Fixing health care requires more nurses

Opinion

The recent death of Chad Giffin, a 49-year-old man, who experienced homelessness, demands our attention, as he had waited eight hours in the Health Science Centre emergency department. Alongside are concerns a Regional Health Authority board member’s resignation over “low balled” health budgets. It is not realistic to think the “fix health care” promise could be kept in the 14 months since the election, however that is enough time for a clear public plan that explains how we got here, steps to strengthen our public health care system, and prevent further privatization.

First, how bad is it? Manitoba’s record of the longest ER wait times in Canada is well documented. In the ’90s, patients rarely waited more than two hours. Manitoba’s poor health indicators such as high rates of diabetes, chronic illness and poverty, including the lack of housing affordable to people with low incomes, all place more demands on our system. Emergency departments are expensive shelters.

In addition to these factors, Manitoba has the worst nursing shortage in Canada. Manitoba Nurses Union (MNU) reports about 13,000 unionized nurses, with 20 per cent, or 2,449 nursing positions, vacant. As MNU president Darlene Jackson has explained, the crisis in access to medical services is largely a crisis in nursing supply.

It took over 30 years to get to this point. Manitoba, along with all other provinces in the early 90s, decided all new Registered Nurses (RNs) would need a four-year nursing degree. The two-year RN program was phased out, like the one-year Licensed Practical Nurse (LPN) program. All hospital and college-based RN training programs were terminated. However, the old two-year RN training seats were replaced with new Bachelor of Nursing seats on less than a one-for-one basis. With fewer nursing graduates each year, and the Manitoba population increasing, the nursing shortage worsened.

Fast forward to 2016. The new Brian Pallister government, “dusted off” the old two-year RN program, renamed it the new LPN program, and started training more LPNs. LPNs previously were restricted in where they could work, and what they could do, but the new LPN’s (trained for two years like the “old” RN’s) could work almost everywhere, while being paid much less. Regardless of classification, Manitoba has still not been training and retaining enough nurses.

To compensate for other Pallister government cuts, around 2017, mandatory overtime became common practice for nurses. Mandatory overtime is the root of the current problem. Imagine coming to work for an evening shift, then being “mandated” to work the night shift as well. In some cases, nurses are required to work two 12-hour shifts back-to-back.

Mandatory overtime has driven many nurses to quit their public nursing job and work for private nursing agencies that do not require it. Mandatory overtime is driving nurses to private agencies, which charge double, triple or more compared to public nurse pay rates. This is costing our governments a fortune, over $1.5 billon across Canada last year, according to a Canadian Federation of Nurses Unions report. The more “overtime mandating”, the more nurses are driven out of the public system, the more pressure to hire from private nursing agencies, and the more expensive it becomes.

If we want to fix health care and reduce wait times the Manitoba government must reverse mandatory overtime and the use of expensive, private nursing agencies with a transparent plan.

Make all overtime voluntary. Increase float pools. Increase part-time positions which allows more nurses available for extra shifts, instead of private agency staff. Currently, only full-time positions are incentivized.

Recruit nurses back into the public system who left for private agencies, or left the profession entirely. Respect and support nurses. Listen to nurses, who know best how wards can run more effectively. Mentor new nurses. Reconsider ethically questionable incentives to recruit nurses from developing countries which have not been successful.

Train more nurses!

The most recent information obtained from MNU projected 981 nursing seats for 2022-23. Estimates are that approximately 66 per cent graduate, according to the most recent 2022 nursing college reports. The College of Registered Nurses of Manitoba reported 443 new grad nurses, and the College of Licensed Practical Nurses of Manitoba reported 170 new grads, which equals 613 new nurses in total. Approximately 400 additional nurse training seats were reinstated by the previous government. Budget 2024 includes unspecified funding for more rural LPNs, possibly as part of $6 million allocated for additional medical specialists. That’s inadequate when considering the number of nurses leaving.

MNU reports the number of nurses retiring or quitting from the WRHA/Shared Health, was “150 to 250 per year between 2019 to 2022”. Estimating, with a shortage of 2,500 nurses, and graduating 600 nurses per year, minus 200 nurses leaving, nets an estimated 400 new nurses per year. At this rate, it would take more than six years to end the nurse shortage. That’s if more nurses don’t quit or go to private agencies.

Promises like “fixing health care” and “ending homelessness” are big and related NDP election promises. These commitments require a clear and transparent plan with targeted investments, including addressing nursing shortages to reduce long wait times throughout the public system.

Marianne Cerilli is a health educator, three-term MLA working in community and social innovation.

Diane Frolick is a Registered Nurse with a BA in Economics and 36 years’ experience nursing, with eight years in ERs.