Group items tagged

The transition reduced supply, which shifted bargaining power to nursing unions and led to bidding wars among the provinces.

Is nursing care better? We have no clue. There is some (largely American) research that attributes hospital care outcomes to RN staffing levels, but the studies have deliberately avoided comparing diploma vs. baccalaureate degree nurses.

Has the class structure of nursing education changed now that the profession is degree-only? Are fewer working class kids inclined to choose a career in nursing because it is much more expensive and time-consuming to acquire the credential? What about Aboriginal peoples, recent immigrants and other minorities?

One of the reasons professions raise ETPC is to increase their status and credibility in the academy. They do this in part by developing complex theory and creating specialized identities. Merging these identities into unified interprofessional teams is a challenge under any circumstances; even stronger and more fragmented identities forged in longer education programs will hardly make this easier. Furthermore, graduates with higher credentials will expect to work at a higher level and many will be disappointed and bored by the everyday but important work of patient care.

Doctors have already made it clear that they don’t want centralization of services to detract from the needs of local communities. “Physicians want administrative feet on the ground. They want local support,” says Harrigan. “Any model we come up with will have to reflect this.”

The government has made four commitments, including developing a multi-year health plan for the province that will set targets for improvement. There is also a legal requirement for the IWK Health Centre in Halifax and the provincial health board — the two authorities created by the new legislation — to prepare annual public-engagement plans to ensure community voices are heard.

Physicians’ response to the merger, which was a prominent 2013 election promise from the Liberal government, has been cautious but supportive. “We’re looking at it as an opportunity to work with government so patients are better served,” says Kevin Chapman, director of Health Policy and Economics with Doctors Nova Scotia.

The new physician bylaws, now being developed by the health department and Doctors Nova Scotia, are also expected to change credentialing and privileging in the province. “We want to streamline this,” says Patrick Lee, CEO of the Pictou County Health Authority who is currently serving as co-lead of the provincial consolidation project.

Privileging is not now required in Nova Scotia, and physicians who want to be credentialed to work in more than one health facility must repeatedly go through the administrative process. Under the consolidated system, all physicians will likely have to be privileged, and credentialing will be simplified. Doctors Nova Scotia applauds both approaches but expressed concerns these systems could be used to restrict physicians to specific geographical locations.

That worry is unfounded, says Lee. “We have no plans to make any of those changes.”

One of the major — and controversial — changes the government has made is to reorganize the way health care workers are unionized. Four existing unions will continue to represent health workers, but they will represent only one group each. The Nova Scotia Nurses’ Union, for example, will represent all nurses in the province. The move is intended to reduce the rounds of bargaining from 50 to 4, according to the government.

The implications are already significant for the health care system, says Joan Jessome, president of the Nova Scotia Government and General Employees Union, which stands to lose 10 000 members under the restructuring. “It’s affected patient care today. [Staff] are all distracted.”

we have three recommendations

Patient-centred care, inter-professional care and comprehensive care are all things that deserve and require additional investment and attention.

We need a pan-Canadian human resources for health observatory function to provide evidence and data on which to plan. Our workforce science in Canada is at a very primitive stage, and we are lurching from one crisis in one locality or one specialty to another.

The second recommendation

Our third recommendation

Canada needs an injury prevention strategy to elevate in the public's attention and bring resources to bear to reduce needless injuries in our life. The reason for this is that injuries cause a lot of loss of life, disability, long-lasting disability and painful disability, and they cost a lot of money.

Jean-François LaRue, Director General, Labour Market Integration, Human Resources and Skills Development Canada

foreign credential recognition

Marc LeBrun, Director General, Canada Student Loans, Human Resources and Skills Development Canada

Canada student loan forgiveness for family physicians, nurses and nurse practitioners, as introduced in Budget 2011

Robert Shearer, Acting Director General, Health Care Programs and Policy Directorate, Strategic Policy Branch, Health Canada

in 2004 the federal government committed to the following: accelerating and expanding the assessment and integration of internationally trained health care graduates across the country; targeting efforts in support of Aboriginal communities and official language minority communities to increase the supply of health care professionals in these communities; implementing measures to reduce the financial burden on students in specific health education programs, in collaboration with our colleagues in other federal departments; and participating in HHR planning with interested jurisdictions

Canada does not have a single national health human resources plan

Health Canada plays a leadership role in HHR by supporting a range of targeted projects and initiatives of national significance.

Pan-Canadian Health Human Resource Strategy

Internationally Educated Health Professionals Initiative

Health Canada supports collaborative efforts as co-chairs of the federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources known as ACHDHR. This committee was created by the conference of deputy ministers of health back in 2002, to link issues of primary health care, service delivery and HHR.

ACHDHR will be providing a written brief

The federal government also participates on ACHDHR as a jurisdiction that directly employs health care providers and has responsibility for the funding and delivery of certain health care services for populations under federal responsibility, such as First Nations and Inuit, eligible veterans, refugee protection claimants, inmates of federal penitentiaries, and serving members of the Canadian Forces and the Royal Canadian Mounted Police.

