UPDATE MAGAZINE December 2013
COMMUNITY NURSING
KEEPING AFLOAT IN SOUTH FRASER VALLEY
Fraser Health’s “home is best” policy leaves nurses with increased workloads and higher patient acuity
TREADING WATER South Fraser Valley region community nurses Michelle Sordal, Mindi Sekhon and Jennifer Mark say the increasing number of clients with acute and complex medical needs being discharged from hospital is making their day-to-day workload demands impossible.
W
HEN ASKED TO describe the ongoing, day-to-day challenges community nurses are up against at Newton Home Health, RN and Steward Mindi Sekhon uses a descriptive metaphor. “Fraser Health is a big ship – like the Titanic,” she says. “The community health nurse department is a little cabin on the ship. The cabin is busting at the seams, and the staff members are trying hard to keep their heads above water. As a steward, I work very hard every day to help the drowning staff stay afloat.” It’s a metaphor Langley Home Health Case Managers, Jennifer Mark and Michelle Sordal can relate to. “We’re just bailing out the buckets of water but we’re not getting very far, very
fast,” says Mark. “The nurses I work with love their clients, but feel unable to provide the type of service and care required dayto-day do to chronic short staffing, unfilled positions and no vacation or sick coverage.” “It’s very difficult,” says Sordal. “I’ve found that over the last couple of years, job satisfaction has plummeted. You don’t feel like you are able to give your clients what they need.” Sekhon, Mark and Sordal say an increasing number of clients with acute and complex medical needs are being discharged from hospital, only to be added to already long wait lists in the community. As a result, home care nurses and case managers have reached a breaking point, and are finding day-to-day workload demands impossible. “Our goal is to be proactive and work
15
with clients to prevent re-occurring hospitalizations and illness, but we don’t get to do any of that,” says Mark. “We only get to do crisis management. There just aren’t enough bodies to take care of the work that is required.” Both Newton Home Health and Langley Home Health were recently the focus of a community nurse survey conducted by the BC Nurses’ Union. The questionnaire focused on issues such as workload, workplace toxicity, weekend work, the grievance process and the PRF process. Workload ranked as one of the biggest concerns among home health nurses. Sekhon says that Fraser Health Authority’s so-called Home is Best care model is creating a tsunami of work for nurses who are already up against unrealistic expectations. And as nurses struggle to meet demands, more and more patients are ending up back in emergency rooms for treatment. “The Home is Best model only works if there is enough staff and funding,” explains Sekhon. “We have very, very long wait lists of patients to see. Nurses are so overwhelmed with their work because of these demands and we’re seeing meltdowns in the workplace. These are professional nurses who are committed to their work but can’t cope with the stress levels.” It’s a similar concern in Langley. “The hospitals are chronically overcapacity and the health authority’s answer to this is to discharge them to the community, often giving the impression that a community nurse will be able to respond to these needs instantly – but this is not the case,” says Mark, who notes there are long waitlists for acute issues such as wound care and palliative care. Both nurses agree that what both worksites need most is more full-time, regular staff. In Langley, Mark predicts four extra nurses and five case managers would take the pressure off. In Newton, Sekhon says six more nurses would make a big difference. South Fraser Valley co-chair Cheryl Appleton says that Sekhon and Mark are not alone, and that Home is Best has led to stressful conditions across the region. “There’s no question that both work-