As one for whom a visit to the hospital is becoming more inevitable every day, I’ve been unable to ignore what’s being said about the coming reorganization of patient care at the Royal Jubilee and Victoria General.
It’s obvious that a lot of critical comment comes from people who think those trying to make things better are simply bean-counters who are raking in more beans themselves than they’re worth.
Registered and licensed practical nurses objecting to the decline in their positions and the increase of those for care aides are said to be fighting for “jobs.” Well, they’re union members, aren’t they?
The nursing cadre is also portrayed as jealously guarding turf which is being given over to lesser-trained beings. Well, they’re professionals, aren’t they?
And care aides are left looking like uneducated dolts, fit for making beds but not fit for doing much for those in them, which is unfair and unhelpful.
The Vancouver Island Health Authority has been able to rebrand itself as Island Health — a disturbingly amorphous brand name — but has been unable to quell rumours that those who empty the bedpans will be sticking needles and tubes into patients.
They won’t of course, because they’re not trained to, and care aides themselves don’t want to do the bulk of procedures that nurses do now. Some of them may qualify to be RNs or LPNs later, but right now they know their limitations and appreciate their position in the health-care team as much as they respect that of nurses.
I know all this because I’ve read the comments — and there have been a lot of them — on the Times Colonist website under reports by Cindy E. Harnett about what’s coming, or is planned.
There was a time when checking into a hospital was taking a risk of checking out of life, so to speak. There are risks still, such as wrong medicines or wrong doses, infections, post-operative pneumonia, deadly blood clots, post-operative bleeding exacerbated by drugs, supplements or herbal “medicines” being taken and anesthetic complications.
Watching for these risks requires constant patient assessment and monitoring. Vital signs may be easy to follow; where they point to, or from, not so easy. Nurses who are trained to recognize risks and react accordingly need to be doing things that some commentators seem to think below them.
Bathing patients helps them examine movement, see whether ulcers or infections are developing, how moods are changing and minds functioning. Feeding patients reveals how they’re chewing and swallowing. Taking a patient to the toilet helps them gauge mobility.
These aren’t just tasks to be run through, but hands-on opportunities for critical, vital contact with a body and mind in distress. A care aide who may have taken only a two-week online course might see and report disturbing signs, but a nurse with years of training still will have to make his or her own assessment.
And this is where the care-delivery model revision seems to be headed for trouble.
Nurses in Nanaimo, where the new staffing system is in place, report that doing all they have to do for 12 patients in a 12-hour shift is impossible: there are medications to administer, vital signs to take, blood work to check, tubes and drains to monitor, IVs to insert, transfusions to give, pain to manage, admissions, discharges, follow-up on home care — and paperwork for everything.
I’m sure the hospital-care planners have considered that every patient brings to hospital a wide range of challenges and needs. A 50-year-old getting a hip replacement is not at all like a 92-year-old with dementia.
The mix of patient needs must be met by an appropriate mix of care, and crucial to that mix is an adequate supply of RNs, though care aides and LPNs, who are allowed to do less than in other jurisdictions, might safely do more here.
Care aides should be able to take vital signs of people requiring long-term care because they’re more likely to be “normal,” but surely not the acutely ill.
Island Health, or VIHAHA as some call it, has yet to show that patients won’t fall through the bottom line in a ledger.
