«UNDERSTAFFED AND UNDER PRESSURE A reality check by Ontario health care workers October, 2005 UNDERSTAFFED AND UNDER PRESSURE A reality check by ...»
In community mental health in general, programs and services are all pretty much downsized in staff, but not in clients. It’s where we work, so we know what’s going on, despite all this stuff about services in the community. Unless they are hidden away somewhere that no one knows about, they don’t exist. It’s ridiculous.
RN – It’s not just the RN staffing, no staffing has kept up with the need.
Housekeeping has been cut. The place is filthy. There has been sputum on the elevator doors for the past 24 hours. It’s not only untidy, it’s dirty and this is a hospital – we’re supposed to care about hygiene and infection.
We are still under threat of being divested. Part of our fear is that we will all be replaced by lesser-skilled workers. We are going to see more layoffs, for sure, but mental health can’t handle any more cuts – it can’t handle what exists now. There are situations where people are just not replaced. The result is increasing pressure to get people out as soon as possible. This pressure to discharge clients in the face of scarcity of inappropriate resources is very difficult. I really struggle with this and know that I would not want to be in this situation. This is the most fragile segment of the population and they cannot advocate for themselves. We are doing mentally ill people a great disservice.
We must stop bed closures and be realistic. Not every mentally ill patient belongs in the community. It’s erroneous to paint everyone with the same brush.
Oh god, there are so many issues around short staffing, and therefore work
- 58 loading. The problems are everywhere in our hospital. There’s an extreme problem on the seniors geriatric ward. Two are three people were still sitting in their urine from the night before, despite staff calls for more help. They couldn’t be cleaned up until after lunch. One of the workers was so stressed and physically exhausted from trying to do it all, she had to book off sick the next day. So then, the next day, the floor is short staffed again, and on and on. Two people are not enough on that floor and hospital management knows it.
The overtime due to understaffing is just phenomenal. It’s almost a daily occurrence that they will call me for OT. If you make the mistake and say “yes,” they will call you twice a day. The workload has increased and it’s intensified and you better be able to protect yourself by saying “no,” because if you can’t you’ll burn out fast. In our hospital, because of the low staff levels, our housekeepers are actually trained to respond to a code and help restrain violent clients. This goes way above and beyond their job descriptions.
Any one of the local health units can be the weak link in Ontario’s chain of protection against infectious outbreaks. It takes only one dysfunctional health unit to incubate an epidemic that brings the province to it knees.
Hon. Mr. Justice Archie Campbell, SARS Commission
The Commission has heard continuing reports of municipalities diverting public health staff and funds to other departments, boards of health with members whose sole objective was to reduce health budgets, and medical officers of health fighting municipal bureaucracies and budget constraints to attain a proper standard of public health protection.
Hon. Mr. Justice Archie Campbell, SARS Commission
Millions of Ontarians got their first glimpse at the inner workings of Public Health when the SARS epidemic hit. Years of negligent government policies, lack of funding, inadequate capacity, mismanagement, bad politics, and other serious problems were played out in the public arena in 2003.
- 60 As a result of the intense and very public scrutiny, the provincial government established an independent SARS Commission, headed by The Hon. Mr. Justice Archie Campbell that produced sweeping interim recommendations for action.
Infectious disease control, which was of primary concern to the SARS Commission, is one of the critically important aspects of Public Health work. But there are many more: chronic disease prevention, water safety, rabies control, food safety, early detection of cancer, sexual health, reproductive health, substance abuse prevention, children’s health, tuberculosis, vaccine preventable diseases, pre- and post-natal care and intervention and more, are all part of a huge basket of responsibilities.
Every day, what Ontario’s 37 public health units do, or don’t do, affects all of us.
Much of the work may be hidden from public view, but if left undone, can have devastating consequences for the entire population.
In 1997, when the Harris government announced it was downloading responsibility for 100% of public health funding to municipalities, workers were vocal in their fear for the public. The downloading triggered substantial reductions in staffing and services.
First hit, were vulnerable groups such as school-age children, elderly people and persons with mental illness. Public Health workers redoubled their efforts trying to compensate, but the system itself was broken.
As a partial fix to the catastrophe they created, the Tories announced a modification and said that effective Jan. 1999, the province would reassume 50% of the approved cost of public health services. What was notable about the announcement was that it still did not restore funding to the former provincial contribution of 75%.
And while there is good news in this announcement, there is also the bad. As one worker noted, “We are so far behind from all these bad years, and the need has grown so much, that we are still not going to be able to do what we need to do to fulfill our mandate and keep the population safe.” In his Walkerton inquiry report, Mr. Justice Dennis O’Connor noted that since the 1990’s, the province has increased the responsibility of boards of health without increasing the funding required to fulfill those responsibilities. The result has been the boards’ compliance with ministerial requirements has decreased.
This was reinforced in the Campbell report that described a “grossly underfunded public healthcare system” with “no elasticity” as a key problem.
Of all of the provinces, Ontario is the only one to extensively cost-share public health programs with municipalities. This has produced bizarre situations in which crucial health programs and services are in competition with dozens of other municipal services. Public Health programs are often the first to be sacrificed. “It’s disgusting what the elected politicians don’t know. It should be that if you aren’t pro-public health, you should not be allowed to sit on the board.”
