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One of those reports was released earlier this year by the federal Auditor-General. It found, among other things, that just one in 45 nurses working at a sample group of onreserve nursing stations had completed all of the government's mandatory training courses; that nurses are being asked to do jobs they are not authorized to do; that the stations had numerous health and safety deficiencies; and that Health Canada does not know whether individual reserve facilities are capable of providing essential services. Several of those issues seem to have been at play when Brody fell ill. His father Fraser Meekis and Ms. Keno have five surviving children - three boys in primary school and two girls still in diapers. Just as the reserve school began a break week in the spring of last year, all of the Meekis boys came home with fevers and sore throats. Mr. Meekis took his ailing children to the nursing station, but the nurse did not take throat swabs, he said. She instead advised him to give the boys Tylenol, to rub their chests with Vicks VapoRub and to come back for a second appointment the following week. Sandy Lake has just one medical vehicle to ferry people to and from the facility. It is a van that sometimes breaks down on the rough dirt roads of the reserve and is often diverted by emergencies. It didn't arrive on time to get the kids to the follow-up visit and the family doesn't own a car. So they missed the second appointment.

"It was a student nurse who was watching my son there," Mr. Meekis said. "I kept asking, 'How come he looks like that?' And the nurse was like, 'I don't know.' And the next thing you know, I saw foam coming out of his mouth and I said, 'He's not breathing!' The nurse panicked. I ran out of the room and said 'emergency, emergency.' "But it was too late: Although the nurses managed to revive Brody once, he died later that morning. The problems at the Sandy Lake nursing station are well known to the community. Council members say the facility was constructed for a reserve of 500 people that is now home to nearly 3,000. Local residents have been trained to perform duties that would normally be done by medical professionals. "So you could have your janitor taking X-rays - when he's available," said John McKay, a councillor who was once in charge of medical administration.

He was sent back home with a couple of Tylenol and Advil and he was told to rub Vicks VapoRub on his chest," Mr. Kakegamic said. Wesley Kakegamic died on March 10. He had been a drug user and his family believes that was a factor in the lack of treatment he received. They are angry at the nurses. But the leaders of the community stress they do not believe the nurses are to blame. "It is the health system that we know today that is failing the First Nations," said Bart Meekis, the Sandy Lake Chief. "We're not asking for more than what the normal Canadian gets for health care," he said. But "we're losing people needlessly." Brody Meekis, he said, was one of them. "I want you to know that this is not about pointing fault at one person to help ease the pain that I feel," Fraser Meekis said of his decision to go public with Brody's story, "but to let you know that the system failed my son."

The number of licensed practical nurses (LPNs) has also jumped every year since 2005; last year saw the biggest increase, with 3,134 LPNs working, up from 2,842 the year before. There are more nurses, but you have to consider whether they're working full time, said Shirley Mc-Kay with the Saskatchewan Registered Nurses Association (SRNA), the regulatory body for the province's RNs.

In 2014, 59 per cent of RNs were full time, 26 per cent were part time and 15 per cent were casual. As for LPNs, 52 per cent were employed full time, 30 per cent part time and 18 per cent casual. Gordon Campbell, president of the CUPE Health Care Council, which represents LPNs, said the numbers have grown, but so has Saskatchewan's population.

"There's more people accessing long-term care, there's more people accessing acute care, hospitals, health centres," said Campbell. Zambory said RNs are regularly seeing an "inappropriate staff mix." "We have to look at having ... the right provider with the right knowledge and skill for the right patient at the right time," McKay agreed. "In certain situations, you may need the registered nurse. ... In other situations it may be different."

RNs provide guidance and help co-ordinate with other professions, including physicians, pharmacists and nutritionists, said McKay. In 2014, SUN members had 768 concerns relating to staffing levels.

In the General Hospital emergency department, Zambory said one RN sometimes looks after 14 patients due to short-staffing. Six patients per nurse is the norm.

