February 2, 2010
Good afternoon. My name is Doris Grinspun and I am the Executive Director of the Registered Nurses’ Association of Ontario. RNAO is the professional association for registered nurses who practise in all roles and sectors in Ontario. Our mandate is to advocate for healthy public policy and for the role of registered nurses in enhancing the health of Ontarians.
We are in the midst of a critical period in our province. As the province slowly climbs out of a severe recession, we find our social and physical infrastructure is strained.
The province’s manufacturing base has fundamentally changed. Unemployment continues to rise. People are still worried about their jobs, their savings, their future and their children’s futures.
Some people believe the future direction of Ontario means having to choose between cutting social programs or cutting the deficit or creating jobs instead of a cleaner environment. But we believe forcing such choices is mistaken and unacceptable. In fact, it’s precisely during times of economic challenge that we need to implement the investments that will pay off tomorrow. Taking deficits seriously means knowing when and how to deal with them. Today, we bring you one simple message from Ontario’s nurses – Keep Rebuilding.
Strengthening Social Determinants of Health
Nurses know that social and environmental determinants have a direct impact on our health. We know that social inequities are directly linked to health inequities. One of the root causes of ill health is poverty. Sadly, nurses know a lot about poverty because we see it in our practice. We see the shame in the eyes of the homeless person, the child who went to school without a meal, and the elder person who can’t eat a sandwich because he doesn’t have money to repair his dentures. Nurses witness the tough choices that people are forced to make when trying to make ends meet: a parent’s decision to forego a meal so his/her child can eat or the prescription that goes unfilled because the money has to go to pay the rent.
We commend the McGuinty government for the leadership it has shown in creating a poverty reduction strategy. The measures taken thus far such as modest increases in social assistance rates are a good start but poverty remains a distressing and acute problem. That’s why we recommend the following:
Implement the Poverty Reduction Plan with multi-year sustainable funding so that all Ontarians can achieve their potential and contribute and share in the province’s prosperity.
Introduce a $100 per month Healthy Food Supplement as a down-payment towards addressing the gap between dangerously low social assistance rates and nutritional requirements.
Stay on track and increase the minimum wage to $10.25 per hour this March, and $11 per hour in March of 2011
Transform Ontario’s social assistance system from a punitive, complicated system of contradictory rules and regulations to a person and family-centred system that treats everyone with dignity.
Fast-track the provincial housing plan because safe affordable housing is essential to good health.
Implement the recommendations on child care and early education in Charles Pascal’s With Our Best Future in Mind report.
Building sustainable, green communities
Like many Ontarians, registered nurses are acutely concerned about climate change. By fighting global warming, we are not just protecting the environment; we are also protecting the health of Ontarians. After the disappointing outcome of the Copenhagen climate summit late last year and the lack of leadership at the federal level, we believe – now more than ever – is the time for action, not talk. We want Ontario to become a leader by:
Establishing clear, tough and achievable targets for reducing greenhouse gas emissions. There is a growing consensus that developed nations must reduce their emissions at least 25 per cent below 1990 levels by 2020, and we expect nothing less of Ontario. A good start would include the following:
o Closing coal-fired power plants ahead of schedule
o Setting aggressive targets to increase the green share of energy, and
o promptly implementing the government’s mass transit commitment.
But clean air alone won’t help us build healthier environments. We’re also concerned about the impact of environmental toxics on the health of families and communities. Ontario can also become a leader on the environment by committing to aggressive targets to reduce the use, creation and release of toxics, and supporting this reduction with a toxics use reduction institute.
It’s during difficult times that we are reminded of what we have and what others do not. The millions of Americans who do not have access to a publicly funded, health-care system know what they don’t have and look to us with envy. Most Canadians, in fact, 86 per cent believe in out publicly funded health care system. But to do so, we must protect our not for profit health-care system and take steps to enhance it so that it meets the changing needs of a changing population. Tommy Douglas was prescient years ago when he talked about expanding Medicare so that prevention played a bigger part than waiting to patch people up.
