On March 15th, 2016, about thirty of Sault Area Hospital’s (SAH) Personal Support Workers (PSW) were put on notice that a transition to a “total patient care model” had rendered their role in the hospital as “surplus”. PSW’s, whose responsibilities are for the personal care of patients, were advised they would be “reassigned to suitable positions” within the hospital as they became available.
Lori Bertrand, RN BScN, is the Director of Clinical Programs at SAH. Bertrand explained that a “total patient care model” assigns one care provider to be accountable to the complete care of a patient or a group of patients. As the model relates to SAH, that care provider would be a Registered Nurse (RN) or a Registered Practical Nurse (RPN).
“That mean that the nurse would do everything for that person. They would provide the personal care such as bathing or walking or feeding, and they would provide their medications, treatments, and conduct assessments of the patients, and documentation and collaboration with physicians and the other care providers,” remarked Bertrand. “It’s a very patient focused model because it’s one person that provides the care throughout the day. Subsequently, if the patient is here for two or three days they are providing successive care for the patient which is good for the patient.”
PSW’s, for now, provide manpower on 2 and a half units at SAH. Bertrand stated that the total patient care model has been implemented through the entire hospital for quite some time and PSW’s had been layered on top of the model to assist with patients who had been transferred to the Alternate Level of Care (ALC) department. These patients would have initially required acute care from medical staff but when their urgent medical needs were resolved, they were unable to return home, perhaps due to lack of family support or community services to assist in the home. As a result, ALC patients remained in the hospital until suitable arrangements could be made for their discharge to a nursing home or other appropriate living arrangement. Bertrand explained that the recent opening of Cedarwood Lodge nursing home has expedited the discharge of ALC patients from SAH, as well SAH has prioritized collaboration with community agencies to establish living options in the community, thereby rendering SAH PSW’s as “surplus staff”.
However, some PSW’s insist that the elimination of their role is a matter of budget.
‘Nancy’, whose name has been changed to protect her identity, has worked as a PSW for over 15 years. “I went into this field because of the one to one interaction with patients. You’re the frontline worker. I can tell you everything about my patients- how many kids they have, when they got married, everything.”
Nancy believes that PSW positions at SAH are being phased out to direct money to other expense lines.
“They’re saying that they don’t have money for PSW’s but then you look at the Sunshine List –management makes way too much money. They keep saying we have budget cuts because the province doesn’t make so much money anymore so we have to trim,” remarked Nancy. “But yet they cut staff and give themselves bonuses. How is that fair? How is that fair to the people in the community? Look at the wait times in Emergency –for weeks on end sometimes because they have closed units, they have closed beds. We have two full units that are wasted.”
When asked if the elimination of PSW’s was directly related to budget, Brandy Sharp Young, SAH Manager of Communications and Volunteer Resources wrote:
Our focus at Sault Area Hospital is to deliver quality patient-centered care. As part of our annual operational planning, we strive to balance quality care to our patients while achieving operational efficiencies. The reassignment of positions and elimination of vacancies has been done with a focus on the care we provide to our patients by introducing new staffing models to better match our care providers with the needs of the patients.
Bertrand stated practicing a total patient care model typically required 1 nurse to 5 patient ratio. “But that is very dependent on any given time during the day, patient acuity and activity, the skill of the nurse- so that’s a basic guideline that is assessed every day. Should we need to add more staff we would in order to respond to the needs of the patient.”
On units where PSW’s are being lost, additional RPN hours are being added though Bertrand was unable to confirm how many. “We will post for additional RPN positions if that is required.”
Nancy isn’t convinced that the total patient care model will be embraced by nurses on the units losing PSW’s.
In support of nurses Nancy remarked, “I know the nurses for the most part aren’t happy about it and have expressed their concern to upper management. It’s falling on deaf ears. It’s not physically possible for them to do a med pass, do the dressings, charting and then do the personal care for all of these patients. This one to five ratio is happening on another floor and the patients aren’t getting the care they need. I had one of those patients come to me and her hair was matted because it hadn’t been combed in days. That’s neglect. Nurses are refusing to do personal care because they just don’t have time.”
Nancy is also doubtful that release of patients back into the community or even nursing homes will ease the workload on nurses and eliminate the need of PSW’s in the hospital. “These patients are discharged but they are just going to end up back in the hospital because their discharge goals just aren’t realistic. You’ll get the same patients flowing in and out of here.”
SAH has indicated that PSW’s will not be laid-off but rather “reassigned to a suitable position”. As per language in their collective agreement a suitable position would be in housekeeping, portering or the kitchen.
“If that is what happens,” remarked Bertrand. “Then certainly retraining will be provided to fulfill the accountability of those jobs in those departments.”
Nancy is as unthrilled with the prospect of reassignment as she is uncertain. “If the hospital refuses to give early retirements then there will be no suitable positions. Our contract says that there has to be opening for them to reassign us but there are none because they are failing to make openings by offering early retirement packages.”
Of her options should a vacancy become available Nancy remarked, “I didn’t go to school to be a housekeeper. I didn’t go to school to do laundry. If I wanted to do that, I’d have stayed home.”
When asked if the union, Unifor, had come forward in opposition to the announced change this March, Bertrand only replied, “Labour relations exist in every organization. We are working collaboratively with the union, the employees and the staff on the units to make this transition as smooth as possible. We are working with the union to accomplish this.”
According to Nancy, however, Unifor has filed grievances. “They are violating the contract about how they are putting us on notice,” she explained. “In order to put us on notice they would need to have vacancies available which they have none. So Unifor agrees to the fact that SAH violated the contract.”
Bertrand expressed that the complete phasing out of PSW’s will happen by July or August 2016. “It’s a gradual approach so we’re working with partners to move patients into the right area. We will continue with PSW’s in the units they are currently in and we will sort of be modifying the system to best support the patients left in the department.”
At this time SAH has not received any expressions of concern regarding the change. “We are not worried at all that our patients are not going to receive the care that they are currently receiving or require,” commented Bertrand.
Adding of the total patient care model Bertrand remarked, “It’s a very positive approach for our patients and I think it will be great.”
Sault Ste. Marie, are you concerned about the potential loss of PSW’s at SAH? Contact your servants below.
Sault Ste. Marie, MPP email: firstname.lastname@example.org or call: 705-949-6959
Sault Ste. Marie, MP email: Terry.Sheehan@parl.gc.ca or call: 705-941-2900
Minister of Health and Long Term Care, Dr. Eric Hoskins email: email@example.com or call: 416-327-4300