<http://www.nursesunions.ca/na/hphe.shtml>
Kathleen Connors, RN, President, Canadian Federation of Nurses
Unions
Presentation to the
House
of Commons Standing Committee on Finance on
Canadian
Economy: Short & Mid-Term Outlook
Maurizio
Bevilacqua, MP, Chair
The
Parliament of Canada, Ottawa, Ontario
6 June 2001
The Canadian Federation of Nurses Unions is the largest
organization of nurses in Canada. We were founded in 1981 and
today have every provincially-based nursesı union, except
Quebec, as a member. We are governed by an unpaid, elected board
of the top officers of member unions. The CFNUıs executive
officers, the President and Secretary-Treasurer, must stand for
election every two years.
We represent 118,000 nurses, including registered nurses,
licenced practical nurses, and registered psychiatric nurses.
They work in hospitals, in long term care facilities, in our
communities, and in our homes.
Our mission is to give voice to nursesı and patientsı concerns
when they are discussed on Parliament Hill and in the national
media. We also take very seriously the protection and improvement
of the medical system which was built by our parents and
grandparents and which has served my generation of Canadians and
our children so well.
Every profession, including medicine, has an insider language.
While itıs necessary we do need words for diseases,
diagnoses, and treatment its use can be disturbing. Sometimes
doctors speak about your body in a way that goes beyond
dispassion to abstraction. And we know that if we let it go on,
those specialists can get lost in those rarified terms and forget
that they are talking about a real person with feelings and
family, friends and coworkers.
As a nurse, I find it no less disturbing when those who
specialize in economic policy talk in terms that go to
abstraction forgetting that the monetary and fiscal talk is
supposed to be about best outcomes for the citizens of our
country.
So Iıd ask you, Mr Chairman and the other members of the
committee, to remember with me the people behind the numbers.
That, of course, sounds trite. But like our experience in
doctorsı offices, we have all heard discussions about the
economy where you come away shaking your head saying, ³Were they
talking about human beings?²
My point here is simple. As in the health care system, the
foundation of the Canadian economy is people. Healthy economies
require healthy people.
Nurses are less than optimistic in the short to medium term about
our economy because of our declining ability to prevent and treat
disease.
Like other workers, nurses worry about our jobs and families. Our
jobs arenıt particularly good right now and itıs having
negative effects on our families. Furthermore, this has and will,
in increasing amounts, hurt the health of our country and its
citizens.
We all know about the locked emergency room doors and the
cancelled operations. But itıs more than that.
What will follow the decline of Canadaıs most important program
is a decline in Canadian-ness. After all, the love people have
for anything even something as great as this nation will
decline as the thing in question becomes less tangible, less
visible. As Canada delivers fewer goods like Medicare to its
citizens, nurses worry that the reason to be Canadian will
decline. A beer is not a good enough reason to say ³I AM
CANADIAN.² But a first-class national not-for-profit health care
system might be.
Canada is experiencing a nursing shortage that, if not addressed
quickly, will become a nursing crisis by decadeıs end. Canada is
short about 20,000 nurses right now but this will be five time
worse by decadeıs end. Letıs put that in perspective.
* Nurses provide 80 per cent of the hands-on
professional care in the system.
* There are about 228,000 nurses.
* The average age of a Canadian nurse is 48.
* The average retirement age is 56.
* In the rosiest scenario, schools of nursing
are projected to graduate less than 34,400 nurses in the 14 years
from 1997 through 2010.[1]
* Some of these graduates take jobs outside
Canada and others decide against nursing.
* Almost 30% of nurses under age 31 are
considering quitting the profession next year.[2]
* By the year 2011, Canada will be short
113,000 nurses[3].
For nurses on the job right now, work means mandatory overtime.
Mandatory overtime means that you can be disciplined if you
refuse. And that places an undue burden on nurses, on our
families and it puts patient care in jeopardy when nurses have to
work one shift after another, day after day[4].
