As board members of the Vancouver Island Health Authority have learned to their discomfort, hell hath no fury like an angry nurse. Fifty angry RNs showed up at a VIHA directors' meeting in Duncan last month, to protest a new staffing plan they say is dangerous. They brought with them a petition signed by 4,000 of their colleagues.
The scheme will see a range of nursing duties taken over by health-care aides. That is controversial, because care aides receive less training. The study program for a registered nurse lasts four years; for a care aide, seven months.
Adding to the inflamed atmosphere, VIHA insists the new approach is all about improved patient care. Nurses see it as a crude attempt to save money.
Despite protests to the contrary from management, the nurses have a point. This does appear to be, in part, a cost-cutting exercise. Otherwise, why replace staff at the top end of the skills ladder with employees on a lower step? And the plan may bring some risk to patient safety. The intent is to restrict the use of aides to routine forms of care, such as bathing patients and toileting. They will be employed only in general-practice wards, and not specialty areas like burn units or intensive care.
But even the best-laid plans sometimes go astray. Every hospital has moments of crisis, or occasional staffing shortages, when it's all hands on deck. The temptation at such times will be to press aides into more complex work.
VIHA says this won't happen. We don't know yet who will be right.
That said, management also has a case. According to the provincial health ministry, general-duty RNs earn an average of $104,000 in salary and benefits. That's toward the peak of the national scale.
Wage rates for care aides are much lower. Combined salary and benefits can be about $50,000.
With such a huge differential, it makes sense to reserve more highly paid staff for top-end duties, and give simpler tasks to aides. If this is perceived as a slight - and it need not be - it was also inevitable.
Aging in the RN workforce, plus pressure to cut costs, are driving this trend across the country. Indeed, most provinces are well ahead of B.C. There is also the reality that in recent years, nurses have pushed hard to broaden their scope of practice. In some areas, their skills now overlap physician care.
This upward movement has brought the profession higher salaries and more interesting work. But it comes with a price.
Hospitals now think twice about employing RNs in areas where care aides offer an affordable alternative. Properly handled, this can be a win/win proposition. VIHA has already promised that no nurse currently on staff will be let go. That's a sensible start.
But there is a further possible step. It was understandable, perhaps, that management would try to gift-wrap this scheme.
Supposedly, it's all about the "right" staffing mix and smarter team work: Cost-cutting doesn't enter into it. But that merely infuriates nursing staff, who can do the math as well as anyone.
There is no reason for this embroidery. The provincial government has handed VIHA a budget that looks at least $50 million below cost pressures. In such an environment, economies are unavoidable.
For themselves, nurses can embrace these changes. They have gained an improvement in their standing. Chores that were never a favourite are being handed off, in exchange for more rewarding work. The risk to patients lies in bungling the transition. Luckily, there are 4,000 nurses well-placed to see that doesn't happen.
This editorial first appeared in the Times Colonist " We want to hear from you.
Send comments on this editorial to email@example.com.
© Copyright 2013