Wednesday, October 21, 2009

Nursing Professional lights up Stelmach and Company

Mr. Ron Liepert
Mr. Ed Stelmach,
Dr. S Duckett

Dear Mr. Liepert,
I heard your confession on television about making a mistake in your communication concerning the plans for health care. That isn’t where I saw the mistake. Your communication was clear to me and many others. Perhaps in your own mind it wasn’t. So allow to share with some ideas you may want to think about.

Many of us professionals see the huge mistake in hiring high paid foreigners who have contributed zilch in this province, instead of listening to front line workers, doctors and nurses right in our own back yard. To think we don’t have skilled people here is unrealistic and incredibly arrogant.

I read Vision 2020. The goals sound good to those who don’t know. but they are so broad that guidelines for those goals aren’t only difficult to narrow down because of their broad range, but there are many directions those guidelines could go within those goals. So that isn’t reassuring to those who know about goal setting and drafting guidelines.

I question replacing registered nurses with more LPN’s.

I do not underestimate the work LPN’s do and there is a very valuable roll for them in the health care system. However, there are limits to their scope of knowledge just as there are limits in the scope of knowledge for example between a medical doctor and a registered nurse just in the quantitative versus qualitative aspects of the education itself.

My reason for questioning this is that the acuity of patients in hospitals has grown very dramatically and requires highly skilled professionals whose knowledge and expertise goes beyond the scope you are recommending. Enclosed is an article I wrote before I left my career in the nineties with the same attrition as is again proposed and which left a big hole in deleting highly experienced staff. I was one of those people. I would like you to read the attached article of just one 36 hour day on a ward- without overtime. Then tell me, which one of those situations of acuity could have been handled by an LPN? This kind of situation has now become the normal situation for most nurses in hospitals. That role cannot be replaced and still provide quality.

Premier Ed, Mr. Liepert and Dr. Duckett, do not under estimate the acuity of patients today. The ones that are in hospital are there mostly because they can’t go home, a clinic or a day ward, and are too ill. They are there because they need to be (except for those who need long term care beds).

My daughter on the other hand was a new grad from the university and left for the USA to get a job in the nineties. She received 3 awards for excellence in nursing since then. We educated her and lost her ICU experience, and as a family we lost a daughter, a sister, grand daughter, cousin and niece, possibly forever unless this province has some incentive in recruiting back our professionals.

How is this government going to retain nurses and doctors that get educated here? If you let go of senior staff through attrition, and many will take it because they have “had it”, and if young don’t start their career here, how is that going to encourage a career in health care for the future for both nurses and doctors?

We need an environment in this province that fosters excitement in health, sciences and research with encouragement for health care professionals to stay in the province because it is a wonderful career.

Your government is building the Edmonton Clinic across from the University of Alberta Hospitals. How do you plan to staff this place?
We need more public medi centres or public health clinics that people can go to even after hours so as not to burden emergency wards.

We need more quality home care if you want to really keep people in their homes.

Front line doctors and nurses need to be part of the plan for decisions in alternatives.

We need to establish prevention through a Public Primary Care Network with proper assessment of needs and education.
This could include seniors, diabetics and others with chronic diseases who may need this type of care.

Special clinics for bone, joint and many other procedures has proven to reduce wait times in a huge way. Don’t cut it and don’t privatize it.
My medical and nursing colleagues from England and Australia do not want a P3 system here.

Dynalife should not have a monopoly on lab work,
They are sucking money out of the system and out of the country.

Do not assume that pastoral care for people in crises can be turned over to other professionals. It is a different art and science form

When a family has lost a loved one, or the sudden death of their child, when someone is facing a fatal diagnosis, when staff are in tears because of the horrendous difficulties they often face,( we are human also) it is the pastoral or grief professionals that are there in an entirely different capacity than doctors, nurses, social workers or even clergy that have an outside church. Their training and education for this role is different. These people are on call 24/7. They are there to pick up the pieces and the spiritual healing of the soul. Health care is more than physical physiology. And to assume that anyone else can do that job is lacking in knowledge.

Consider a possibility of replacing the now defunct health care premiums with long term care premiums. If it was a government run program instead of a private insurance company, it could have the same long term benefits as EI and CPP. Many people could not afford private Long Term Care Insurance. I pay as much as $220.00 a month for twenty years. In the event, I should need it for home care, assisted living, or other facility, I would only receive $2000.00 a month. An average senior in a long term care institution lives a mean average of 2 years. If I die before I use it, the insurance company keeps all the money. Twenty years at $220.00 a month equates to $52,800 profit not counting interest just from one person.

If the government had a cheaper program to replace health care premiums for everyone, there would be plenty of money in the pot for long term care. Every young person will get old or some may need support at a young age as a result of crippling illness, car, recreational or industrial accident which at present costs the tax payers millions.I am currently working with some of these young people in their 20’s.

Use highly experienced senior nurses as a bigger liaison between patient and doctor instead of getting rid of them.
I was a nurse clinician in a specialty area of Nephrology (physiology and diseases of the kidneys) with 34 years of experience from the pioneering stage of dialysis (second unit in the world next to Seattle) to the evolution of treatment over the years, teaching, and finally as a nurse clinician in the area of dialysis and renal transplantation.

I took 4th year medicine and worked under the supervision of the Nephrologists for a year first. It was very satisfying and saved them many hours of work after that. We worked as a team. I was able to see and assess the newly discharged transplant recipients while the doctors made rounds on the ward and would communicate with them after saving time for everyone. They still saw them regularly in clinic. Many senior Nephrology nurses and I knew what they didn’t. I knew all the patients thoroughly, all 800 of them. The doctors and junior staff relied on that knowledge and expertise from us “old senior birds”. It didn’t take away from what they needed to do. It added to the quality of care.

There has been talk in Ontario about Physicians Assistants. The scope of a nurse clinician or nurses who make cardiology, or surgery, or orthopaedics or any other area their specialty, the scope is much bigger with more education as they see the total picture of the person, the family, the community and the resources. Such experienced nurses could be a very added value in community settings and are a necessity in acute care hospitals for stability, continuity of care, teaching and research.

I know these are difficult times. I ask that you consider what I have just told you. Putting money in the right place will save money long term with a healthier society. Another slash and burn of the nineties will not be cost effective in the long run, and neither will private health care.

After you read my enclosed attachment, consider who you want to care for you, a well run public system or a deregulated private institution for profit? Pray they have a crash cart in the event of a cardiac arrest and that someone knows how to use it before they transfer you to the public hospital. There by the Grace of God go you.

Professional Nurse
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