RPNAO calls for innovative leadership in the face of misleading media coverage

You may have already seen some of the dramatic headlines here in Ontario and around the world recently:

  • “Fewer nurses means more hospital deaths” – The Toronto Star
  • “Study links nurse ratios with patient deaths” – The Irish Examiner
  • “Patients more likely to die in hospital because of savage nurse cuts” – The Mirror (UK)

These articles cite a major study published in The Lancet, which shows patients are more likely to die after common surgical procedures in hospitals where Registered Nurses have heavier workloads. The study looked at more than 420,000 patients in 300 hospitals across Europe and found that for every one patient added to a nurse’s workload, the chances of a surgical patient dying within 30 days increased by 7 per cent.

The research also suggests that in some areas of practice, such as an acute surgical unit, there should be as many university-educated nurses as possible for the best patient outcomes. What the Toronto Star article fails to mention, however, is that currently, the majority of RNs in Ontario (54.5%), like RPNs, do not have a university degree. In fact, it will be some time before all RNs have a degree. To quote Steven Lewis (2009), “Somewhere around 2050, the last registered nurse without a university degree will ride off into the sunset.”

This research provides us with important findings, but it is unclear how these findings would translate to the Ontario nursing workforce given the differences in the backgrounds and categories of our nurses compared to European nurses. The findings do, however, reinforce the fact that advanced leadership will be required in order to ensure that our nursing teams are designed in a way that works.

RPNAO has always been a strong proponent of ensuring that nurses (be it RPNs or RNs, with their wide array of educational backgrounds) be carefully assigned to patients that match their knowledge. With evidence that some of the very acute areas require more degree nurses and smaller workloads, it is up to organizations to find new ways to deliver care that ensure patients always have access to the right care provider and the right amount of care. Unfortunately, overly-simplistic statements that condemn colleagues or advocate for an entire workforce of degree nurses are not only unrealistic, but also prevent us from finding appropriate solutions for Ontario’s health care system that optimize the practice of all members of the nursing workforce.

Arriving at solutions to the challenging issues facing health care will require all of our collective wisdom. Imagine our surprise and disappointment when our valued colleagues at the Ontario Nurses Association (ONA), the union representing RNs, stated in the article in The Toronto Star that the problem facing hospitals is the trend to replace RNs with RPNs. In reality, statistics from the College of Nurses of Ontario show that over the past two years, RN positions in hospitals have increased by 3,161, while the RPN positions in hospitals have increased by 2,155.

Before celebrating the growth of either group, however, it’s important to note that the rate of full-time positions in hospitals for RNs has dropped by 1.6% and the rate of full time employment for RPNs in hospitals has dropped by 3.9% over the past year. This suggests the growth of positions may not mean a corresponding increase in actual hours worked by either group.

Since the growth of RPN positions in hospitals is clearly lower than the growth of RN positions, and since the full-time rate for RPNs has dropped more sharply than the rate for RNs, statements like the “race to the bottom, the cheapest labour” and the replacement of RNs by RPNs being “done by stealth” smack of turfism and should have no place in the serious discussions and efforts needed to solve the challenges facing health care.

All nurses are suffering under crushing workloads and hospital processes that compromise their ability to provide care. And both categories report they are facing layoffs and increased difficulty finding work. This isn’t the time for turfism and misplaced blame. This is the time for complex solutions that ensure we have enough nurses of the right category to care for each patient unit in each hospital.

We at RPNAO invite our nursing colleagues across Ontario to join us in serious efforts to address these problems. Our patients and our nurses – of all categories – deserve nothing less.