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«UNDERSTAFFED AND UNDER PRESSURE A reality check by Ontario health care workers October, 2005 UNDERSTAFFED AND UNDER PRESSURE A reality check by ...»

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The most dramatic example of this loss of patient focus is hospitals’ and governmental responses to the SARS epidemic.

Before SARS, we were already plagued with much too-low staffing levels and dirty hospitals. Staffing and cleanliness are the cornerstones of infection control. Our post-SARS reality is worse, with even less staff and dirtier hospitals. Deaths from hospital-acquired infections, such as MRSA, C. Difficile and VRE2 underscore the need for a dramatic increase in housekeeping employees, but this is not even on the radar.

Warnings of the potential for even higher rates of hospital infections and a possible Key hospital-acquired infections: methicillin-resistant Staphylococcus aureus; C-Difficile; vancomycinresistant enterococci.

–  –  –

This disconnection between public policy and public need has never been greater and poses serious dangers for the future. The most immediate one is the huge number of workers who will be retiring, starting next year. By 2008, it is predicted that we will face a nursing shortage of more than 30,000 RNs. Pension plans are already grappling with thousands of workers in all classifications who are leaving. Yet, despite this looming “people” crisis and the need to attract hospital workers, Premier McGuinty continues to create a culture and climate in the workplace that has never been worse.

The disrespect, grueling work days, daily harassment by management, soaring injury and infection rates, inappropriately low wages, and lack of satisfaction at the end of the day of a job well done, are fuelling an unprecedented exodus.

Workers aren’t just telling each other how bad the hospital environment is, but are also counseling family members, friends, and neighbours to stay away from hospital work. Sixteen people told us they were asked for advice about career paths and tried to dissuade the young adults from following in their footsteps.

“My neighbour told me her daughter wanted to talk to me about becoming a hospital registered practical nurse. I told her that hospitals were bad places to work and will get worse. I explained in detail about my workday. Thank god, she has decided to study as a paralegal instead. I wouldn’t have wanted that on my conscience.” The explosion of privatization initiatives, and in particular, P3 (Public-Private Partnership) hospitals, also has the capacity to change health care forever. P3’s are forprofit initiatives that allow corporations to finance, design, own or operate the building, and then lease the hospital back to the board, community or government, for a profit.

They raid public dollars by driving up costs, cutting staff and delivering second-rate

–  –  –

But the government has plowed ahead in Brampton and has added Sault Ste.

Marie, North Bay, Belleville, Mississauga, and Ottawa (Montfort), St. Catherines, Halton and the Centre for Addiction and Mental Health to its immediate P3 list.

If the Liberals are successful in implementing plans to privatize more than two dozen hospitals, there will be no going back. This will become their legacy, changing forever the entitlement and prospects of future generations of Ontarians.

There was so much to be undone after the Mike Harris years and so many promises about restoring quality to our health care system. Not only do workers report a far worse working environment but, most frightening of all, Premier McGuinty and Health Minister Smitherman do not seem inclined to want to make our hospitals the centres of health and healing that they should be.

Here are some accounts of what is really taking place.

Infection Control Post-SARS Infection control in our hospital? What a joke. We went to a board meeting and they brought up the Avian flu pandemic. The chair of the board of our hospital asked if we are prepared for another outbreak, and in particular pointed to the Avian flu.

Everyone just looked around the table. Is he kidding? Are we prepared? The answer was “no.” How can we be? Nothing has changed.

_________________________

Since SARS, everyone’s work area has actually been expanded. That means we do less cleaning because we sure can’t work any harder or faster. This morning, the nurses who work on the floor with people recovering from heart attacks were talking about how

- 32 filthy” it was – the walls, vents, beds, high and low corners, bathrooms. They’re right.

Cleaning is so much different now than it used to be. Hospital management used to actually care about every inch of space being clean for the patients, because they are vulnerable. When I see their public statements, I just shake my head, because it’s much different than what is really happening in here.

_________________________

They’re coming at us all the time with attendance awareness programs and it’s actually leading to more accidents, and more illness. Now you always see sick workers coming in because they are going to face possible discipline. It’s really bad for the patients with all these possible infections running around. We’re putting them in jeopardy.

_________________________

There are still not enough people in housekeeping. Doctors sometimes won’t gown, and visitors are allowed to walk up and down the halls in their gowns. And the hospital is dirty. We’re going to get hit again. We just haven’t learned anything.





_________________________

If we don’t get more housekeeping staff, there is no possibility of infection control. I don’t know how many years we have been saying that a hospital is not a factory, and that it has to be sterile. I mean, this is basic logic, no? The public need to be safe but they still aren’t when they come here. I don’t get why they don’t understand that in this age of superbugs, housekeeping is critical.

_________________________

I’m working at that hospital, killing myself, getting sick from the workload and they still they push my attendance. Talk about potential for injury and for infecting patients.

_________________________

- 33 I’m in housekeeping and when I cleaned a room, I cleaned it as though my mother was going to be the next patient. Back then that’s the way the hospital wanted it and expected it. Now, we clean it as though it’s an office. Hospital managements’ attitudes have changed so much. They really don’t care as much as they used to. That’s really scary because, oh, brother, you just won’t believe how dirty things have gotten.

_________________________

Despite SARS there is a still a casual attitude at our hospital about infection control.