At Wascana Rehab, one RN h

been responsible for 105 patients on two separate floors, said Zambory. Typically, at night, one RN and one LPN share the care of 60 to 80 people.

Santa Maria was the "worst-case scenario," she said, with one RN managing 147 patients on three floors.

At Pioneer Village, Zambory said, often on nights and weekends there is no RN on duty. Common practice calls for three RNs or LPNs to each care for upwards of 96 residents. "(RNs) have the critical thinking skills, we do the split-second decision making. ... We're not interchangeable (with other staff)," said Zambory.

"If you have an elderly person with complex (needs), chronic diseases," said McKay, "their health condition can change fairly quickly, so you need the ongoing oversight of the registered nurse to be there assessing the patient, anticipating some of the subtle changes."

Campbell said LPNs work within their scope of practice, can work without direction from a RN and can be in charge in some cases, like in long-term care. "Where there is the proper number of staff, regardless of who they are, it doesn't become an issue," said Campbell.

A recent report by the Canadian Institute for Health Information found that the odds that a senior person living in a Canadian nursing home will be given antipsychotics are nine times higher than for the elderly living in the community.

Ensuring seniors remain calm and easy to manage is not what residents suffering from dementia personally need the most from nursing homes, but this may be what nursing homes need from them. The evidence suggests that in several cases these facilities are using prescription drugs as a cost-effective way to deal with their residents’ unwanted behaviours.

There’s one thing we know for certain: using prescription drugs as a response to nursing home struggles with staffing shortages and insufficient resources is not a solution.

The evidence suggests that behavioural interventions and improved management of dementia can significantly reduce the need for antipsychotic medication. Such solutions require better designed, better equipped and better staffed nursing homes. How well prepared are we to provide these conditions?

The core problem lies in the largely insufficient funding levels for nursing homes at the same time that this sector is facing a rapidly growing demand for services. Significant investments will be needed for nursing homes even if the goal is limited to maintaining the status quo. Strong determination is needed from politicians and policy-makers if they seek to improve the current conditions.

Provinces typically express concern when such issues are raised. Policy-makers establish new guidelines, promise to better educate doctors and stakeholders and may even make data about drug use in nursing homes publicly accessible. Sadly, this has not been enough, as evidenced by the large numbers of seniors in these institutions who continue to take unnecessary medications. More — and different — action is needed to ensure an efficient response.

Better designed, better equipped and better staffed nursing homes are what the elderly need.

By: Nicole F. Bernier Published on Wed May 21 2014

Nova Scotia Government & General Employees Union president Joan Jessome, who represents the majority of Capital Health nurses, said Glavine is attempting to hide the fallout of legislation.

Many nurses are leaving because they weren’t given a say about their representation under the new provincial health authority, not because of propaganda, said Jessome. “They’re fed up.”

An arbitrator’s decision Friday will all but certainly place all nurses with the Nova Scotia Nurses’ Union.

NDP health critic Dave Wilson said Glavine should acknowledge that some of the Liberals’ moves since coming to power are hurting health care. More focus should be placed on workplace concerns and staffing levels rather than union reorganization, he said.

Glavine said steps continue to address shortages, including adding seats at nursing schools and a proposal at Dalhousie University to condence the nursing program from four years to three.

"There's going to be an ebb and flow (in hiring) as programs come and go," he told reporters Wednesday. This wave of cuts to nursing positions is worrisome and "out of the norm" according to Doris Grinspun, CEO of the Registered Nurses' Association of Ontario. Grinspun says registered nurses have been among the hardest hit in the bout of cuts so far, but the cuts won't just affect nurses: she warns they could affect direct patient care. "The patients will suffer the consequences because some of these organizations - the terrible thing is not only are they replacing RNs, but they're moving into models of care delivery that we left in the '70s," Grinspun said, describing dwindling one-on-one time with more qualified nurses. The problem isn't only government funding, Grinspun insists."The RN hours of care is directly linked to health outcomes of patients and that if you want to have better outcome don't get rid of RNs," she said.