It doesnıt end there. Nurses feel in fact they are
under-valued by administrators and the systems in which they
work. Why? Hereıs a short list:
* Low pay relative to responsibility[5]
* Many doctors and administrators are deaf to
nursesı suggestions even when life is at stake[6]
* Inflexible work rules
* Inability to schedule regular hours and
consequently, family life including vacations etc
* Lack of support for continuing education and
skills upgrading[7]
This translates into a nurse workforce whose morale is low, who
is the sickest in the nation[8], and who, in some quarters, is
just not going to take it anymore.[9]
Nurses by their nature are care-givers and NOT activists. But
whatıs happened to the system in the last decade has changed all
that. We are now in the winter of nursesı discontent. Without
dramatic federal action, thereıll be no thaw soon.
Nurses also worry that our not-for-profit, publically delivered
system of health care is being taken from us. We are coming
reluctantly to the conclusion that government is refusing to fix
the system that has served our country so well. And we fear what
will follow.
In the 1980s and 90s, Chrysler Chairman Lee Iacocca railed
against the cost to business of private health care in the United
States. ³It cost Chrysler more than steel,² he used to say. He
also remarked that he had no such burden in Canada.
Thatıs looking at private, for-profit health care at the
business level. At the level of the individual, itıs even more
disturbing.
I, myself, have just recently experienced the system from the
patientıs side of the bed. I was treated for uterine and bowel
cancer for 18 months. From 1999 through the year 2000 and into
the first few months of this year, I received care in hospital,
in my home and as an outpatient.
The quality of the care I received was great though itıs
plain to see that the system is under great strain.
But please be aware that, if I get another catastrophic illness,
I will get great care again. Unlike our neighbours to the south,
I will receive no call from some silver-tongued insurance agent
saying, ³Ms. Connors, hearty congratulations on your recovery
and itıs been really great to have you as a customer, but
unfortunately you are no longer insurable with our company. HASTA
LA VISTA, BABY!!!²
We can all rest assured that we wonıt get that call. At least
... for now.
Thatıs not exactly a comforting thought, is it?
So, why am I raising the nursing shortage and the erosion of
Medicare in a Finance Committee meeting?
Because both of these problems have the same root federal
budget cuts.
Now wait just a second. I am not saying that the system was
perfect before the cuts. It had inefficiencies. It needed
improvement to be sure. But as a patient, Medicareıs problems
werenıt acute until after the budget cuts of the 1990s.
In 1992, Canada spent 10.2 per cent of its gross domestic product
(GDP) on health care. But in that year concerns about reigning-in
the deficit caused the federal and provincial governments to cut
spending on health care.
From 1992 to 1997, per person spending on health care decreased
across the country. Since that time spending on health care has
begun to rebound, but we are still only at 1992 levels of per
capita spending. Meanwhile,
* The economy (GDP) grew
* Our population grew
* Our technological capabilities grew
* But our spending on health care did not
despite the September 2000 agreement between the federal and
provincial governments.
Today we are only spending 9.2 per cent of the value of our
domestic economy (GDP) on health care. Thatıs down a full
percentage point from 1992.[10]
Itıs worth repeating: the economy grew but health care spending
did not keep pace. Furthermore, today our neighbours to the south
spend 50 per cent more per capita on health care than do we.
So why all the talk about health care spending being out of
control? Dr Gordon Guyatt of McMaster University Medical School
tackled that recently. He noted that itıs easy to present
misleading statistics. For example, Dr Guyatt wrote:
³The Ontario governmentıs health spending rose from $17.7
billion in 1995 to $18.4 billion in 1999, a 3.8 per cent rise.
However, after correcting for inflation and population growth,
real spending per person fell by 6.7 per cent. Alarmists note
that Ontario is spending 40 per cent of the provincial budget on
health care. But that is not surprising: Queenıs Park has
chopped welfare payments, environmental protection, and
education. Indeed as a proportion of provincial GDP, government
expenditures have dropped from 16 per cent to 12 per cent since
1992. Meanwhile, the population has aged and is demanding more
intensive health services.²[11]
The cutbacks turned some Premiers into reluctant pruners of the
Medicare tree. But for others like Mike Harris and Ralph Klein,
it gave them an excuse to begin hacking at Medicareıs trunk
while blaming it solely on the governing federal party. They also
began crowing about private, for-profit medicine even though
there is no proof that private medicine is more cost
efficient.[12]
No one in government is calling for the restoration of all the
money cut from Medicare. You might think the reason for this is
that Canadians believe that the agreement made last September
restored all the money. As we noted, it didnıt. Yet no
government delivered program is dearer to Canadians than Medicare
and none is more central to their physical well being.
