Proposed changes don't sit well with nurses

FOGO ISLAND - Patients at the Fogo Island Health Centre will soon see a change in the way the facility is staffed with respect to nursing positions.

Scheduled changes to the staffing disbursement of these positions is causing concern. Debbie Forward, president of the Newfoundland and Labrador Nurses Union, feels the proposed changes being implemented by Central Health pose safety concerns for staff and patients at the facility.

Trudy Stuckless, vice-president for professional standards and chief nursing officer with Central Health said that while there will be some changes to the staffing at the facility, it won't result in any cutbacks in staffing positions.

"What we are doing is making a change on the night shift from midnight to 8 a.m.," explained Ms. Stuckless. "Right now they have a registered nurse and two licensed practical nurses (LPN) on that shift. Normally they work that shift from 8 p.m. to 8 a.m., a 12-hour shift, and those are the staff they would have on a 12-hour shift."

Ms. Stuckless said there would be no change in staffing from 8 p.m. until midnight. But at midnight one of the LPNs will be going home.

"What we are doing is moving the third person, the LPN to the day shift," said Ms. Stuckless. "We will be utilizing that position in the outpatient and emergency area. The LPN in that position will require the new skill set that LPNs have now which is the medication course and the health assessment course - they will be working to their full scope of practice."

Ms. Stuckless described the changes as a reallocation of resources within the facility to the busier time of day. She said that by using the LPN position in the outpatient and emergency area, it would free up a registered nursing position to be used in the float pool.

"This will allow us to free up registered nurses on the day shift to go into our float pool which will allow us to have people in our float pool to provide relief for registered nurses when they take vacation or sick leave and that sort of thing," explained the chief nursing officer.

She did note that there would be no lay-offs or reduction in staff but rather a reallocation of staff which gives more flexibility on the day shift and reduces demand for registered nurses so that the Fogo Island Health Center can have nurses available for relief.

"Those nurses that are available for relief will still be permanent full-time," added Ms. Stuckless. "They won't be causal, just called in as needed, they will be working a regular full-time schedule."

Ms. Stuckless said the changes will be permanent but noted they will be evaluating it. She did note that she is confident that the new arrangement will work fine.

"We have other sites that are similar in size to the Fogo Island Health Centre, they actually have a few more beds than Fogo Island, and they work with two people after midnight and we have found that is working fine, we haven't had any major problems with it," said Ms. Stuckless.

Care

Ms. Forward said the concern nursing staff have isn't with workload but rather with providing the best possible care for patients.

"We've been talking to the nurses at the health centre and they have concerns about the number of staff that will be available on the night shift," explained Ms. Forward. "Currently there are three nursing personnel available. There is one registered nurse and two LPNs and these three individuals care for the in-patients which are made up of some acute care and some long-term care residents as well as caring for any emergencies that may come into the emergency department."

Ms. Forward said the nursing staff at the facility are concerned that if there is an emergency overnight and the registered nurse responds to it and it is serious, the only other staff member they have left to call on is the LPN leaving no one to provide care for the inpatients.

Patient safety

Ms. Forward said nurses have raised their concerns with patient safety to their employer and were informed that they would have a nurse on standby. And they can call a nurse back.

"Our members say that is really great but in the meantime we have to deal with the emergency and by the time we call someone and they get back to the institution time elapses which is critical to patient care," explained Ms. Forward. "There is no physician in the building so they don't have a physician resource to call on, they have to call the physician back as well."

Ms. Forward said Central Health has also suggested they would contact the private ambulance operator about upgrading the education of the ambulance staff to paramedic status which she said is great if the emergency comes in by ambulance noting however that if the emergency is brought to the facility by a family member then that will be of no help.

"Nurses are concerned. They don't feel they have enough staff if they have an emergency," said Ms. Forward. "The nurses say they don't want to be put in the situation of having to make a decision when there is an emergency come in, either I try to deal with this myself and try to call people back and do the best I can in the meantime until someone comes in or I call the LPN and say you need to come and help me which leaves your acute care patients and your long-term residents without anybody looking after them. What if something happens to one of those people?

"Nurses say they don't want to be left in a position of having to make that choice."

Ms. Stuckless said they do have adequate staffing on Fogo Island to fill the core staffing needs at the facility - all the staffing on the day and night shifts - but noted that the problem falls in the area of relief.

"It's been difficult to have enough registered nurses to provide relief for the nurses who are there," said Ms. Stuckless. "That's why we have been developing a float pool so that we can have permanent full-time people in a float pool and their job would be to relieve when others are off.

"There may be times when no one is off on an annual leave so they would be extras on those days. But we find that is the only way we are able to attract registered nurses is through permanent full-time relief pools as opposed to just having them come on a casual basis and then they don't know how many hours they are going to get."

Ms. Forward said the nurses union recognizes there is a nursing shortage on Fogo Island, however, they don't feel the decision of Central Health to reallocate resources is the answer.

"We say to the employer there is a shortage of nurses, yes we absolutely agree with you, but the solution to that isn't decreasing your staffing, the solution to that is doing better recruitment and better retention, not by decreasing staffing where nurses are very concerned about quality and safety," said Ms. Forward.

Ms. Stuckless said they are still recruiting for the relief pool however she noted that the changes being implemented at the facility will free up two nurses to go into that pool.

Consultation

Ms. Forward said the nurses union is asking Central Health to stop this process or at the very least delay the implementation of these changes until further consultations with nursing staff can be had.

"Nurses sense around this is that they weren't consulted, the employer says they were but nurses feel that management came in and they told them this was happening," said Ms. Forward. "Nurses raised concerns and management ignored them so that isn't consultation, certainly not meaningful consultation.

Ms. Stuckless said the nursing staff knew about the proposed changes to the staffing allocations at the Fogo Island Health Centre. She said the process has been ongoing for over a year now and nurses were involved. She feels the statement by the nurses union that nurses weren't consulted is not the case.

"No that's definitely not the case," said Ms. Stuckless. "I don't know if some people feel at the end on the day when they don't agree with something that they haven't been consulted but we have been working on reviewing staffing at Fogo Island and planning to implement these changes since early in 2006," said Ms. Stuckless. "Over the past two years we have had numerous meetings with the staff. We have actually gone out and sat down with them. We have met with the union through the professional practice committee which is route that you would go when you are dealing with professional practice issues for the Newfoundland and Labrador Nurses Union and also the labour management committee which is the committee that would be representing NAPE which is the union the LPNs would be in."

Ms. Stuckless said they met with the LPNs and registered nurses together as well as with their managers and the physicians on staff at the center noting they have "had extensive meetings with staff."

Ms. Forward said the nurses union is hoping that by raising this matter publicly, the community will become aware of the planned changes and she said they are hopeful that residents will express their concerns to Central Health as well.