RNAO welcomes key health investments, says RNs and NPs needed to end hallway health care

The investments in health care outlined in Thursday's provincial budget provide a compass for RNs, NPs and other key health providers to help the government steer the necessary system changes to benefit Ontarians, say members of the Registered Nurses' Association of Ontario (RNAO).

RNAO is pleased that spending for health is increasing by an additional $384 million for acute care. However, no increase in hospital funding will deliver better patient care if RNs continue to be replaced by less qualified health professionals and Ontario continues to have the lowest-RN-to-population in the country. RNAO CEO Doris Grinspun urges the government "to earmark this new investment to hire RNs and end RN replacement. The evidence tells us RNs deliver better clinical outcomes for patients, and better organizational and financial outcomes for the system overall." Targeted funding will ensure hospitals post and fill the more than 10,000 RN vacancies that currently exist.   

Enhancing people's health and keeping them out of hospital hallways can only be achieved when primary care becomes the centerpiece of Ontario's health system. For this to happen, the 9,000 RNs and RPNs already working in primary care should be enabled to work to their full scope.  Along with that, the government also needs to transition the 4,500 RN care co-ordinators now working in the province's Local Health Integration Networks to interprofessional primary care teams. "Given the government's plans to better integrate the system and create a more seamless experience for patients, these RNs must be immediately located in primary care." This can happen now and not when Ontario Health Teams are up and running. Care co-ordinators can quickly trigger home care services, especially with the additional investment of $267 million for home and community care, says Grinspun.  

Grinspun says authority for RNs to prescribe certain medications must be expanded to include diagnosing common ailments within their scope and across all sectors. RNAO looks forward to working with Health Minister Christine Elliott on this evidenced-based solution that will benefit patients. And to capitalize on the critical role NPs play in the system, Grinspun says NPs are also eager to hear details on when they will be able to perform point-of-care testing, act as most responsible provider in hospitals more often, refer patients to specialists and complete forms for access to mental health services. "All these measures optimize RN and NP scope of practice and are changes that do not cost money and improve people's access to health services," adds Grinspun.

When it comes to long-term care, the government's investment to create 15,000 new beds and upgrade 15,000 existing beds in nursing homes is welcome; however, more beds without better staffing will not improve the level and quality of care provided to seniors. That's why RNAO is calling for four hours of nursing and personal care per resident per day, as well as a staffing mix that includes at least one attending NP for every 120 residents, 20 per cent RNs, 25 per cent RPNs, and no more than 55 per cent unregulated care providers. This is the only way to give seniors, many with complex care needs, the safety and dignity they deserve," says Grinspun. Also essential are changes to the funding formula so homes that improve health outcomes of their residents are not penalized for doing so.

RNAO welcomes the province's decision to improve access to mental health and addiction services and housing supports by providing $3.8 billion over 10 years. "This is an essential investment and one that our members welcome given the number of people, including children and youth who are suffering," says RNAO President Angela Cooper Brathwaite.

In the face of Ontario's opioid epidemic, RNAO says no community that has identified a need for vital, life-saving health services should be denied funding for consumption and treatment services. While the association applauds the ministry of health for relying on evidence to fund 15 existing sites that provide these services, RNAO urges the government to confront the province's growing death toll and expand these services at Toronto Public Health's The Works and reverse its decision not to fund two other sites in Toronto, and one in Ottawa, whose applications for provincial funding were turned down.

The association is delighted that the government is following through on a promise to provide $90 million in dental care for seniors on limited incomes. It was one of the recommendations RNAO put forth in its pre-budget submission in January. Cooper Brathwaite says such care should be offered in community health centres, aboriginal health access centres, public health units and mobile dental buses. "This is an important measure since we know the majority of seniors on limited income lack access to dental insurance. Improved oral health prevents chronic disease and improves quality of life and dignity," adds Cooper Brathwaite.

Nurses would have preferred to see larger investments in social and environmental determinants of health to improve the well-being of all Ontarians. For example, missing in the budget is a detailed plan to deal with poverty. Nurses say poverty is the single largest determinant of a person's health. It makes people sick and leads to premature death. A planned increase in the minimum wage to $15 per hour earlier this year would have put more money in people's pockets. The government's alternative, an income tax credit, actually leaves 1.3 million working Ontarians with less money and will reduce the government's budget balance by $1.9 billion over the next four years.

Climate change is happening very quickly and represents the greatest threat to the health of Ontarians. RNAO is alarmed that Ontario has scaled back its legislated targets for greenhouse gases. RNAO regrets that the budget confirms Ontario's continued opposition to carbon pricing, which is an effective and efficient way of fighting carbon pollution – an approach supported by virtually all economic experts.

Continued support for light rail and rail transit is good news. The new $11.2 billion for major transit project is a mixed blessing. While any enhancement in transit will improve health by taking polluting cars off the road and reducing congestion, the new money is heavily focused on subways, which are costly and divert funding from cheaper alternatives such as buses, light rail and active transportation.

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 RNAO.ca or follow us on Facebook and Twitter.

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