I came to this hearing prepared to hear the assertion that ³we
canıt afford to spend any more money on health care.²
In answering that question, first I want to ask who is ³we²?
Two-thirds of Canadians, according to a May Ipsos-Reid[13] poll,
would be willing to forego tax cuts to increase the number of
nurses. Furthermore, 9 in 10 would cut direct aid and tax breaks
to business to increase the number of nurses on the job.
And letıs not forget, without cutting a thing, the federal
government does have the money. The surplus Canada is
experiencing is a whopping 19.8 billion (yes, billion!)
dollars.[14]
Besides whatıs the alternative? Longer waiting lines and more
de-listing of services? Or is the alternative more private
clinics, like eye clinics and day surgery clinics and cancer
treatment clinics? Or will it mean Aetna and Liberty and Humana
and all their private bills will become a part of our daily
lives? Are Canadians really ready for that?
The terrible thing is that they might. Canadians just might
accept expensive, inefficient, bureaucratic, for-profit,
bottom-line driven private care if government doesnıt act to
restore all of the funds cut in the 1990s.
For the sake of the health of the people who comprise our
economy, and for the sake of their children, I hope, Mr Chairman,
the finance committee can recommend restoring the funding cut
from Medicare in the 1990s.
The most important reform to Medicare could be a future emphasis
on prevention. Why do I say this? Because as nurses and citizens
of this country we know that healthy people get sick
unnecessarily.
The names ³Walkerton² and ³Battleford² come to mind. But also
Sydney, Nova Scotia where toxic waste has made people sick for a
generation. And the dozens of toxic ³hot spots² along the
Canadian side of the great lakes. And what about the air in our
cities that is so polluted during the summer that the elderly,
the very young and people with respiratory diseases are regularly
warned to stay inside.
I want to ask you as leaders of this country: Where will this
stop?
Do we have to become, environmentally speaking, Mexico City
before we say ENOUGH!!
Budget cutbacks decimated regulatory enforcement. A lack of
action on progressive environmental reform has left us worse off.
After all, we have more people and more cars and an even greater
output of industrial pollution.
What will this Parliamentıs legacy be in this area? Our
environment is our health. Besides our children, it is our most
precious possession, our dearest asset.
It desperately needs attention now and Iım sure that with the
kind of realistic accounting that (Iım getting abstract here)
³internalizes² some of the now ³externalized² environmental
costs, weıll save taxpayers lots of money in the medium
term.[15]
The same point needs to be made about the cuts to some vital
social or ³people² programs. Housing, early childhood
nutrition, care and education programs insure that many Canadians
donıt become early and sometime catastrophic patients in our
health care system.
Sure leaders of a ministry or a level of government can brag
about the money that they have saved taxpayers through massive
budget cuts. But in reality, they have just shifted the cost to
another ministry or level of government. In effect, all they have
done is get working Canadians to pay the bill out of another
pocket.
We believe that Canada should run a tight fiscal ship. We believe
that this includes paying down the debt because we know the debt
is a bill that grows unless we pay it down.
But thatıs not the only bill that grows without action. Little
bodies that donıt get enough nutrition regularly grow sick.
People without housing get sick and need expensive medical care.
Children and adults without preventative health education and
other health maintenance programs need the system more and
thatıs a shame. Itıs a burden for them and a loss for our
society.
So while we put billions of dollars on the debt, when at the same
time we ignore acute environmental and social problems, we may be
doing nothing more than shifting the costs, hiding the bill --
and thatıs potentially a much bigger bill. Bigger in many ways.
This shift is bad for kids and their parents. And it gives all of
us, as a nation, a sense that mean- spiritedness is what the
Canada of the 1990s and the new century is all about.
