Government & Medicine

Doris Grinspun gets the dough

Ontario commits $50 million to full-time nursing

By Ilina Stranberg

"All the new grads can get full-time jobs," says Doris Grinspun, RN, MSN, executive director of the Registered Nurses Association of Ontario, referring to 3,000 registered nurses and 1,000 registered practical nurses who will be graduating this spring. "The key message is the excuses for not hiring nurses are over." That key message was the announcement, on February 25, by Health Minister George Smitherman that the government would make sure $50 million of a $385 million bail-out of the province's hospitals would go to hiring full-time nurses.

Only a week earlier, the crusading Ms Grinspun told the National Review of Medicine that the lack of funding was "the dismantling of nursing." She continued, "It's a total displacement of RNs that hit a low point in 1998, when 53% of Ontario nurses were forced by cutbacks and management decisions to work part-time and casual. Management thought cost savings could be realized by having all these people work part-time but it didn't pan out, because we ended up paying much more than the benefits to overtime, agency time and sick time."

Ms Grinspun, formerly director of nursing at Mt Sinai Hospital in Toronto, is a warm and energetic woman who was born in Chile and moved to Canada after sojourns in Israel and the USA. She's a committed and passionate professional who has lobbied tirelessly against the excessive use of part-time and casual nurses, which she claims is "a threat to the quality of patient care, the viability of the healthcare system and to the nursing profession itself."

With the $50 million injection, the cash-strapped Ontario government has clearly shown it stands behind its commitment to 70% full-time employment for RNs. Mr Smitherman says nurses are "at the heart of health care," and acknowledges the health hazards they face in the current hospital environment. Because there are not enough nurses, they clocked 2.7 million hours of over time last year — two million of it at triple time. Many of those in part-time and casual jobs work in three places instead of one, stretching themselves beyond acceptable limits.

Until the money came in, Ms Grinspun called the outlook grim. "We're expecting to lose 6,000 RNs this year to retirement," she told NRM, "and we could lose up to 23,000 more by 2006 if they retire at 55 (the average age for RN retirement.) We'll never have enough nurses if most of them are working part-time and casual."

An RNAO study released in May 2003 showed 11% now working part-time and casual would move to full-time employment immediately if it were available. "That would mean 4,000 more RNs working full-time, and that's a good number," said Ms Grinspun. "But if we were to improve working conditions, 46% would move back to full-time, and that would eliminate the shortage. We could move in a matter of less than a year to 73% full-time employment for RNs." Now the chance the province will hit the target is vastly improved.

TOMORROW'S NURSES
Ontario, with only 67 RNs per 10,000 people, has the lowest RN-per-population ratio in the country — well below the national average of 74 — and a disproportionately high level of part-time and casual employment in the nursing workforce — 43% of Ontario RNs do not have full-time employment and cannot find it.

"I want to work in a full-time environment. I don't want to be a piecemeal worker — I want senior nurses to educate and mentor me," says Brian Ericson, a senior nursing student at the University of Toronto, who's graduating this summer and has already heard the siren song of US recruiters. And finding a full-time job as an RN in Ontario was looking pretty doubtful to him — hopefully Mr Smitherman's announcement will keep him in the province.

Though it was worse in Ontario, the problem is a national one. US recruiters actively chase Canadian nurses offering dozens of full-time jobs in a choice of disciplines, good salaries with signing bonuses, and first-class relocation packages (with all immigration and licensing paperwork taken care of).

A LITTLE RESPECT
Canadian public polls continue to show that RNs hold the highest national public trust. "Employers will tell you they value RNs, doctors say they can't work without RNs, but moving beyond the rhetoric of are we valued, are we loved, the question is, are we respected?" asked Ms Grinspun. She said the misguided management decisions that created the current situation amount to "borderline negligence," and believed the medical profession should not stand by and watch organizations repeat past mistakes.

Some have started to stand up and take notice. The February 10 issue of The Wall Street Journal published advice from American doctors on how to find the best medical care. To find a good doctor, ask a nurse, suggests Dr Michael F Nigro Jr, a surgeon from Virginia. And to find a good hospital, find out if the nursing service is fully staffed. "It need not be a medical-school teaching hospital but, more importantly, one with a good nursing staff," writes Houston gastroenterologist Dr John R Mathias. "It is not doctors who get people well, it is the care of the nurses that get people well." Their sentiments are echoed in the statistics. The Ontario acute care component of the Hospital Report series for 2003 showed several evidence-based indicators on 2001-2002 post-admission outcomes related to nursing care: 948 medical patients developed pneumonia, almost 200 developed decubitus or pressure ulcers, and another 50 suffered fractures. With nine out of ten hospitals claiming a shortage of nurses, one would have to look hard to find one that's fully staffed.

In the past, hospitals received government funding and failed to use it to ease the nursing situation. For that reason, prior to the government announcement, Ms Grinspun went to considerable lengths to insist than any nursing money be given "with strings attached." In the funding announcement the health minister went out of his way to insist on that very thing.

NEW RECRUITS
The new grads are on the way: RNAO's recruitment initiatives, combining previous $500,000 government funding with a strategic marketing plan, and the efforts of 300 RN volunteers, successfully increased the 2003-2004 nursing program applicants by a whopping 96%. The immediate priority is to change management staffing decisions to accommodate more full-time nurses on an ongoing basis and set a positive direction for the future.

The government's announcement clearly says to grads, "you will all have full-time employment when you graduate in April, so please don't sign contracts with other people." There is 71.6% full-time employment for RNs in the US right now, so they're already there — but still they're contacting our upcoming grads directly, sending them e-mails and calling them at home with offers of full-time work and signing bonuses of $6,000 or $9,000 US. Some have already signed up. They're upset. They've sent e-mails to the minister, e-mails to the premier and everybody else that would care to hear about it. All these grads want is full-time work."

As it turns out, the government was paying attention.