too many patients receive care in the costliest and most labour-intensive place, the hospital

Nurses spend much of their time doing non-nursing work (i.e. work not directly related to patient care)

they often work with outdated, inadequate staffing plans that give them little influence over staffing decisions

this means giving nurses at the bedside a mechanism to say ‘enough is enough’ when workload reaches a level that is unsafe

move on to solutions

we need a staffing model that is flexible, sensitive to the characteristics of the patient and nursing population, adaptable on a shift-by-shift basis, and receptive to the input of front-line nurses

let’s recognize that the health of our nursing workforce, and the quality of patient care, depend on real solutions to the problem of excessive workload

Nice, an authoritative body whose recommendations are supposed to be implemented across the NHS, has spent months examining evidence on the impact staff numbers have on both the quality and the safety of the care patients receive.

Leng will also tell hospitals that nurses need to be constantly on the alert for "red flag events", such as patients not receiving help to go to the bathroom or not receiving pain medication, which can trigger an immediate need for more nurses on the wards.

"A 1:8 ratio still means that the nurse only has seven and a half minutes per patient per hour, which is too little. If it's more than eight then patients won't get fed, care plans won't get written, and nurses can't sit and talk to patients and reassure them about their condition. Care just won't be given to a proper standard, and patients can die," said Osborne, a former director of nursing at St Mary's hospital in west London.

Eight should be the absolute maximum number of patients a nurse should have to care for but "if you get to that level it's bordering on unsafe care", so ideally the ratio should be 1:4 or 1:6, she added.

All the same, there were hints of how the coming election campaign will shape up, with Davis and Ball firing attacks at each other. Ball repeatedly reminded the audience that the government made substantial budget cuts in 2013, and then made cuts again in 2015. Davis emphasized his background as a police officer, and attacked Ball for saying that he'd make nurses work harder in an interview on the CBC. Forward came away from the event saying that it didn't leave her ready to endorse one party or another, but the union extracted some important promises out of all the candidates that she can hold them to after the election.

Forward said that the union will be making itself heard in the coming months leading up to voting day on Nov. 30. "The public respects registered nurses and know that we're going to be advocating on their behalf," she said. "And we do it at the bedside, and it makes sense that we do it in election time."

Hospital management says it will monitor the implementation of the cost reduction measures carefully and could even reverse some of them if that is deemed necessary. The petition, which had already garnered some 50 signatures as of midday Tuesday, says BGH faces "major direct care cuts" to areas such as the intensive care unit, operating room, complex care, palliative care, emergency, the stress test clinic, day surgery, diagnostic imaging, medical/surgical, and the switchboard. It adds the provincial government has "cut hospital funding in real dollar terms for the last eight years."

The petition calls on the legislature to stop the planned cuts and to "improve overall hospital funding in Ontario with a plan to increase funding at least to the average of other provinces." Local supporters plan to hold a rally in downtown Brockville in coming weeks to circulate the petition on a Saturday morning at the Brockville Farmers'Market, said Mary Jane Froats, the Ontario Nurses' Association's (ONA) bargaining unit president at BGH. Hospital management earlier this month announced its latest cost-cutting measures: A reduction of more than 26 full-time equivalent (FTE) positions, including 9.1 FTE registered nurses, 7.9 FTE registered practical nurses, 6.4 FTE personal support workers and 3.2 FTE support service jobs.

Anne Clark, ONA's regional vice-president for Eastern Ontario, said the cuts will hurt patient care by creating "severe understaffing." "In my professional nursing opinion, hospitals should never cut at the bedside, should never cut jobs that provide direct care to patients," said Clark. She added the cuts in nursing will result in more than 16,000 person-hours of nursing care gone from BGH, a workload that will be shifted onto remaining nurses. "We are seeing health-care decisions being driven by dollars and not our patients' needs," added Clark. Louis Rodrigues, first vice-president of the Ontario Council of Hospital Unions, cited tragic stories from patients' families left on a patient care hotline created by CUPE.

