Fixing what ails nurses in the health-care system

Here we are again. Another government, another nurses' crisis. First, let's understand this: labour relations are just the tip of the iceberg. It's another spasm in the stress of our health system and, with health gobbling up greater and greater chunks of the provincial budget, a societal and political problem beyond the hospitals.

Once the dust settles, here's what's needed. A third-party review of the role of nurses in relation to the entire system, in the same way that the John Ross report four years ago related emergency care to the entire system, triggering improvements and pointing the way for more. True, one is reluctant to ask for more reviews, but there must be judgment above government and unions butting heads.

To tease it along, I've done my own review -- a couple of days cruising among the tens of millions of entries on nurses and related subjects on the web. I've come to some tentative conclusions.

The first is that, as you may guess, we are not alone. Hits like "New Jersey nurses near exhaustion due to heavier workloads," or "Nurses need naps, Manitoba study finds," abound. The European Federation of Nurses Associations cites "nurses pay cuts, freezes, diminished recruitment and retention rates, and observed compromises in quality and patient safety" as the reality.

A study at Australia's Monash University entitled What nurses want seems to ring true in a broader sense, and perhaps here in particular. Nurses' key problems, it found, was that they "did not trust their employer to keep promises," that they had "limited influence in important workplace decisions," had "a poorer industrial relations climate than the general population" and viewed their management more poorly than other workers.

So does anything work?

Apparently something does. You might be surprised, but it's called the Toyota Management System. It catapulted the Japanese car maker to world status, and at the cutting edge it's being applied to hospitals. It's a bureaucracy-busting system in which any employee, upon discovering a problem, can "stop the assembly line" instead of sweeping it under the rug for fear of being ignored or blamed. All available resources are then pulled in to not just solve the problem, but change the process that led to it, keeping it from recurring -- bad practices being the bane of systems everywhere. In hospitals, this means an internal hotline, the empowerment of employees, notably nurses, improved morale and operational savings.

In New Zealand efficiency improvements in hospitals have been reported of as much as 35 per cent. In the U.S., where the practice is spreading, the Virginia Mason Health Centre in Seattle started in 2002 and is considered the leader. A recent medical journal report on it concluded that the system had "drastically increased the number of safety concerns that are resolved ... while drastically reducing the time it takes to resolve them. Transparent discussion and feedback have helped promote staff acceptance and participation."

Note to government: review this.

Nurses are the pivots of the health system, the ones who know the practical stuff, but are not recognized as such by a system that's mostly about administrators and doctors, leading to frustration and wasted skills.

If nurses were properly valued and had satisfactory working conditions, presumably there would be more, including some coming out of retirement. Beyond hospitals, getting nursing right would also fix our problems with doctors. We say we don't have enough (and $10 million to find more in the current budget), but in fact we arguably have too many, especially in HRM. In Quebec, there's talk about creating 24-hour nursing stations in Montreal as first contact points with the medical system, on grounds that 90 per cent of what doctors do doesn't need a doctor.

Having highly paid doctors waste time pandering to our modern hypochondria and self-inflicted illnesses is a waste of resources. (Dr. John Ross, who had been head of ER at the QEII, complained in his report about the waste involved in dealing with drunken students and young students from away for whom the ER was "mother and grandmother.") We're moving toward more nurse practitioners, but too slowly, because inefficient systems and unhappy nurses are a drag on the process.

As for the labour relations, it's sad, but new governments seem to always get caught flatfooted by public-sector contracts, as though they never saw them coming, and react badly. In health care, the fact that the health districts do the negotiating gives the illusion that government is off the hook -- in part, they were set up for that purpose. In this case, although the union's desperate swing-for-the-fence demand for fixed nurse-patient ratios was a bit much from one day to the next, talking about it might have avoided what's going on now. Government's handling of public-sector negotiations is another thing that could use some review.

Ralph Surette is a freelance journalist in Yarmouth County. This article was first published in the Chronicle Herald.

Photo: Stewart Rand/flickr

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