Nursing care model prompts many questions

Victoria registered nurse wonders about implementation of Island Health's plans

I have many questions as well as grave concerns about Island Health’s Care Delivery Model Redesign.

On paper, persons with lesser education can do the “tasks” of bathing, distributing medications, etc. In the community, family caregivers are taught specific tasks to help their loved one, but they rely on professionals for help with assessment.

When registered nurses perform a task such as bathing, they also assess for subtle changes in a patient’s condition. This is essential in acute care with short patient  stays and complex medical conditions.

In today’s world, any straightforward surgeries or medical conditions are managed while the patient remains in the community.

Does this model mean an increase in the number of patients the RN is responsible for? What is the ratio of RN’s to care aides? Is this a version of the long-term care model modified for acute care?

Does the model put the nurse in the impossible position of being responsible for, yet unable to assess their patients properly?

Team nursing is not a new concept. Throughout my nursing career I have worked in various teams. The issue is not working in teams, but working in acute care and having to rely on teammates who have limited education, lack assessment skills and are thus task-oriented.

In the early 1980’s, some U.S. hospitals implemented a patient-care model for acute care which trained care aides to perform such specific tasks as changing IV bags and others deemed unnecessary to be done by registered nurses. These hospitals also deemed cost and shortage of nurses as the reason. The end result? There were so many critical incidents and lawsuits during that period that most dropped the care model.

Is our new model different from that one? Have Island Health officials researched potential outcomes?

Also, I would like to know if the “shortage of nurses” and increase in overtime are a result of current trend to cut full-time RN positions? I know nurses here, in Ontario and also New Brunswick who want full-time work but are forced to work on call in two or three different places to make ends meet.

I look forward to Island Health providing the public answers to these questions.

Joy Moore, RN


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