"We will not sit by while our acute care hospital system is slowly dismantled and privatized," said Rodrigues. Another speaker, Council of Canadians member Jim Riesberry, placed the ultimate blame for the current "austerity" in the hospital system at the feet of the federal government, blaming both Prime Minister Stephen Harper and his Liberal predecessor, Paul Martin, for starving provinces of health care cash. BGH vice-president and chief nursing officer Cathy Cassidy-Gifford rejected one claim made by Rodrigues, who said successive cuts at BGH had led to bed closures. She said the reductions being implemented between now and the end of the year are based on consultations with similar-sized Ontario hospitals in a "benchmark" group. There is also a steering committee in place meant to monitor patient care once those cuts are implemented, said Cassidy- Gifford. "If you see there needs to be changes, there will be revisions based on the situation, ensuring that our patients are first and that our staff are able to work in a safe condition as well," she said.

Leeds-Grenville MPP Steve Clark, who was away at the Progressive Conservative summer caucus meeting, said in a Twitter message he will gladly present the petition to the legislature. Clark last week sent a letter to Health Minister Dr. Eric Hoskins, saying the minister's failure to act by reviewing hospital funding has led to the most recent BGH cuts. In a statement emailed to The Recorder and Times, a spokesperson for the health minister referred staffing questions to BGH management. "Our government's investments have helped to ensure that there is a stable nursing workforce now and for the future. More than 24,000 more nurses are working in Ontario since our government took office, including more than 3,500 new nurses added in 2013," the statement read. Between 2005 and 2012, the province has added 657 nurses in the region covered by the South East Local Health Integration Network, it added.

Curits Coates, right, representing the Ontario Health Coalition, speaks at a protest over Brockville General Hospital cuts with Jim Riesberry of the Council of Canadians on Tuesday.

Arbitrator Jim Hayes found the "vaccinate or mask" policy was unreasonable, and "a coercive tool" to force heath-care workers to get the flu shot. Experts testified that it was illogical to force healthy nurses to wear masks, and Hayes concluded the masks were not protecting patients or nurses from the flu.

"They were basically coercing and shaming nurses into getting the influenza vaccine if they individually chose not to take it," she said. "They made them all wear masks and they had little stickers on their name tag that everyone knew meant 'I don't have my vaccine.' " The policy made private medical information public because everyone could tell who had been vaccinated and who had not, said Dr. Michael Gardam, director of infection prevention and control at the University Health Network and Women's College Hospital in Toronto. "Essentially they are outing you, because your personal health information -- whether you get vaccinated or not -- is now public knowledge because you're forced to wear a mask," said Gardam. "People know who you are."

The influenza vaccine is only about 40 to 60 per cent effective even in good years, said Gardam, which means all hospital workers should wear masks all the time if they were actually effective at preventing the spread of the flu. "So the only way you can really explain that argument is to say 'well, it's not really that the masks are working,' " he said. "It's because the masks are a way of driving you towards vaccination."

The policy "was symbolic rather than a scientifically based tool in the fight against influenza," and amounted to a "draconian shaking of the finger at nurses," said Haslam-Stroud. The ONA said there are provisions in its agreements with hospitals that require a non-vaccinated nurse to move to another ward if the medical officer of health determines there is a flu outbreak in the area where he or she works. "I am not going to suggest that anyone should be forced to take the vaccine," said Haslam-Stroud. "I personally take it, but it is an individual right as a nurse." The "vaccinate or mask" policy started in B.C. hospitals before moving to some health-care facilities in New Brunswick and Ontario.

FRANK GUNN/CANADIAN PRESS FILES • The Ontario Nurses Association says hospitals will no longer be allowed to shame health-care workers into getting a flu shot following an arbitrator's ruling striking down a "vaccinate or mask" policy.

