The staffing crunch in long-term care could be addressed through the hiring of more registered practical nurses, the Wettlaufer inquiry has been told.
“It is far better to have a qualified RPN, especially overnight, than to be scraping the bottom of the barrel for mediocre (registered) nurses, as Ms. Wettlaufer was described,” said Tom Friedland, a lawyer representing the Ontario Long Term Care Association.
There is a shortage of RNs in long-term care, but there is no such shortage of RPNs, he testified on Wednesday, the last day of public hearings at the inquiry.
Serial killer Elizabeth Wettlaufer was an RN.
RNs have more education and a broader “scope of practice” than RPNs. They hold more senior roles and have greater responsibilities. They also get paid more.
Long-term care homes have a difficult time recruiting and retaining RNs, especially when compared to hospitals which pay more and have better benefits.
The workload in long-term care continues to grow because residents have more complex health needs.
Friedland said that long-term care homes “are desperate for RNs,” especially in rural areas where the shortage is most acute.
It was because of this desperation that homes overlooked Wettlaufer’s many shortcomings, the inquiry has heard.
The inquiry is probing the circumstances that allowed Wettlaufer to go undetected as she killed eight patients in southwestern Ontario nursing homes over the course of almost a decade.
Wettlaufer checked herself into a mental health hospital in 2016 and confessed to carrying out the crimes. She subsequently pleaded guilty to injecting patients with overdoses of insulin.
The OLTCA wants the province to scrap or amend legislation that requires every home to have at least one RN on duty at all times. At the very least, the organization wants RPNs to be added to the requirement.
RNs are often overqualified for the work they do in long-term care, Friedland said in his final submissions.
“Much of this work could just as effectively be performed by RPNs, especially in homes that overall have less acute residents,” he said.
Friedland recommended that RNs be available remotely for video consultations.
The Registered Nurses Association of Ontario, which also has standing at the inquiry, argued against the elimination of the rule requiring homes to have at least one RN on duty at all times.
RNAO lawyer Christine Mainville said that given the growing needs of residents, the requirement isn’t even enough.
“What is critical in our submission is that we not reduce the qualifications of staff in favour of simply having more staff. It is essential that long-term care homes have not only enough staff, but also staff with the appropriate knowledge, competencies and skills to meet residents’ increasingly complex needs,” she said.
Mainville said homes need a mix of RNs, RPNs, nurse practitioners and unregulated employees, for example, personal support workers.
“An inappropriate skill mix puts residents at risk and undermines their care. An appropriate skill mix is designed to match residents’ needs with the competencies of the providers…, to react appropriately and quickly to emerging complications and emergencies and to assess the residents accurately,” she said.
The public inquiry will next week enter a new phase. Commissioner Eileen Gillese will engage in policy consultations with various affected groups.
She will report on her findings next year.
Gillese said her report will contain recommendations that will “restore public trust in the long-term care sector and home-care services.”
Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle