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Changing the role of nurses puts patients, budgets at risk

In response to budget constraints in hospitals, some organizations are reverting to models of functional nursing — a task-oriented model that delivers fragmented care — and replacing registered nurses (RNs) with less qualified health-care providers.
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The Registered Nurses Association of Ontario says saving money by changing the role of nurses in hospitals not only increases costs, but also puts patients at risk. File photo
In response to budget constraints in hospitals, some organizations are reverting to models of functional nursing — a task-oriented model that delivers fragmented care — and replacing registered nurses (RNs) with less qualified health-care providers.

These organizations say it will save them money, but studies show it will actually worsen health outcomes and increase costs. This is a short-sighted solution that jeopardizes the future of Ontario’s health system.

Evidence demonstrates that increased RN care results in better clinical and financial outcomes. More specifically, increasing the number of RNs decreases mortality, morbidity, adverse events, and lengths of stay — both in hospitals and in home care.

It is important to note that RNs should be selected to provide the total nursing care of unstable patients with unpredictable outcomes. RPNs, on the other hand, should provide care to stable patients with predictable outcomes and PSW support, where appropriate, as delegated by a nurse. Fragmentation of care leads to medical errors.

Conversely, total care by RNs results in fewer deaths, readmissions, pressure ulcers, pneumonias, post-operative infections, urinary tract infections, upper gastrointestinal bleeds, cardiac arrests and medication errors. A higher proportion of RNs is also linked to shorter lengths of stay.

While sometimes introduced under various names for the sake of innovation and cost-cutting, team nursing is neither new nor cost-effective. Team nursing was the prevalent form of nursing care delivery prior to the advent of primary nursing in the 1980s. Since then, primary nursing, where RNs are assigned responsibility for a caseload of patients, has been the dominant model of nurse deployment in hospitals. While sometimes looked to in aid of hospital re-engineering efforts, the team approach has not proven to save costs.

Evidence overwhelmingly demonstrates that nursing models of care that advance continuity of care and continuity of caregiver from the most appropriate nurse are linked to safe, high-quality patient-centred care. The most appropriate nurse, RN or RPN, is assigned based on the patient’s complexity and care needs and the degree to which the patient’s outcomes are predictable. Rolling back the clock to outdated models of care delivery results in fragmented care and is detrimental to both patients and to nurses.

Accordingly, we urge the Minister of Health and Long Term Care, Dr. Eric Hoskins, to intervene.

Maria Casas
Policy Executive Officer
RNAO, Sudbury Chapter