But McKenna argued nurses in the long-term sector have gone into rooms where a homicide has occurred, and those in emergency rooms constantly deal with victims of violence and horrible accidents.

"You shouldn't exclude particular workers because they might not be the first one to step their foot into a vehicle accident setting," she said. The legislation would mean first responders could access Workplace Safety and Insurance Board (WSIB) benefits far more easily than they can now.

The presumptive legislation, if it passes third reading as expected, is slated to be proclaimed into law Wednesday. It had been long sought and has now been widely lauded by first responders.

In a statement issued on behalf of 8,000 Ontario paramedics, the Canadian Union of Public Employees (CUPE) said the bill will help lessen the stigma associated with PTSD and help first responders get treatment "before it's too late."

"Research shows that because of frequent exposure to traumatic situations, paramedics and other first responders are at least twice as likely to suffer PTSD than the general population," the CUPE statement says.

Craig MacBride, spokesman for Labour Minister Kevin Flynn, said the government is committed to workplace safety for nurses, creating a leadership table on violence in health care and also amending the Occupational Health and Safety Act to help prevent workplace violence and harassment.

It's also important to remember that nurses, like all Ontario workers, are covered for PTSD through the WSIB. Bill 163 simply creates a more responsive process for those who are most likely to face traumatic experiences on a regular basis," MacBride said.

This put nursing groups in an awkward position. After saying publicly for years that PAs are a danger to patients because they are unregulated, now they would have to make the opposite case: that regulating PAs is unnecessary because there is no evidence they have harmed the public.

HPRAC, and the Minister of Health agreed with the RNAO. PAs, said HPRAC’s report, do not pose sufficient harm to patients to require regulation, although as their numbers grow, that may change.

What’s really broken is the relationship between physicians and nurses, at least at the organizational level. PAs, whose practice of medicine depends entirely on collaborating and consulting with physicians, are just collateral damage in a century-old war.

There are signs that in the US, where PAs are one of the fastest-growing professions and in high demand, some PAs want to break out of their “assistant” shackles to practice more autonomously, which many of them already do in underserviced areas where physicians choose not to practice.

Maureen Taylor is a Physician Assistan

The book highlights some of the darker elements of the nursing profession, including workplace cliques, bullying, drug abuse, sex, poor working conditions and even cases of assault.

"Nurses have no place to turn," Robbins told CTV News Channel. “They often work for 12 to 14 hours straight… with no breaks.

In one passage of the book, nursing is described as being like "high school but with dying people."

Another element examined in the book is the constant threat of violence and abuse nurses face on a daily basis.

It is widely considered one of the most dangerous professions, as frustrated and emotional patients and visitors may verbally and physically assault an attending nurse at any given moment, Robbins said. "So they get bitten, punched, hit, scratched, and what's just as bad is that many workplaces make them feel like getting assaulted is just part of the job," she said. "Nobody in any other profession would have to tolerate that."

At the University Health Network, the number of reported violent incidents against staff by patients doubled in two years. Reported assaults included incidents of verbal abuse, as well as patients kicking, punching and throwing urine at staff, according to reports obtained by the Star through an access to information request. UHN said the increase is likely due to a change in the method of reporting incidents and to a push from unions encouraging staff to increase reporting.

"Sadly, I'm not surprised (by the increase in assault reports)," said Doris Grinspun, CEO of the Registered Nurses' Association of Ontario, who called on the government to hire more nurses. "When you do not address staffing, the temperature only raises more and more." ONA president Linda Haslam-Stroud told the Star Thursday that she is in discussions with Hoskins and Flynn about addressing workplace violence for nurses but is waiting for confirmation of how they plan to tackle the issue. She added that talking is not enough. The ONA wants to see increased hospital staffing levels, better trained security guards and more accountability from CEOs.