An independent panel of nursing experts recommends Campbellford Memorial Hospital dissolve its registered nurse float resource pool and reallocate resources to help improve work conditions in the medical/surgical inpatient unit.
The recommendations are among 141 made by an independent assessment committee (IAC) following a three-day hearing held in late June. The IAC’s findings were released this week in an extensive 102-page report outlining suggestions to improve staffing and recruiting and to retain nurses. The IAC panel included a registered nurse chosen by the Ontario Nurses’ Association (ONA), one selected by the hospital and one from a panel of independent RNs who would act as chairperson.
Considered a last resort to resolve issues between nurses and their employers, in the spring the ONA requested an IAC to probe issues in the rural hospital’s inpatient medical and special care units.
The ONA said some concerns date back to 2017 and include “inadequate” staffing and skill levels. The union claims the result is a negative impact on patient care at the 70-year-old, 34-bed hospital located 50 kilometres southwest of Peterborough.
The union heavily criticized changes the hospital made, such as terminating two RN positions and eliminating two vacant positions it was unable to fill last fall. The hospital created an RN float resource pool composed of four full-time positions to serve various roles between the medical-surgical unit and the emergency department as determined by staffing needs in the moment.
Along with a tour of the hospital, the committee heard from staff and received 74 recommendations from the ONA on issues such as staffing, patient acuity, fluctuating workloads, education, leadership, a “poor work environment,” communication, staff safety and non-professional duties.
The panel agreed with the ONA and recommended that the RN float resource pool be dissolved and that the hospital reallocate the four full-time RN positions (hours) to the inpatient unit.
Heather Campbell, the hospital’s vice-president of patient services and chief nursing executive, says the resource pool helped tackle workload issues.
“I think the float pool was an innovative way to help solve some of those issues,” she said. “The recommendations that come forward is certainly something we’ll need to look at.”
The IAC also says the hospital should add an additional registered nurse to the night shift seven days a week, the team leader’s role should be extended to seven days a week, 12 hours a day and the ward clerk’s coverage should be expanded to 16 hours per day on weekdays.
If a unit is placed in overcapacity/surge, the panel says additional RNs “must be called in first.” If no RN staff are available, then registered practical nurses can be utilized.
The committee acknowledged the hospital’s staffing changes were made based on intent to “meet financial obligations” and benchmarking data with comparative hospitals, however, the panel noted the “lack of staff involvement” for the changes was a contributing factor to the “ongoing dissatisfaction.”
ONA president Erin Ariss says the report reflects a need for “focused attention” in the medical/surgical units at the hospital, which will mark its 70th anniversary later this month.
“If commitment and actions are implemented within each of these key areas, the IAC panel believes that this will ultimately assist the Campbellford Memorial Hospital’s medical/surgical Unit to become a quality practice environment,” Ariss said. “ONA looks forward to working collaboratively with Campbellford Memorial Hospital to implement each of these excellent recommendations.”
Campbell says it was “unfortunate” that the situation between the hospital and nurses reached the point of an IAC.
“Is it unfortunate that it got to this point? I would suggest to anyone going through this — yes,” she said. “However, I feel like we are in a very good place to move forward.”
Within three months, the hospital should develop a medical/surgical orientation program with the nurse education, nurse manager and staff to address the staff testimonials about the lack of “continuity and consistency” of training and orientation, the panel stated.
Orientation should be three to six weeks in length, depending on a nurse’s level of competency and experience.
“A well-developed orientation program provides newly hired nurses with concise and accurate information to bring more comfort in the new role, encourage employee confidence, improves communication, help new employees adapt faster to the job, contribute to a more effective, productive workforce which improve employee retention,” the panel stated.
Staff also highlighted concerns about non-nursing duties, such as housekeeping, food tray and laundry pickup and even dealing with bat removal, of which the panel was highly critical.
“Bat removal should not be an expectation of registered nurses,” the panel stated. “Nursing responsibilities should include securing the area where the bat was seen and conduct(ing) patient assessments to ensure they have not been exposed to the bat and offer reassurance. Security and maintenance staff must be notified immediately and assume the responsibility for bat and bat droppings removal.”
As a result, the panel recommends a hospital review of all non-nursing duties and says appropriate resources for the functions “must be implemented” within the next three months.
When it comes to patient transfers, the panel recommends expanding access and use of the Ontario/telemedicine network for consultations and followup appointments for patients to minimize the transportation of patients.
The panel notes transfers by air or land ambulance often require an RN to accompany the patient and the panel says it is “imperative” to plan and schedule in advance to “ensure nursing resources are readily available.”
Health and safety
Under health and safety, the panel provided 20 recommendations, including meetings every two months for critical incident briefs, and said the hospital should complete a security coverage gap analysis to “identify areas of opportunity.” The panel also suggested a Level 3 security guard for one-to-one observation of patients deemed violent.
The panel also encouraged improved communication among staff and managers and recommends hospital-association committee meetings to continue bi-monthly to promote ideas and information and review any staff issues.
The ONA will review the hospital’s implementation of the recommendations over an eight-month followup period.
Angela Preocanin, ONA first vice-president, says the union is optimistic moving forward.
“I understand the members are very pleased with these 141 recommendations, so we are hopeful that the employer will come forward and start with the implementation phase,” she said.
— with files from Sam Houpt/Global News Peterborough