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New Quinte Health Care nursing model brings controversy

Trenton Memorial Hospital is one of four hospitals operated by Quinte Health Care. All four hospitals will use the new nursing model. QNet News file photo. [1]

Trenton Memorial Hospital is one of four hospitals operated by Quinte Health Care. All four hospitals will use the new nursing model. QNet News file photo.

By Joseph Quigley [2]

BELLEVILLE – A new care model that will cut nurses in favour of other health workers is stirring debate between nurses and Quinte Health Care [3].

The model will have nurses working collaboratively in teams of two or three, along with a personal support worker [4] to care for groups of 13 to 15 patients. This is a departure from the current primary care model, which has individual nurses caring for five or six patients. The new model will be phased into QHC over the next year.

However, the change will come with a reduction in nursing staff. 39 union nursing positions will be cut [5], with the void filled by personal support workers.

QHC vice-president Katherine Stansfield said the model will save money and increase the amount of care provided.

“What we’re doing is adding hours of care but at a lower cost. We’re looking at who is the right member of that team, where do we need the expertise and who is available to give that care. (We want people) working at their top scope (and to) make sure we get those proportions right,” she said.

Part of the savings will come from the difference in wages between the workers. Registered nurses make more than twice as much as personal service workers, according to a QHC presentation on the model ($43.45 vs. $21.97 per hour at top of scale).

In a QNet News live discussion on local health care [6] on March 27, Stansfield said nurses are currently underutilizing their best skills.

“There is limited help from support staff to assist with activities of daily living such as ambulation (or) grooming. Both (registered nurses) and (registered practical nurses) then spend much time with these activities instead of using their clinical skills in conducting complex assessments, discharge planning and healthcare teaching,” she said.

QHC has also said the model will help decrease emergency room wait times, increase staff satisfaction and improve or maintaine quality indicators when introduced elsewhere.

Others hospitals in Canada introduced a similar model and saw some positive results. The Vancouver Island Health Authority Care Delivery Model Redesign [7]found that patient experience [8]and health outcome metrics [9] did not change significantly in the first few months after the model was implemented. Some employee metrics [10], like reducing the need for overtime hours, improved.

Another study [11] co-ordinated by the Model of Care Initiative in Nova Scotia [11]found that their model change resulted in patients reporting a more positive experience.

A graph from the Model of Care Initiative based on patients surveyed. Patients chose what negative points they felt applied to their experience. The new model was introduced in 2010. Darker bars represent surveys in the last year of the old model, while lighter bars are the first year of the newer team-based model. In general, though negative patient experiences were reduced only marginally by the new system, the reduction was consistent across all categories. [12]

A graph from the Model of Care Initiative based on patients surveyed. Patients chose what negative points they felt applied to their experience. The new model was introduced in 2010. Darker bars represent surveys in the last year of the old model, while lighter bars are the first year of the newer team-based model. In general, though negative patient experiences were reduced only marginally by the new system, the reduction was consistent across all categories.

The Ontario Nurses Association [13] objects to cutting nursing jobs. Its vice-president, Vicki McKenna, said she’s seen team-model nursing phase in and out of popularity.

“I know that team-model nursing has come and gone over the years and so I have seen team model nursing (go from) being the theory of the day to it being discounted as not being as effective.”

McKenna said the patient’s bedside needs the specialized skills of a registered nurse.

“When we’re looking at hospitals, we’re looking at a group of patients who are in many cases acutely ill with quickly changing conditions and unpredictable situations that can occur at any time. And that’s why its so important to have skilled and trained people at the bedsides,” she said.

She added nurses want to be helping patients with their daily living activities.

“Any nurse that I know, they want to be at the bedside with the patients observing them and doing things such as baths or assisting people in and out of bed. Some people might assume that that’s an easy task anyone can do, and I’m not saying PSWs aren’t capable of doing those things because they certainly are, but I think a registered nurse would tell you that a part of the way that they can assess a patient is by having their hands and their eyes on that patient through some of those tasks,” she said.

McKenna also said studies show that more nurses at the bedside improves health care.

A 2012 research review from the Canadian Nurses Association [14]found evidence that more nursing staff has a positive impact on patients. A different American study [15] found that understaffing nurses was related to increased death rates.

Stansfield said she understands concerns regarding the model change, but believes that it is still the way forward.

“It’s a challenge and part of it is unfortunate because it does create some unrest in the organization. I understand where that’s coming from and I understand why some people are unhappy with the change. But I think if we have the ability and really support the staff in the way that we’e planning out, over time those concerns will be addressed and we can see the benefits of the model,” she said.

Stansfield also said she could personally attest to the success of the model.

“This model was actually one of the first models I practiced in when I was a bedside nurse. It was one of the best and most collegial atmospheres I ever worked in and I have to say the care we delivered we felt was second to none. We had great team spirit and our patients were very satisfied with our care. I’m absolutely convinced that this is the right model for us,” she said.

McKenna said the differences between models is complicated and that decisions about the future of nursing are difficult.

“It’s not easy to make a simple statement on (whether) team-based nursing is better than primary care nursing. I think it would be unfair to make an across board judgment on that. Health care today is complicated. There’s not an easy or a quick answer to many of the questions to a lot of the changes that are happening out there.”

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