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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.

"It's another day where we are hearing about hospital budgets being balanced on the backs of nurses. This is several thousand hours of RN care that is being removed from this community."

Of the 53 positions to be eliminated, 28 will be registered nurses.

"We are working to decrease length of stay in that service, since it is significantly out of step with provincial benchmarks," PRHC spokesman Arnel Schiratti stated in an email Wednesday night. "By doing so we can treat the same number of patients with fewer beds. By moving to benchmarks four beds will no longer be needed as we treat the same number of patients."

"At the end of the day, there will be three potential layoffs. As this migrates over time, we see that (number) coming down," he said.

While registered nursing positions take the brunt of the cuts, Tremblay said overall the number of nurses employed at the hospital is actually going up.

There will be a bump in registered practical nurses from 204 in 2012-13 to 222 in 2013-14 and registered nursing positions will go from 711 to 755, the hospital said.

The cutbacks represent a 2.5% staffing decrease. PRHC currently employs about 2,070 people. The 2013-14 operating budget will be balanced, without surplus or deficit.

PRHC full-time employees average 10 sick days per year, costing $3.2 million. The leading Ontario hospitals in that category average only six days per year.

Sick days tend to lead to more overtime costs. In 2012/2013, PRHC paid out more than $1.9 million in overtime and the hospital is aiming for a 30% reduction.

“We need 16 to 17 per cent more RNs to catch up with the rest of the country,” he says. “Ontario hospitals are by far the leanest in the country, and the community and long-term care sectors are understaffed as well. More nurses should be going to the community to keep people out of hospitals. I think it’s one of those areas where the healthcare system finds it easier to cut back on nurses than cut back on money going to doctors. Right now family doctors are averaging $300,000 a year.” Full-time RNs make a base of $53,000 in their first year of work and up to $78,000 base if they have many years of experience. Overtime pay is typically one and a half times the hourly rate.

The Ontario government should bolster employment, and hence domestic demand in the economy, by increasing investment in public services and social programs

Drawing on post-2008 public investment measures adopted in China, Brazil, Australia and Kenya, the paper demonstrates how the Ontario government can be a leader in bringing the Ontario economy out of economic crisis for the common good, including eventually eliminating the deficit and debt.

the Ontario government should commit financial resources to create an additional 9,000 permanent full-time equivalent rn positions by the end of fiscal year 2014-2015 in order to begin addressing the particularly low rn-to-patient ratios in Ontario relative to other Canadian provinces.

mass construction of low-income housing in Ontario

In the long-term care sector, a minimum staffing standard should be funded and regulated at an average of 3.5 worked hours of nursing and personal care per resident, per day, including 0.68 RN hours per patient per day.

not substituting or replacing RNs with registered practical nurses

increase state revenue through taxation of corporations and the wealthy, beginning with cancelling the reduction of the corporate tax rate to 10 per cent.

work with the federal government to establish job creation targets in various areas. This should include job-intensive green job creation and fully subsidized skills training programs

For the full research paper see:http://www.ona.org/publications_forms/research_series.html

There is a crisis in our hospitals - we are dramatically understaffed and under-resourced in terms of both nursing staff and other health-care staff. But rather than trying to beggar their neighbours, we suggest that the RN association focus on working with all nurses and all health-care workers and the local community to increase the staffing of all nurses and health-care workers in Ontario hospitals. That is where CUPE Local 1974 will be putting our energies - and wherever possible we will do this with our registered nurse colleagues. Mike Rodrigues President, CUPE Local 1974

Dewar couldn't estimate how much money will be saved by the layoffs because staff numbers change constantly. Three full-time and two part-time management positions will not be filled and savings will be re-directed to front-line services in long-term care. For some time, the Saskatchewan Union of Nurses (SUN) has raised concerns that registered nurses (rns) are being replaced by licensed practical nurses (LPNs). When asked if this could happen, Dewar replied: "For rns or LPNs, what's really important is how you organize that care team to deliver quality care and there is a substantive overlap between the two professional groups."

