«UNDERSTAFFED AND UNDER PRESSURE A reality check by Ontario health care workers October, 2005 UNDERSTAFFED AND UNDER PRESSURE A reality check by ...»
Infection control and lessons not learned from SARS Infection control in the Toronto service is almost non-existent. Even after everything we learned with SARS, management does the bare minimum – only what they absolutely have to do. They never take any initiative to insure the protection of the paramedics, our patients or our families. We received a directive, after SARS, telling us that we should reuse blankets if the previous patient wasn’t coughing or sneezing. Do you believe it? What about MRSA? VRE? C difficile?1 You would think they would have learned a lesson, but they didn’t.
If we have a patient in the back of our vehicle and they have a fever and cough we are supposed to treat them like an isolation case. That means wearing gowns, masks, safety eyewear and gloves. Yet if one of our co-workers is sick, they are forced back to work through constant harassment. The sick time attendance programs are nothing more than an attempt to compensate for serious understaffing. Sick days are essential to the provision of good health care. They are there for the public’s protection and for our protection because we are constantly exposed to infection, disease and the physical demands of caring for the sick, ill and injured. We think this is humiliating and demeaning. We are professionals - grown men and women who take our jobs seriously and give more than 100% every day. But every day they continue their harassment.
MRSA (methicillin-resistant Staphylococcus), VRE (vancomycin-resistant enterococci)
- 11 We are all overworked. There’s no time for lunches. No time to have a rest. We’re pushed hard all day. The shortage of staff means that after transporting, for example, MRSA patients and other isolation cases, they want us back out again so there’s no time to even thoroughly clean the ambulance. Trucks must be cleaned at base but often, we have to respond to the next call. If you have to take a truck out of service for two hours, you have to take the whole crew out of service. Our increases in staff never keep up with the increases in volume so there just isn’t time. Low staffing is a problem for infection control, for the next person we transport and it also poses a threat to our health.
The stress and pressure really get to you. We’re transporting someone to hospital and the dispatcher is calling to ask if you can unload quickly and take the next call, and you have to say “no” because the hospitals are backed up from understaffing and you’ve got to wait with your patient. And then they ask again, and you say “no.” And again, and again. It doesn’t stop. And the minute you can leave hospital, you’re off again knowing you have go through the same thing with the next person.
It’s Not Tea For Two:Nourishment and Rest are Critical
Lunch seems like a small thing but it’s a huge deal for all paramedics in the province. Most of the time, we don’t get a lunch break until we’ve been at work for six hours on a 12-hour shift. Some of the time we don’t get a lunch break at all, or any break, because we’re so short staffed. You’re speeding through crowded city streets and through red lights, and you need to be as alert as possible. And you’ve got to be working at the top of your abilities when you’re giving medication. Bad mistakes can be made. For example, epinephrine and morphine look the same but they do completely opposite things. For all that, you need energy and concentration, not low blood-sugar.
They’re implementing dangerous policies all the time in order to overcome the shortage of vehicles and resources. For example, when hospital emergency gets backed up, they strip one medic from each team and send them back on the road to respond to other calls. But you can’t operate a stretcher as one person, so now you are compromising someone else’s care.
Non-union, private transfer services Don’t be fooled. They’re not the real thing...
These services began big time as a result of the Harris downloading. We used to service all the transfers and then got to the point of too many emergency calls and transfers, and not enough trucks and paramedics.
The private services are unregulated under any provincial health care legislation. They don’t even need a taxi license, and no rules or qualifications exist about who can attend to a patient. There are at least three different services up here right now. I’ve heard that one of them – just one – has billed out $5 million. That equates to 6-8 real vehicles on the road with real paramedics. If you totaled them all up, there would be even more real emergency service vehicles. When these guys get into real trouble, if their patient went sour, (not that they would necessarily recognize that, but if they did), they would have to call 911 and guess who would have to respond and get their patient? Us. That’s what they are required to do. But some of them are real cowboys and will just flip their lights and sirens on, which is totally illegal.
.... But they’re taking incubator babies, heart catheter patients and people in really serious condition.
Those private transfer services purposefully mislead the public. It’s illegal to impersonate a police officer but not a paramedic. These people get access everywhere, even in some airports, because they look like us.
They’ve got lights and sirens, just like a real ambulance but they not allowed to use them since they aren’t an emergency vehicle. Even hospital nurses get confused, because their uniforms are like ours. But the minute something serious happens, they have to pull over to the side of the road and call us to come and get them. They’re not the real thing but they are taking incubator babies, heart catheter patients, people as serious as that and if something happens, it can mean serious trouble for those patients, or death. The other problem with them is that they often transport multiple patients. This is just bad health care. I’ve seen them take one of the patients into emergency and leave the other alone in the vehicle. Paramedics must be in physical contact with the stretcher at all times. For good reason, you are not permitted to leave patients alone in an ambulance.
May 5, 2005 We have been reviewing attendance records and note that during the 12-month period ending December 31, 2004 you were absent on 5 separate occasions for a total of 19 days. This attendance record does not meet the attendance goal established by the
organization which is:
• no more than 5 separate occurrences of absence for all staff (irrespective of the total number of days absent) within a 12-month period; and/or,
• a maximum of 10 days absence for paramedic staff or 7 days absence for all other staff in any 12-month period.
