RN's Replaced By RPN's - GTA

[2bNurse-88]

Hey all.

I just wanted to share something that's currently happening in a lot of Ontario hospitals & i'd like to get some insight as to why it's happening?

Where I work (i'm a nursing student working part-time) in Toronto, Ontario, they have laid-off 26 RN's in the past 3 months & have replaced them with RPN's in mental-health, extended care, medical, and surgical (post-op) units across the hospital. Where my mother works in Hamilton, through Hamilton Health Sciences, they laid-off 15 RN's in the past month, and replaced them with RPN's, & from what I hear from my nursing instructors, this is happening in a lot more places than just Toronto and Hamilton.

Why is this happening? is it because RPN's cost less to pay? or is there a deeper meaning to all of this?

[NotReady4PrimeTime, RN]

It's definitely ALL about the money. Alberta is heading down the same road... only here they're hoping to put PNs in the ICUs too. They tried this experiment in the 1990's and ended up spending many millions more to return the RNs to the workplace later.

[dishes, BSN, RN]

As a RN I am concerned about this trend, but not surprised. I figured this was the direction we were headed years ago, especially when I looked at the courses for the RPN diploma programs and saw how similar they were to the old RN diploma programs.

Healthcare facilities have tight budgets for 2010, so they will cut overspending any way they can. Nurses are going to realize too little, too late, that RN jobs have become overpriced and are easy targets for the chopping block. I am worried that if nurses stay oblivious to this problem and if ONA demands salary increases in the upcoming contract negotiations they will just be adding fuel to the fire.

dishes

[Fiona59]

Jan, there are LPNs down in Calgary in the ICU's for the last five years. We haven't heard of any adverse outcomes.

Part of the issue is the expanding scopes of practice. The LPNs I work with don't want the extra responsibilities without compensation and it's just not happening. I've never been asked by the province or my College if I want to continue expanding my scope.

But dishes has it it right on the head. RN unions have negotiated well inthe past and are pricing themselves out of many units. The scope of practices are so close on my unit that the only thing that divides the RN and LPN in duties is who gets to pierce and hang a bag of blood or travisol. There have been many times on my unit when there has been no blood products or patients requiring TPN. The RNs and LPNs are caring for the same patients same skills. I've picked up patients that an RN had the shift before me. No change in the patients stability. Just what nurse was deemed appropriate for the room. My manager will give LPNs more complex patients than an RN with less than two years experience. Is it fair to the LPN, No but is it better for the patient, usually yes.

[2bNurse-88]

Dishes is right about the RPN program. It's much different today than it was 5-10 years ago. It's much more in-depth, the courses are far more difficult. The cut off grades to even get accepted are in the 90's. They're teaching RPN's a whole lot more than they used to.

[loriangel14, RN]

Another trend in Ontario is the addition of Personal Support Workers in hospitals. Even in St Mike's in Toronto. It is very different getting used to working with unregistered staff on the floor. This has been done in the east apparently and is working it's way west.

[2bNurse-88]

Another trend in Ontario is the addition of Personal Support Workers in hospitals. Even in St Mike's in Toronto. It is very different getting used to working with unregistered staff on the floor. This has been done in the east apparently and is working it's way west.

That may be a good thing if you look at it this way: That takes a load off RN's and RPN's. With PSW's now on the floor, nurses won't have to bath, cloth, change patients any longer & can focus on their priority assessments, meds, and other vital aspects of patient care. As long as PSW's stay in their scope, this could be beneficial.

[loriangel14, RN]

That was how management tried to sell it to us. In reality it doesn't work that well.

The problem is that when we do personal care it is an opportunity for assessment of the patient, skin condition, mental alertness, mobility, appearance of urine and stool. With the PSWs doing the cares you have to hope they alert you to anything signifigant. As unregistered staff they are not trained in assessment so you still have to double check things.

[2bNurse-88]

Yes, you have a very good point there Lori, I never looked at it that way, and after you said this, I can see now, how PSW's may not be such a good idea afterall.

I guess we'll have to wait & see.

[Guvner]

Kingston General is apparently doing this to save money. I remember reading a news article that explained they would be using more RPN's in order to help bring their budget under control and after talking with someone I know who is an RPN student she said they are doing it, but being very quiet about it.

Financially it makes perfect sense for the hospital to do this, RPN earn less money and can do depending on the hospital policy most of what an RN can do.

[linzz]

As an RPN, I don't ever want to work in an ICU. Maybe I am out of touch with hospital nursing but the idea of being in an ICU scares me. It seems to me that those on the floors are plenty sick enough.

[Fiona59]

As an RPN, I don't ever want to work in an ICU. Maybe I am out of touch with hospital nursing but the idea of being in an ICU scares me. It seems to me that those on the floors are plenty sick enough.

You hit the nail on the head. The average surgical patient on my unit would have been considered a "trainwreck" 10 years ago and in ICU.

The ones in ICU would have been dead 10 years ago.

I'm at the point of wondering "just because they know how to do it, should they really be doing it" with a lot of the patients we see.