There have been times when a section of a long-term care home in St. John’s has operated at night with only one registered nurse on duty, says the president of the province’s nurses’ union.
Debbie Forward said there’s normally a minimum of one registered nurse per wing per night on staff — there are two wings in each of the two buildings that make up Hoyles-Escasoni Complex — but on occasion only one has been working overnight and this can create a dangerous situation.
“This is always a concern for us, because it falls back on safety, because the core staffing is two in each building on the night shift, and the employer says that’s our minimum staffing. So whenever you take one of your minium staffing out, you have to say we’re putting our residents at risk,” Forward told The Telegram Thursday.
“You hope nothing happens, so you say to the RN, do the best you can do. Prioritize. There will be things that won’t get done. It’s impossible to do it all. Do the things you have to do,” said Forward, president of the Newfoundland and Labrador Nurses’ Union.
She said unfortunately, the work that doesn’t get done by the night shift then gets added to the workload of the day shift.
Forward said while RNs have told her they feel understaffed, the employer has managed to maintain the minimum staff requirement during the past few months.
Complaints about understaffing, resident care and food at the Hoyles-Escasoni Complex were raised in The Weekend Telegram when Ken Kavanagh, whose elderly mother resides there, said he was angry because his mother was fed spaghettios as a meal and was being left in bed for hours before staff were getting her up, cleaned and dressed for the day.
Since then residents and other family members have shared their concerns with The Telegram regarding medication, personal care and nutrition.
According to Eastern Health, on a 30-bed unit, about six nursing staff would work daytime shifts, and three would work the night shift. This is maximum staffing levels.
“Eastern Health acknowledges that there are times when nursing units within a long-term care facility may not have adequate numbers of staff with regards to the recommended hours of care (3.58 hours daily) because there are no staff available to call in or work overtime shifts. This is closely monitored by management to ensure residents’ care needs are met and employees are working safely,” says a statement to The Telegram.
The nursing care team at Hoyles-Escasoni is made up of registered nurses, licensed practical nurses and personal care attendants.
At the facility, which has 357 long-term care beds, the maximum number of staff on duty from 8 a.m. to 4 p.m. is 85; 4-8 p.m. is 69; 8 p.m.-12 a.m. is 44, and 12-8 a.m. is 34.
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According to information from Eastern Health, Hoyles-Escasoni has 247.4 core full-time-equivalent positions — 32.2 registered nurses (RNs), 111.6 licensed practical nurses (LPNs) and 103.6 personal care attendants (PCAs).
Eastern Health said it is struggling to maintain staff levels as it has about 100 staff on long-term leave and has to deal with, on average, eight to 10 sick calls daily from the nursing staff.
“We have significant temporary call-in staff. However, due to high levels of absenteeism, we don't have enough. The sick leave rate is higher in long-term care than anywhere else in our system, and we have the highest sick leave nationally,” Eastern Health said in a statement.
Forward said registered nurses are aware health care costs money, but the debate can’t just be about dollars.
She said it has to be about care.
“We have to make sure care of our residents is a No. 1 priority. Yes cost is a factor. We’re not saying long-term care has to be provided by RNs and LPNs. There is room for other care providers, but at appropriate numbers,” said Forward.
She said it may be time for everyone to re-evaluate the model of care that was put in place in 2006 when registered nurses numbers were reduced and personal care attendants were added as a third-care provider.
“I’m hearing from our members that we cut our numbers too thin. One registered nurse to oversee the care of 80 to 100 residents at some of our facilities, I think that’s stretching it too thin,” said Forward.
“And having the personal-care attendants as an unregulated care provider who can provide very prescribed care. Have we added too many of them at the expense of the regulated care provider? If the licensed practical nurse is cut too thin, then how can they oversee and support the personal-care attendants?”
Forward said if the registered nurse numbers are too low — the ones who are co-ordinating care for residents and providing support to the other nursing staff, as well as intervening should a resident become unstable or require care beyond the scope of the LPN — the patient care strategy won’t be effective.
“They’ve taken the knowledge piece, the problem-solving, decision-making part out of the long-term care system, and it makes a difference,” she said.