The Public Health mandate versus reality
The province is responsible for establishing minimum requirements for public health programs and services. It does this through the Mandatory Health Programs and Service Guidelines. The array of programs and services that local Boards of Health are required to deliver is reassuring. But reality looks much different.
- 62 For example, the Ministry notes that chronic diseases are the leading causes of death in Ontario. “They are a modern epidemic in terms of premature death, disability and health care costs.” Common chronic diseases include heart disease, stroke, cancer, chronic lung diseases such as emphysema, diabetes, osteoporosis and many others.
“While treatment and early detection efforts are important, it is prevention which has the greatest potential to reduce the significant burden of chronic diseases and increase the overall level of the population’s health.” But in the bid for public dollars, programs like these and prevention in general is losing out. “It looks great on paper but in reality we have this rinky-dink budget for chronic disease prevention. It’s not going to do anything. We are two people down in staff. We have a huge area, and a ridiculously low budget. It’s not possible.” The same holds true for many other programs. Sexual Health workers, for example, point to an epidemic of Gonorrhea and Chlamydia and are desperate for staffing and funding to meet the public need. They can’t get it.
And although the provincial Mandatory Health Service and Program Guidelines note the importance of the social determinants of health, including economic and educational factors, and workplace environments, real action with respect to these issues has almost disappeared from the public arena.
Many things have still not changed, yet they must.
Public Health is not only suffering from a serious lack of funding and staffing, but checks and balances for monies received must also be put in place.
“We urgently need funding and staffing, but we also need our Board of Health to do its job. The province gives money to the local health units, but no one audits to make sure the work is actually done.”
- 63 The “fault lines” that Mr. Justice Campbell spoke of in his report are still there.
Workers are still trying to compensate for inadequate funding and staffing. But extra effort on their part will not result in a sector that is able to protect and assist the public in the way that it must. That responsibility lies with the province.
Here is what Public Health workers have to say.
We can’t substitute for what is missing Our area is short of family doctors so they look to us to fill the need. And it’s not just the doctor problem, social safety nets are going and we have had to fill more and more of the gaps. I’ve been in public health since 1990, but I have never seen so much need. It keeps on growing and we can’t fill all those holes. Fewer social services are driving a lot of the increase, but also we don’t have staff to do it all. It is really stressful.
It’s like a balloon these days, especially with the Sexually Transmitted Infection Clinic.
The balloon gets bigger and bigger and bigger. You can’t do health promotion and protection and crisis management all at same time when you don’t have enough staff. We have an epidemic of Chlamydia in our area and it is growing. We cannot possibly keep up with the staff we have. Also, if you get an HIV case you must treat it with priority, but people are not getting the timely care they need and that is crucial. It must be worse elsewhere, because I work at a good unit.
It’s a revolving door in here because we just can’t keep new nurses. It’s too stressful. They just can’t believe everything they are expected to do and don’t feel like they are giving good care. Give us more staff, better wages, job security, time back after a crisis so that we can recuperate. Maybe then, we’ll see a change. But right now, it’s bad.
The joke in our area is if you get the short end of the straw you go to the public health board. It’s not the most glamorous of jobs for municipal politicians. They are just politicians, not health experts, and they often don’t get it. When they have to vote on a budget, they want to get re-elected. They don’t want to be seen to raise taxes for Public Health.
Understaffing is money. It’s as simple as that. We have a big mandate from the province, but we don’t have “the big boy budget” because our local politicians don’t want to raise taxes and then find themselves out of a job.
We MUST meet the need. Right now a full extension of services and programs is urgent. We have an epidemic of sexually transmitted infections. Public health units should be arguing with the province and speaking up for programs and funding. Tell them that we need to do what public health should be doing, and that is protecting the public.
- 65 Health promotion and prevention are hard hit No new sexual health clinics have opened under McGuinty, but we need them.
They might be extending some of the hours but that’s not an answer because there is not enough staff. We are overextended. That’s bad news for the public. We can’t even meet the demand of the community development work and it is a critical component of what we do. We no longer just parachute in and do sex, drugs and rock ‘n roll. It doesn’t work like that when there is a crisis. And there is a crisis now. We have an epidemic but not enough people or funding to deal with it. One of the things we are supposed to be doing is going into the Board of Education and working with teachers so they feel confident.
But where do the too few of us get the time? And now I just got told I am responsible for 23 schools on top of the other responsibilities. It’s nuts, and just can’t be done.
They come to us and say go out and deliver these programs. But we can’t do it all.
I work with people that can’t sleep at night because they will never get it done. We always find ourselves confronted by huge ethical dilemmas. For example, mental health waiting lists are so very long that teens can’t get help they often urgently need. Do they really expect us to say to a suicidal teen, “Here is your referral and good-bye?” Yes, they do. We have to deliver a teaching program, but the time allotted to teach is so short that our College is calling it unsafe. Our chronic disease program is understaffed and can’t meet its obligations, and promotion and prevention programs are getting less and less.
The understaffing is reflected in so many ways. The mandatory guidelines say one thing and that’s all well and good, but it doesn’t reflect what is really taking place. My workload is overwhelming.
Public Health used to deliver pre-natal classes in Toronto, but it is stopping now for all but high-risk moms. For the rest, it is shifting to the private sector and you will have to pay. It is not inexpensive. We already pay our taxes and now there will be one