Panel issues suggestions to improve hospital care

(Canadian OH&S News) — The endoscopy units of Humber River Hospital (HRH) in Toronto have come under criticism by an independent panel of nursing experts, who have authored an 89-page report with recommendations to improve patient care and nurse safety.

According to a press release from the Ontario Nurses’ Association (ONA), registered nurses (RNs) at the hospital expressed concerns about understaffing, fragmentation of patient care, poor staff support and an incorrect mix of staff skills in the two endoscopy units. In its report, published on Aug. 8, the panel — or Independent Assessment Committee (IAC) — made 32 recommendations in nine areas: staffing, roles and responsibilities; processes; communication; collaborative working relationships; safety; leadership; education; and managing change.

“The panel believes that as a result of the IAC hearing and the open discussions that occurred,” the report concluded, “the two parties [union and employer] can come together to implement the recommendations and achieve the common goals of quality patient care, the ability of nurses to enact their professional responsibilities and a healthy work environment.”

Among the specific recommendations: hiring one more full-time RN at each of HRH’s locations; scheduling two RNs in the Church Street location’s procedure room when no anesthetist is running the second room, for continuous monitoring; and assigning an aide to clean rooms, equipment and stretchers, so nurses don’t have to do it.

Budget constraints a possible issue: ONA

“In my more than 30 years as a nurse, issues like this, we were able to deal with at the frontline,” said ONA first vice president Vicki McKenna. “Now, what we believe is happening is, there are budget constraints that are preventing, in some cases, organizations from appropriately assessing the level of care that patients require and the staffing requirements.”

In particular, violence and harassment have been commonly reported problems in HRH’s endoscopy units. While the report cited this issue, much of it focused on the management of the units, including nursing shifts, the number of staff available and the mix of their skills.

“There are a number of recommendations about the non-nursing duties that nurses were performing, which were taking away from the bedside of the patient,” McKenna said, referring to cleaning tasks and similar duties.

She added that while the recommendations were specific to HRH, the hospital wasn’t alone in having these problems. “I’m not going to say every hospital in Ontario has a crisis situation happening, but some of our hospitals are not dealing with these issues in an appropriate manner,” she said, “and that’s very unfortunate.

“But what the positive thing can be is, if the parties, both the nurses and the administrators, sit down and work out a plan to enact these recommendations as best they can,” she said, the report could “raise light to the situations and have the units deal with them as necessary, so patients are safe and the nurses are safe as well.”

The panel’s assessment followed attempts by HRH nurses to confront their colleagues and managers about the situation. When that didn’t work, the RNs took advantage of their contracts’ “professional responsibility clause,” which involves forming an outside expert panel to assess the situation and come up with solutions. The IAC includes members of the ONA and the Ontario Health Association.

HRH did not respond to calls from COHSN.

The IAC’s report is available online at http://www.ona.org/documents/File/professionalpractice/IACReport_HumberRiverHospital_Endoscopy_20140808.pdf.