Shelagh Jane Woods, Director General, Primary Health Care and Public Health Directorate, First Nations and Inuit Health Branch, Health Canada

Dr. Brian Conway, President, Société Santé en français

account for over a million Canadians who need access to quality health services in their own language.

Acadian and francophone communities outside Quebec

Senator Eggleton

I am interested in the injury prevention idea. We hear of it from time to time. Do you have some specific thoughts on what an injury prevention program or strategy might look like and how it might fit in with the health accord? One of the things the Health Accord brought about in 2004 was the federal government saying to the provinces, “If you do this and you do that we will give you money here and there.” Maybe we should be doing that here. Maybe we should ask the federal government to provide an incentive for the provinces to be able to do something. It would be interesting if you could come up with a vision of what that strategy might look like.

Health human resources: credentialing and immigration.

Aboriginal health system improvement.

New technology approver and regulator.

Health promotion and disease prevention.

Epidemic preparation.

Will Falk, executive fellow in residence at the Mowat Centre for Policy Innovation

Sanders is not even a registered Democrat: Though he caucuses with the party, he has sat as an independent since he was elected to Congress in 1990. He self-identifies as a democratic socialist. In an Iowa church basement in December, he called for "a political revolution in this country." Not the stuff of major-party nominees. But no one else with sterling progressive credentials appears to possess the martyrdom instinct to stand in front of the Hillary Clinton express.

If you had two million people, a phenomenal response, putting in $100 bucks, that's $200 million. That is 20 per cent of what the Koch brothers themselves are prepared to spend. Can we take that on? I don't know the answer," he said. "Maybe the game is over. Maybe they have bought the United States government. Maybe there is no turning back. Maybe we've gone over the edge. I don't know. I surely hope not." This man could be progressive Democrats' last great 2016 hope.

A small but vocal effort to draft Massachusetts Sen. Elizabeth Warren, the most formidable left-leaning Democrat, has shown no sign of accomplishing anything. Warren would be a long-shot. Sanders may be a no-shot. But his presence in the debate could at least drag Clinton to the left on economic policy. And some activists believe his candour on the gap between rich and poor, which he described Monday as "grotesque and growing," would keep him afloat.

"Any candidate who speaks up as aggressively and as forthrightly as Sen. Sanders has on the growing income inequality in this country is a viable candidate. Income inequality will be the defining issue of the 2016 election," said Neil Sroka, communications director for Democracy for America, a political action committee founded by former candidate Howard Dean. Democracy for America is trying to convince Warren to enter the race. She keeps saying no. Sroka said the group is supportive of a Sanders candidacy even if Warren gets to yes.

"I think having more candidates in the 2016 Democratic primary talking about income inequality issues ensures that every single candidate has to talk about those issues," he said. Much of the recession-era country has come around to Sanders's anti-elite fury. He said Monday that "the business model of Wall Street is fraud and deception," demonstrating a populist frankness resonant with the segment of the Democratic base uneasy with Clinton's coziness with big donors.

Sanders offered a 12-point prescription for change. He called for a doubling of the federal minimum wage to "at least" $15 per hour, $1 trillion in infrastructure spending, repealing NAFTA, Europe-like free university tuition, and a Canada-like single-payer health-care system that insures everyone. Obamacare, he said, has been only a "modest success." He said he has seen "a lot of sentiment that enough is enough, that we need fundamental changes." Lest anyone get too excited, he added a caveat. "On the other hand, I also understand political realities," he said. "And that is: When you take on the billionaire class, it ain't easy."

Figuring out precisely what people perceive as "just pay" is complicated, but there are social standards and patterns. People who feel paid appropriately experience a balance of investments and rewards. Investments such as education, skill, effort and seniority are on one end of the scale - that is, how much have you put in? Rewards are on the other. When the scale tips toward investments, you feel underpaid; when it tips toward rewards, you feel overpaid. We all have internal standards, but we also rely on social comparisons: "Why does so-and-so earn more than me? I have better credentials, work harder and have more seniority!" Getting less than you deserve It hurts to feel under-rewarded - to get less than what (you think) is just - on a cognitive, emotional and even physical level. Perceived underpayment and job dissatisfaction go hand in hand. A recent Accenture study of 3,600 entry- to managementlevel business professionals across 30 countries found that feeling underpaid is the top reason for worker dissatisfaction.

Likewise, in the CANWSH and GSS studies, roughly one-quarter of those who feel severely underpaid are "very dissatisfied" with their job, while about 6 per cent of those who feel appropriately paid are "very dissatisfied." Feeling underpaid doubles the probability that a worker will report experiencing "stress, depression and problems with emotions" on a majority of days in any given month. Physiological reactions are common, too. Perceived underpayment raises the risks of rating oneself as having poor health, headaches, and stomach, back and chest pain. All this affects sleep quality: Those who feel severely underpaid have more difficulty falling or staying asleep. Perceived underpayment also hurts because it amplifies other stresses, such as interpersonal conflict, work interfering with non-work life, and having too much work and not enough time. That's a lot of suffering - and it isn't equally distributed in the population. In collaboration with Atsushi Narisada and Sarah Reid, our research shows that the pain of feeling under-rewarded hurts more among those who earn less, mostly because of the link with greater financial insecurity.