He emphasized it's important to assess what care is required by patients and who can best deliver that care. CUPE Local 3967 president Scott McDonald said Friday's announcement was news to him. The local represents most RQHR workers who aren't RNs, including those in housekeeping and maintenance, dietary professionals, technicians and LPNs. CUPE has had brief conversations with the health region, but McDonald didn't think the layoffs were a firm thing until he heard Friday's announcement.

He said CUPE's 5,500 members are already overloaded. "These layoffs are going to affect patient care. I don't see any way of getting around that," said McDonald. SUN president Tracy Zambory agreed. There are already "huge challenges" when it comes to staffing, said Zambory. She pointed to the 28 per cent increase in critical incidents as reported in the Health Ministry's annual report released in July. That includes errors in medication and diagnosis. "Regional health authorities have been told they have to come up with efficiencies; that translates down always to the front-line staff," Zambory said. Realigning staff won't impact services, bed numbers or programs, Dewar said. On Thursday, the Saskatoon Health Region issued 70 layoff notices.

Numerous factors could explain the difference in the number of layoffnotices the province's two largest health regions are handing out - including the SHR's larger deficit, Dewar said.

Hurley is travelling throughout the province, to explain how over the last decade Ontario's acute hospital funding has been on the slide compared to other provinces. In 2005-06, Ontario was "in the ballpark," with per capita funding of $1,112 compared to $1,159 for the rest of Canada, Hurley said, citing figures from the Canadian Institute for Health Information. Ten years later, Ontario's funding was $1,396 compared to $1,750 for the rest of Canada. He said the numbers extrapolated for Windsor are conservative, taking into account only the City of Windsor's 211,000 population, even though Windsor Regional's patients come from all over the Windsor-Essex region (population 389,000) and beyond.

Hurley said while Ontario did increase its funding for hospitals during the last decade, it did not come close to accounting for inflation, population growth and the aging population. This year, hospitals received a one per cent increase, but their actual costs rose 4.5 per cent, he said. "So their budgets have been cut again." Windsor Regional declined to comment on Hurley's assertions. In a statement, Health Minister Eric Hoskins said his government is doing what citizens want - continuing to invest in a health-care system that "puts patients first," asserting that 94 per cent of Ontarians now have a family doctor, and that wait times for some procedures are among the shortest in the country.

This year, it's increasing health funding by $1 billion, a 2.1 per cent increase, and it's increasing funding to hospitals by $345 million this year. "In Windsor, (since 2003) we've increased funding for local hospitals by more than $126 million - an increase of almost 50 per cent," said Hoskins. He also said Ontario is investing additional millions into home care, community health centres and home-based hospice and palliative care, because people prefer to receive their health care at home instead of a hospital. Hurley said the province argues that while it has been actively downsizing the acute care system, at the same time it's increasing investments in home care and longterm care, to "pick up the slack." But he said Ontario is actually spending less on long-term care and home care than the rest of the provinces. He said Ontario's high readmission rates are a sign the system is suffering. "So we have fewer beds, there's tremendous pressure to get people out of those beds and send them home, and often when they're sent home they haven't been made well actually and they return to hospital for a more lengthy and expensive readmission." Hurley said his council is calling on the government to fund hospitals "at least" at a level that reflects their rising costs, to stop reducing the number of beds and staffing, and to increase access to the people who need it.

The people being hardest hit by this are elderly, he said, who often have lived a long time without serious health problems, until they're hit with a health crisis that lands them at a hospital doorstep. "First they queue up in an ER for hours, and if they're going to be admitted it's likely a stretcher in a hallway," he said. And once admitted, there's likely pressure to get them discharged before they're fully well, he added. "For the elderly in particular they feel the brunt because there's rationing going on, the beds are so scarce." bcross@postmedia.com

Michael Hurley, president of the Ontario Council of Hospital Unions, discussed health-care funding in the province Thursday during a news conference at the Royal Canadian Legion Branch 255.