October 30, 2018

Meeting the Demand for Health Care in NL

I’m proud of the work Registered Nurses do every day to care for Newfoundlanders and Labradorians – and I know you appreciate their work as well.

Yet, over the last fifteen years, I have watched as our health care system has changed dramatically.

We need registered nurses now more than ever…. … but are we meeting that need?

First, let’s acknowledge that Newfoundland and Labrador faces some unique challenges when it comes to our health.

Compared to the rest of Canada, we have:

  • a higher proportion of seniors over the age of 65,
  • a large land mass with a dispersed population. We have the same population as a place like Hamilton Ontario, but our province covers a land mass larger than PEI, News Brunswick and Nova Scotia combined
  • Our province has one of the unhealthiest populations in the country with high rates of heart disease, diabetes, and cancers
  • We also have higher lifestyle risk factors like smoking, drinking and obesity

Due to these all these factors, the basic health needs of our population are simply higher than other provinces.

On top of these factors, changes over the years have increased the demand for health care across all provinces.

Treatments have advanced and become more complex, while technology has expanded.

Many patients cared for in Intensive Care today may not have survived their illness or injury 15 years ago.

Residents in long-term care are living longer, and facing more complex health challenges.

The need for mental health services, chronic disease management, and the complexity of care in the community setting has increased significantly.


So, what has NL done to meet this increased demand for health care?

Well, since 2012, we have eliminated over 300 Registered Nurses from our workforce.

Many of those cuts were in long-term care facilities, despite our rapidly aging population.

Rural areas of the province have also been hit hard.

The number of other care providers has also changed:

  • There has been a steady decline of licensed practical nurses – (LPNs)
  • While the number of unlicensed care providers called Personal Care Attendants has tripled.
  • It is concerning to see our regulated nursing providers (RNs and LPNs) being cut from the system.

Another concerning trend in the RN workforce is the rising use of causal RNs.

We now have over 1,000 casual (relief) positions. That’s almost 20% of our workforce. It means we have one of the highest rates of casual RNs in the country.


Why does it matter how many casual RNs we have?

Because casual RNs are relief RNs. They do not have a set schedule.

More casual RNs in the system results in less certainty that we have the staffing levels to meet patient demands at any given time. High use of casual jobs can also impact recruitment and retention.

So how has our health care system been meeting the demand for care?

By relying on two unsustainable fallbacks: inadequate staffing and excessive overtime.

Inadequate staffing happens when staffing levels are insufficient to meet the needs of patients.

Last year, inadequate RN staffing caused over 300 surgeries to be cancelled at Eastern Health alone.

Consistent inadequate staffing and unrealistic workloads result in burn-out and fatigue among RNs, which can lead to injury and high levels of illness.

It also results in excessive overtime, and RNs being mandated to work.

It’s not acceptable for a pilot to fly for 16 consecutive hours. How is it ok to force a registered nurse to work 14, 15, 16 consecutive hours caring for patients – sometimes even an unthinkable 24 hours straight!

This is unsafe for RNs and their patients.

These are expensive, ineffective methods of providing health care. We need to do better.


So what’s the solution?

It’s been over 15 years since the last staffing review, and in that time our province has seen many significant changes.

It’s time to staff based on the needs of today’s patients.

A staffing review will examine the number and types of providers needed in the system to establish safe staffing levels.

We think that’s a good place to start. Visit RNValue.ca to learn more.