so many others in Ontario ndash has been overcapacity for several months In February the pediatric intensive care unit transferred 15 patients to Kingston Toronto Hamilton or Montreal for care Two newborns needing neonatal intensive care were sent to Kingston and two were sent to Montreal
Tellingly the remarks of CHEOrsquos chief of staff Dr Lindy Samson
mentioned nurses ldquoWe only consider sending children ndash either babies or older kids ndash out of town once we have exhausted all our usual strategies That includes calling in nurses for extra shifts and overtime and opening extra beds Itrsquos not the first second or third approach that we take We only do it when we have no more nurses to callrdquo
The hospital acknowledged that the number of nursing hours worked in the pediatric intensive care unit had ldquoskyrocketedrdquo in 2018 with CHEO nurses working more than 14000 hours ndash or 50 per cent more than what hospital officials had predicted would be required
In the pediatric intensive care unit CHEO nurses worked 50 more hours than what hospital officials had predicted would be required
Behind the Front Lines page 7
UNDER THE RADARNews the Media is Missing
Private Surgery Centres Killing Patients
ONA has frequently spoken out against the further privatization of medicare in Ontario
Not only do private providers have to find savings to carve out profit from funds that otherwise would go to public hospitals and health-care providers but even the US has noted that ldquoas surgery centers boom patients are paying with their livesrdquo
A recent joint Kaiser Health News-USA TODAY report found that 260 patients have died follow-ing ldquoin-and-outrdquo procedures at these centers since 2013 In addition dozens of patients some as young as two years of age have died after routine operations such as colonoscopies and tonsillectomies
The centers are intended to be low-cost alternatives for patients
who require minor procedures They have been around in the US for nearly 50 years but now out-number hospitals as federal regu-lators have okayed an expanding list of outpatient procedures as they struggle to cut federal fund-ing of health-care costs
ONA believes this is a cautionary tale for Ontario As ONA has spoken out about there has been creeping privatization in our system with lsquoroutinersquo procedures such as cataract surgeries and colonoscopies
being performed by for-profit clinics
As this USA TODAY-Kaiser report shows these kinds of private surgical centers call
9-1-1 when patients experience complications shifting the
burden of caring for seriously ill patients back onto the
public system
Nursesrsquo Contract Will Expire Soon
After it Takes Effect
The Windsor Starrsquos Brian Cross found an arbitration decision for 26 registered nurses who work at the city-owned long-term care facility Huron Lodge and was astounded to see that the four-year deal expired 44 days after it was handed down
As ONA President Vicki McKenna RN told the Star ldquoItrsquos absolutely unusual ndash itrsquos not unheard of but itrsquos unusualrdquo
The Ontario Nursesrsquo Association members had been working without a contract since April 1 2014 The new contract runs to March 31 2018
Cross attempted to interview management of Huron Lodge but was not successful his report notes that RNs in hospital and long-term care are considered an essential service and cannot strike Arbitration was the last resort
As for ONA McKenna said that while no dates have been set for the next round of bargaining she is hoping it wonrsquot be a repeat of this one
wwwonaorg
Sheree Bond Media Relations Officer (416) 964-8833 ext 2430 or cell (416) 986-8240
shereebonaorg
ONA members work in hospitals long-term care public health the community and industry and can answer your questions as health care continues to evolve in this province
Previous Issues of Behind the Front Lines
Need a reliable and informed source Speak to front-line nurses
Behind the Front Lines ndash an electronic newsletter that takes a look at the stories behind the stories
Behind the Front Lines page 7
UNDER THE RADARNews the Media is Missing
Private Surgery Centres Killing Patients
ONA has frequently spoken out against the further privatization of medicare in Ontario
Not only do private providers have to find savings to carve out profit from funds that otherwise would go to public hospitals and health-care providers but even the US has noted that ldquoas surgery centers boom patients are paying with their livesrdquo
A recent joint Kaiser Health News-USA TODAY report found that 260 patients have died follow-ing ldquoin-and-outrdquo procedures at these centers since 2013 In addition dozens of patients some as young as two years of age have died after routine operations such as colonoscopies and tonsillectomies
The centers are intended to be low-cost alternatives for patients
who require minor procedures They have been around in the US for nearly 50 years but now out-number hospitals as federal regu-lators have okayed an expanding list of outpatient procedures as they struggle to cut federal fund-ing of health-care costs
ONA believes this is a cautionary tale for Ontario As ONA has spoken out about there has been creeping privatization in our system with lsquoroutinersquo procedures such as cataract surgeries and colonoscopies
being performed by for-profit clinics
As this USA TODAY-Kaiser report shows these kinds of private surgical centers call
9-1-1 when patients experience complications shifting the
burden of caring for seriously ill patients back onto the
public system
Nursesrsquo Contract Will Expire Soon
After it Takes Effect
The Windsor Starrsquos Brian Cross found an arbitration decision for 26 registered nurses who work at the city-owned long-term care facility Huron Lodge and was astounded to see that the four-year deal expired 44 days after it was handed down
As ONA President Vicki McKenna RN told the Star ldquoItrsquos absolutely unusual ndash itrsquos not unheard of but itrsquos unusualrdquo
The Ontario Nursesrsquo Association members had been working without a contract since April 1 2014 The new contract runs to March 31 2018
Cross attempted to interview management of Huron Lodge but was not successful his report notes that RNs in hospital and long-term care are considered an essential service and cannot strike Arbitration was the last resort
As for ONA McKenna said that while no dates have been set for the next round of bargaining she is hoping it wonrsquot be a repeat of this one
wwwonaorg
Sheree Bond Media Relations Officer (416) 964-8833 ext 2430 or cell (416) 986-8240
shereebonaorg
ONA members work in hospitals long-term care public health the community and industry and can answer your questions as health care continues to evolve in this province
Previous Issues of Behind the Front Lines
Need a reliable and informed source Speak to front-line nurses
Behind the Front Lines ndash an electronic newsletter that takes a look at the stories behind the stories