RNAO is pleased with the government’s commitment to open 25 NP-led clinics. These clinics are modeled on the successful NP-led clinic in Sudbury, which opened its doors in the summer of 2007 and already provides access to 3,000 people who previously didn’t have access to a primary care provider. Eleven of these clinics have already been announced but funding has not yet followed. Now, we must move from announcements to funding.
It is shameful that in a province as rich and as progressive as ours, nearly one in 12 adults did not have a primary care provider in 2008. This is a fundamental challenge in dozens of communities around the province and we must – for the sake of patients and because it makes sense from a financial perspective –urgently increase access to primary care and open all 25 clinics this fiscal year.
There are other important programs that are cost-effective and must receive permanent funding. RN First Assists, or RNFAs, are registered nurses with additional certification in surgical assistance. A recent Ministry study shows that RNFAs improve patient outcomes, decrease surgery time and reduce surgical wait times. Yet RNFAs have not yet received permanent funding and episodic funding has led to inefficient delays and loss of skilled RNFAs to other jurisdictions. It is imperative that permanent and full funding be immediately allocated to prevent disruptions in services when March 31st hits.
An essential component of keeping people healthy and caring for them when ill is securing access to nursing services. There is clear evidence linking care provided by RNs with better health outcomes in hospitals, long-term homes, and the community at large. Full-time RNs are also associated with lower mortality rates, better care for patients and improved morale.
Nurses in this province are proud of their education, skills and expertise. They consider themselves partners in health with their patients and clients. But they are also growing weary of workloads. The one statistic that best illustrates the problems associated with workload is the RN-to-population ratio. Ontario’s RN workforce is failing to keep pace with the province’s growing and aging population. The latest figures tell us that there are 71 RNs for every 10,000 people in the province, down from 80 RNs in 1989.
The McGuinty government made good progress since 2007, but we are not on track to meet the commitment of 9,000 additional nurses by election date -- unless we commit to fund 3,000 additional RNs in 2010. Ontario is lagging behind in nurse per population ratios as compared to the national average. To bring the nurse-to-population ratio up to the equivalent of the rest of Canada would require employment of almost 15,000 more RNs in Ontario. Thus, it is imperative that the government meet its target of 9,000 additional nurses by 2011, and – at the very least – 3,000 of these positions must be funded in 2010.
There is good news in the increase in the share of RNs working full-time from 50 per cent in 1998 to 65.6 per cent in 2009. That puts our goal of 70 per cent of RNs working full-time within reach. We must stay the course if we are to provide continuity of care and continuity of caregiver to Ontarians in times of health and in times of illness. Nurses want to see that we reach 67 per cent full-time employment in 2010. We can and we must do it, if patients are to receive quality care and nurses are to build their careers in Ontario.
Let me speak about building a nursing career in Ontario
There are other pressures on the nursing workforce that we must confront. The average age of an RN working in nursing continues to go up. Today, it’s 46.3 years compared to 43.3 years in 2001. An aging nursing workforce means we must renew our energies to attract more individuals to nursing, retain those currently in the workforce, and keep new graduates here at home. That’s why Ontario has a nursing strategy for building a nursing career in Ontario.
We believe our collective strategy helps the nurses of today and tomorrow build their nursing career here in Ontario. As I indicated earlier, much progress has been made to recruit and retain RNs in Ontario. We must not lose the momentum. We commend the McGuinty Government for:
· Continuing full funding of the Nurse Graduate Full Time Guarantee Program
At the same time, we ask Government to show the same type of commitment to our most experienced nurses by:
· Expanding the Late Career Nurse Initiative to make it permanent and available to all nurses who are 55 and over, who work full-time or part-time, in all sectors.
Our recommendations will serve to continue to strengthen Ontarians and Ontario. They will also help us continue to provide the kind of expert care, knowledge and quality patient care that RNs are known for. Budget shortfalls cannot and must not derail the rebuilding of this province and our profession. Thank you for giving us the opportunity to present the views of the Registered Nurses' Association of Ontario.