Every employee makes an important contribution to the organization. There is concern that the quality and continuity of the services we provide to the residents of the County may suffer through staff absences. Absenteeism also creates a burden for other employees who have to “take up the slack”. Failure to meet the attendance goal over a prolonged period of time, as set out in the program, could result in loss of employment.
Therefore, we need you to meet with ______________ on 5/20/2005 at base 1 at 1830 hours and attempt to identify ways to improve your attendance record. The employer is committed, where possible, to provide assistance and support to you. If there are any extenuating circumstances that may be contributing to your absences, they should be discussed.
Yours truly, Bill Stephenson Director of Human Resources c.c: Employee File (2)
The recent cold weather has increased the use of blankets to protect our patients. In addition, we are entering the holiday season, where the frequency of linen laundering may be temporarily reduced.
It has been identified that some crews are using two or more blankets on particular patients, and then discarding the blankets for laundering. Unfortunately, the number of blankets in the system was not calculated based on this practice Further, in most cases blankets do not need to be discarded after single use. As long as patient is adequately covered/wrapped in a sheet before a blanket is applied, and there is no involvement of blood or body fluids in the management of the patient, then the blanket is considered acceptable for re-use.
In most cases, proper use of a sheet in the handling of a patient will prevent the blanket from becoming contaminated, while still providing protection and comfort for the patient.
Blankets can therefore be re-used unless they are visibly soiled.
We have ordered an additional shipment of blankets which will arrive this week. This will assist in maintaining sufficient stock in the system over the next several weeks.
Through normal use, there should be no shortages. In this regard, we would also ask your co-operation in the judicious use of blankets, in order to ensure their availability for all patients.
No more personal touches, no basic human interaction is allowed any more. They don’t realize this is a person, not a machine. It’s incredibly stressful. I tell you, whatever Harris started McGuinty is finishing. We are really disappointed in this government.
Mike Harris created nothing less than a disaster in Home Care, sabotaging its original intent, and creating a climate of fear, chaos and neglect. His promise of quality home care was used as the lynchpin in the plan to close hospitals, beds, and emergency departments, and get rid of health care workers.
Quality home care never materialized. But one of the finest hospital systems in the world was ravaged.
At the very heart of the Tory plan to weaken the public sector’s delivery of Home Care was the introduction of “Compulsory Competitive Bidding”. Big for-profit corporations went head-to-head with the not-for-profits tendering for service contracts.
Organizations such as the Victorian Order of Nurses and the Red Cross vanished from many communities while the private companies’ market share soared from 18% to over 50%. Small community-based non-profits were replaced by a handful of large forprofit organizations. In 1995, there were 24 small community-based providers in Ontario;
today there are only three.
The inevitable result of inviting for-profit providers into home care has been a destabilization of the entire sector. Services have either disappeared or are rationed.
When Ontarians do manage to qualify, there is no more continuity of caregivers, and no time to deliver services. Turbulence and instability are the norm. Even the culture of home care has changed.
This transformation stands as eloquent testimony to the fact that the private sector cannot do it better; but also it can’t do it cheaper, more efficiently, or humanely.
At a minimum, more than 500,000 Ontarians need home care services. The need continues to grow, while at the same time, the quality and availability of services are decreasing.
For workers, the forced bidding competition for home care contracts has produced massive job insecurity and dislocation, scandalously low pay with few or no benefits, bad working conditions, stress, and injury. It is not a sector that workers can depend on. No career or job planning is possible. No long-term financial arrangements can be made. The bidding process, with its winners and losers, is driving workers away.
The closure of VHA Health and Home Support Services that employed 400 people, provided 58% of services in the Hamilton area and served 2,500 clients is an example of the chaos inherent in the competitive bidding process.
As one support worker noted, “I feel like a slave with people bidding for me every few years at the cheapest rate.” When home care workers attempt to unionize to improve their working conditions, for-profit agencies, such as Comcare in Kingston and We Care in Sarnia, close up shop.
The revolving door for workers produces daily crises for clients. For those relying on home care, continuity of caregivers has always been one of the most important elements. Many of the functions performed in the home are intimate. It can take a long time for a client to develop trust. And each client has individual needs that workers must take into account when providing services. That is why home care recipients speak of how onerous and demoralizing it is to continually train new workers.
It has been equally discouraging for those waiting for public home care services.
Much of the time they can’t get access to them. As one worker noted, “Oh, no. We don’t have problems with waiting lists anymore, because we either cut the services or raised the bar so high they can’t qualify.” The 2004 Annual Report of Ontario’s Provincial Auditor notes that a one-year freeze in funding between 2001/02 and 2002/03 led to an overall decrease in nursing visits of 22%, and a decrease in homemaking hours by 30%.
People suffered badly. They still do.
In October 2004, in order to remedy the problems, the government announced that former Health Minister Elinor Caplan had been appointed to conduct an independent review of the competitive bidding process used by Community Care Access Centres.
However, when the report was released in May, the two most important elements of change – the end of competitive bidding and return of home care to the public, not-forprofit sector – were absent.
Instead, Caplan identified the biggest challenge as the “clear need for consistent, accessible information that can provide a basis to measure client outcomes, disseminate research and best practices and report on overall home care performance.” And, out of 70 recommendations, “the most important one, from which all else flows, is the need to establish the Centre for Quality and Research in Home Care.