Everyone has a stake in understanding the social causes and consequences of perceived underpayment. We need to talk about it and address it collectively as departments, organizations and institutions. The conditions that surround unjust earnings are ripe with chronic stress. Ultimately, that makes this a public health concern. If monkeys aren't cool with getting less than they deserve, why should we be? Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Dr. Scott Schieman is a Canada Research Chair (Social Contexts of Health) and professor of sociology at the University of Toronto. His research focuses on the causes and health consequences of social stress. You can follow him on Twitter @ScottSchiemanUT.

"There was unequivocal systematic manipulation of data on the part of this researcher," hospital president Marilyn Emery told the Star in an interview. The study in question found "significant" improvement in the bone density of post-menopausal women who applied nitroglycerine ointment to their arms every evening for two years.

"The findings were made to look more positive than they were," explained Dr. Paula Rochon, vice-president of research at Women's College. Jamal, an endocrinologist, resigned her clinical privileges at the hospital last month, prior to the conclusion of the probe. She stepped down from the senior positions she held at the facility last June.

She also recently resigned as an associate professor of medicine at the University of Toronto. JAMA, the most widely circulated medical journal in the world, is now considering whether to run a retraction. "JAMA is aware of the concern of Women's College and will make a decision about (a) retraction in the coming weeks," editor Dr. Howard Bauchner said in an email. Jamal declined an opportunity to comment through her lawyer, Jennifer McKendry. "We do not have instructions to make any comments on your story," McKendry said.

The investigation found there were no deficiencies in any institutional systems or processes at the hospital, which adheres to nationally accepted research standards. "Despite that, it is still very important that we look at how we can review everything that we are doing and how we can work to raise the bar to learn from this experience," Rochon said.

The hospital learned from the University of Toronto last March that something might be amiss with Jamal's research, and the two bodies together commenced an inquiry. A formal investigation was then launched in June. Some 243 post-menopausal women participated in the study, with some receiving the ointment and some receiving a placebo. They have been sent registered letters, informing them that they may have received inaccurate information about the research.

"There is no evidence of negative outcomes for any of these research participants," Emery said. Research papers published in JAMA are peer-reviewed. It's unclear how allegations of wrongdoing by Jamal first surfaced. U of T spokesperson Althea Blackburn-Evans said the university received an allegation of research misconduct, which it passed along to the hospital, where Jamal had her primary appointment. Asked if Dr. Jamal explained what happened with the research findings, Emery responded: "No, we haven't been in that kind of conversation with (her)."

However, Emery acknowledged there is pressure among researchers to get good results on studies and to get them published. "Having said that, there is pressure in many roles (and) we wouldn't be looking to that as a rationale necessarily," Emery said. Jamal has impressive credentials. She graduated from U of T's medical school in 1991 and specialized in general internal medicine. She then did a two-year post-doctoral fellowship in biostatistics and epidemiology at the University of California, San Francisco.

That was followed by the completion of a Ph.D. in clinical epidemiology at the University of Toronto. Jamal's research has also focused on the treatment of fractures among patients with impaired kidney function. She has been the first or senior author on about 50 published papers, some of which are editorials and the others systematic reviews. Most were done prior to her work at Women's College.

Asked if her previous work is now being called into question, Emery said that's a "natural question" and one the hospital is now reflecting upon with regard to any work done under the name of Women's College. Jamal's public profile on the website of the College of Physicians and Surgeons of Ontario shows her now working for the Appleby Medical Group on Lake Shore Blvd. W. in Toronto.

Other non-RHPA occupations have less oversight. Personal support workers, who provide services including assisting with bathing, helping patients adhere to their medications and other tasks in the home, don’t have any provincial body to monitor their training or to ensure they’re practising appropriately, explains Miranda Ferrier, president of the Ontario Personal Support Worker Association (OPSWA).

these doctors tend to err on the side of under-delegation, knowing that if something goes wrong, they’ll be held accountable.

A personal support worker could be fired because of an accusation of abuse or neglect and they can literally get up and walk down the street and get hired by another agency and they wouldn’t know anything about it,” says Ferrier.

The OPSWA conducts a national criminal record and credential check for the 16,000 PSWs registered with them, but registration is voluntary. There are over 80,000 PSWs in the province who haven’t registered with OPSWA, Ferrier explains. “We would like to see one curriculum for all PSWs,” she says. “There should be expectations upon them for retraining and we should have the ability to blacklist ones that get charged with abuse.”

however. Chinese medicine practitioners were granted self regulating status in 2013 and naturopaths in 2015 – but not without controversy.

The problem is that not just in Ontario but broadly, in Canada, we’ve defined regulation in health care as self regulation and other countries don’t do that.”

UK and Australia

government oversight

New legislation should also allow smaller professions that can’t afford to maintain an RHPA-defined College to have title protection, says Grosso. And the voluntary oversight the professions currently do recognized legally, she adds. “When it comes to public protection, size should not matter,” says Grosso. 

Alberta’s government has overseen the development of a College of Paramedics,