_________________________

As a person who works in an operating room, I am never surprised when anyone gets an infection. We have all of the equipment but there is not enough cleaning staff, and they can’t possibly do all that is expected of them. Infection spreads. Don’t they know that? If huge parts of the hospital are dirty, you can’t protect patients coming out of surgeries or anywhere else for that matter. They cancel surgeries when there are not enough nurses. When there is not enough cleaning staff, life just goes on as though it’s normal. I don’t understand the reasoning.

In pursuit of the mysterious community They say they’re taking the diabetes and ambulatory clinic “into the community”.

What is this community? Where is it? Someone please tell us. We can’t find it.

_________________________

They are closing a lot of our programs: stroke and brain injury, motor vehicle accidents, neurology, and others. They tell us that many of them are going into the community. They want us to believe there is some miraculous group of people who we don’t know and never heard of who will be doing this work. Well, who are they? I bet it’s us.

_________________________

- 34 Programs in our hospital have been disappearing. We are discharging patients needing occupational and physiotherapy therapy into “the community.” But, really, this community is just the private sector. It’s for those who can pay.

Huge consequences for workers and the public We’re facing terrible staffing issues, just terrible. There’s been a dramatic increase in volumes, but not staff. Cytology used to deliver results in 24 hours. It now stands at 48. And cancer care, well, we’re supposed to be spinning out results in 24 hours and we can’t do it. There is no way! And those patients, they need those results.

They are really, really sick. CT people never go home or if they do, they just have to turn around and come right back. They have no family life, no real rest. The government is just driving us into the ground and so is management. People are not going to stick around. What’s going to happen to the patients then?

_________________________

These days, they are throwing new RN grads right into the emergency department. We are so understaffed, you can’t leave emergency for a break if you are working with someone who isn’t skilled, and often you can’t go for a break at all because it’s all-hands-on-deck. There is no way the 15-minute triage standard can be consistently met. Because there are only two people working in emergency, you just pull the charts off the board and run. That’s not good care. It’s just one person after another, and still, you can’t keep up. I can’t begin to tell you how bad the morale is.

_________________________

It never feels good not to be able to do what you need to do for a patient. As therapists, we give people the ability to function, to achieve their best potential for daily living. From a professional point of view, we are always looking at best practice and we know that is not the way it used to be and not the way it should be. As an occupational therapist, I can tell you, not being able to do what you know you should really gets to you. It’s demoralizing. We have staff leaving because they just don’t want to be around

- 35 that amount of pressure and still feel bad at the end of the day about the quality of care they have delivered.

_________________________

On the night shift, you are the one RN in the emergency department, but if there are no patients there, you are expected to work on the medical surgical floor as the incharge person. You are also the admitting clerk, the switchboard operator, and the person who runs to the pharmacy for medications. All this, when we should be attending to our patients who need us. We need more RNs and more service workers. This isn’t quality care.

_________________________

People used to be appalled at sick people on stretchers in the hallways of Emergency. And the media used to run stories about it because it is really bad health care. But now it’s like the government just accepts it as a normal way that the health care system should operate. At our hospital, instead of doing something, they actually put up permanent numbers over the beds in the hallways. That’s sick. Have our expectations dropped so low that we don’t even think of this as a problem anymore?

_________________________

We have a code. It was called Critical Status but that name was freaking out patients so the hospital changed the name to Level 3. It means there is no bed available and someone has to go. Imagine that. They do it all the time. The best of the worst has to get out so we can have that bed. Meanwhile a medical floor exists with empty beds waiting, but they won’t staff them.

_________________________

Code white is our name for get ‘em out. For the longest time, we didn’t know what “code white” meant. It’s for physicians and nursing staff and means they have to get people out of beds because there aren’t enough available. It’s an emergency code and it’s called a lot. That means there are a lot of sick people getting booted from our

- 36 hospital because of understaffing. It kind of says everything about understaffing and what it’s doing, doesn’t it?

_________________________

Emergency is way overloaded. Our nurses are filing workload complaints in order to protect their licenses because they often can’t meet the 15-minute triage standard set by the government. There aren’t enough staff or beds. We used to have two emergency departments. Now there is only one and it is much too tight. This really upsets me because patients are at risk and we are not there because we can’t be everywhere. If someone is having a stroke, or heart attack, it is vital to get to them immediately, but that’s not the case any more.

_________________________

No, we can’t meet that 15-minute triage standard all the time. On a really busy day, there is no way. That certainly creates enormous stress for us. When people have to wait over four hours, it not uncommon to see what we call “waiting room rage”. At that point, we know we are in for a lot of verbal assaults, and potentially more than that.

_________________________

–  –  –

We are losing really valuable staff. Sick kids are now on same wing as maternity moms and newborns, and that’s not good for any of them. Every single one of us runs all day. They just won’t hire new staff. Never mind that. We’ve heard there are more layoffs coming.

_________________________

You should see our gross room. All tissue samples come into it. If you saw it, it would probably knock you out. Every conceivable surface is covered with specimens just

–  –  –

There’s a big staffing shortage coming up with so many workers retiring. I have no idea how they are going to attract people to this sector. No one wants to be here anymore. It is just too stressful and dangerous too. We have full-time people working up to 150 hours in pay period. Instead of hiring more people, the hospital just runs us all into the ground. They are working people to death.

_________________________

We have a CT scanner. Motor vehicle accidents, stroke patients, really serious cases depend on us, but they won’t train us. I do general x-ray and mammography. I don’t do CTs. I was told just to come in when I get some time and they’ll go over it with me! These are specialty courses for a reason: people’s lives depend on the diagnostics.

But they don’t want to pay properly trained people so they just give us more to do, and more, and more.

–  –  –

_________________________



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