Registed Nurses' Association of Ontario


RNAO commends government for commitments to NPs in long-term care, RN prescribing and evidence-based care, and calls for a stop to RN replacement


TORONTO, April 23, 2015 – Expanding scope of practice for registered nurses (RN) and nurse practitioners (NP), integrating NPs in long-term care homes, and supporting evidence-based practice, as the government has committed to doing, are all essential to improve access to care and health outcomes, says the Registered Nurses’ Association of Ontario (RNAO). If the government is truly putting patients first as outlined in today’s Ontario budget, it must reverse an alarming trend of replacing RNs with lesser qualified personnel and mandate employers to stop this practice, says the association.

RNAO's president Dr. Vanessa Burkoski says she’s pleased the government is keeping its commitment to create 75 new NP positions in long-term care homes, a promise first made by then health minister Deb Matthews in February 2014, and one RNAO expects to see rolled out this year. “Once we have NPs in long-term care, we will be able to provide a level of comprehensive care that currently doesn't exist in this sector,” says Burkoski, adding that this will reduce the number of unnecessary transfers to hospital emergency departments, which are costly, inefficient and cause emotional strain for elderly residents and their families.

A budget promise to remove barriers that currently restrict NPs from making direct referrals to specialists is welcome, adds Burkoski, because it will improve access to care. “This and many of the changes we want to see system-wide will improve care overall and reduce costs,” she says. Burkoski also praised the government for following through on its commitment to expand the scope of practice of RNs to include prescribing medications.

RNAO cautions, however, that these promises won’t mean a thing if employers continue to replace registered nurses with other health-care workers. “We are dismayed that the government is turning a blind eye to the replacement of RNs - a move that led to disastrous results in the late 1990s,” says Burkoski. “Put simply: research shows that more hours of RN care lead to more lives saved and fewer complications.”

“We know this government is committed to person-centred and evidence-based care, and replacing RNs with less qualified staff contradicts the government’s goals,” says Burkoski, adding that “most patients who receive hospital care today have complex conditions that require the expertise of RNs.” RNAO is launching a provincial task force to tackle the RN replacement issue head on and demands the government safeguard patient care by mandating employers to stop replacing RNs with less qualified health providers.

News that the government intends to sell off a significant chunk (60 per cent) of Hydro One prompted concern from RNAO, which equates the asset sale to experiments with Medical Tourism - both of which are bad policy decisions.

In an attempt to raise revenues, several Ontario hospitals opened their doors to Medical Tourism, a practice which allows people from abroad to seek medical treatment for a fee. After RNAO's vocal insistence that the practice be stopped, Minister Eric Hoskins directed hospitals not to solicit international patients and not to enter into new contracts. RNAO says a legislated ban is the only way to ensure that the province's publicly funded health system remains universal and delivers not-for-profit care. “Much like Medical Tourism, the plan to put public assets up for sale is both short-sighted and detrimental for Ontarians,” says Dr. Doris Grinspun, RNAO's Chief Executive Officer.

Missing in the budget is a detailed plan to confront one of the most pervasive health issues facing Ontario today: poverty. Despite a promise to increase the province's minimum wage in October to $11.25, RNAO says the working poor need at least $14 an hour to make ends meet. The association also says thousands of people who rely on social assistance need incomes that reflect the true cost of living.

“We appreciate the incremental increases in the hourly wage, and modest increases in social assistance, however, if the government is truly committed to ending poverty, it needs to make greater investments in these areas and attach clear timelines and targets to its poverty reduction strategy. Otherwise, the livelihoods of thousands of individuals and their families, who already have limited resources at their disposal, will not improve and we will pay more in illness care,” says Grinspun, noting that poverty results in ill health.

Knowing that the environment also plays a key role in people's health, RNAO applauds the significant investment in public transit detailed in this budget as an environmentally friendly step. However, it’s too bad the government is privatizing Hydro One to do it, the association says. The government could have avoided this and another austerity budget by restoring Ontario’s fiscal capacity in a more sustainable way by implementing more progressive taxation and broader use of green taxes.

RNAO, however, singled out the government's announcement to put a price on carbon as one of the budget's bright spots. “We commend the Ontario government for taking an important step to deal with the effects of climate change. Putting a price on carbon is an essential move if we are to deal with the devastating effects of our changing environment,” says Grinspun. RNAO cautions, however, that the success of a cap and trade plan lies in making sure that permits are auctioned off rather than given away to polluters. “Companies that produce emissions must take responsibility for the harm they are causing our environment. We have to take measures to ensure the air we breathe and the water we drink are safe. It’s the only sensible thing to do,” emphasizes Grinspun.

This year marks the Registered Nurses' Association of Ontario's (RNAO) 90th anniversary. RNAO is the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. Since 1925, RNAO has advocated for healthy public policy, promoted excellence in nursing practice, increased nurses’ contribution to shaping the health-care system, and influenced decisions that affect nurses and the public they serve. For more information about RNAO, visit our website at or follow us on Facebook and Twitter.

Marion Zych, Director of Communications, RNAO
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