I heard a teenager say recently, ³We used to care, but we donıt
anymore.²
Is that where weıre going? Is that the vision of this
Parliament? Is this your legacy to our children? I donıt think
so and if Iım right, weıll know it by your actions in the
next few months. Nurses, patients and the rest of Canada are
waiting for leadership your leadership.
Let me leave you with the three most important points I have to
make:
1. Fully restore the funding cut from our
health care system in the 1990s. With the possible exception of
spending to meet the rapidly rising cost of pharmaceuticals,
there is NO SPENDING CRISIS.
2. Restoring funding is not enough! To improve
Medicare, restored funds must be accompanied by a large dose of
accountability. Strings must be attached to ensure that funds are
spent to sustain health care providers, the system within which
we work, and to truly improve patient care.
3. Lastly, many environmental and social
programs are health maintenance and disease prevention programs.
Cutbacks made to them in the 1990s didnıt save taxpayersı
money, they simply shifted and delayed the bill.
Canadians fought to make our country healthier through Medicare,
and through social, environmental and other government-initiated
actions. Now we must fight to restore and improve them.
The founders of Medicare merit the tribute, and our parents and
our children deserve no less.
Thank you.
[1] Centre for Health Services & Policy Research, University
of British Columbia, Armine Kazanjian et al., ³Nursing Workforce
Study², Volume III, April 2000, table 18.
[2] Health Affairs, May/June 2001, Linda Aiken et al., Nursesı
Reports on Hospital Care in Five Countries, Exhibit 1, p. 46.
Nurses are quitting their jobs at a remarkable rate too. This
five country study of 43,000 nurses found that one-in-six
Canadian nurses working in hospitals plan to quit in the next
year. Even worse, among nurses under 30, that figure rises to
almost one in three.
[3] This projection by the Canadian Nurses Association (an
umbrella of nurse licensing bodies) takes estimated graduations
into account.
[4] High rates of illness and high turnover in nursing leaves a
10 per cent vacancy rate. This results in nearly 20 per cent of
nursing care being provided on overtime provided by tired and
sometimes exhausted nurses.
[5] Nurses are responsible for the lives of men, women and
children, yet accountants make more money. According to 1996
Government of Canada census data, the average income of full
time/full year accountants is 18 per cent higher than registered
nursesı average. A better comparison may be all (full &
part-time) accountants versus all (full & part-time)
registered nurses because, then as now, a large minority of
nurses worked part-time full time jobs were unavailable. In
this case, accountantsı average income is 28% higher than
nursesı. Over an entire career, a nurseıs income grows by 36%,
as compared to an accountant whose income will grow 193%.
[6] In the inquiry into twelve infant deaths at the pediatric
cardiac unit at the Winnipeg Health Sciences Centre, Justice
Murray Sinclair wrote:
³... the experiences and observations of the nursing staff
involved in this program led them to voice serious and legitimate
concerns. The nurses however were never treated as full and equal
members of the surgical program, despite the fact that this was
the stated intent ... the attempted silencing of members of the
nursing profession, and the failure to accept the legitimacy of
their concerns, meant that serious problems in the pediatric
cardiac surgery program were not recognized or addressed in a
timely manner.²
The Justice goes on to recommend that:
³the Province of Manitoba consider passing ŒWhistle
Blowingı legislation to protect nurses and other professionals
from reprisals stemming from their disclosure of information
arising from a legitimately and reasonably held concern over the
medical treatment of patients.²
Murray Sinclair, Associate Chief Judge, The Report of the
Manitoba Pediatric Cardiac Surgery Inquest: An Inquiry into the
Twelve Deaths at the Winnipeg Health Sciences Centre in 1994, The
Provincial Court of Manitoba, Chapter Ten: Treatment of Nurses.
[7] US employers often provide tuition and paid time-off for
nursesı continuing education. The Republic of Ireland has
eliminated nursing school tuition in order to deal with their
nursing shortage. Neither approach is taken in Canada. The CFNU
in conjunction with the Canadian Labour Congress is asking the
federal government, as a first step, to let nurses and nursing
students use Employment Insurance to support their education
efforts.
[8] Hospital Quarterly, November 2000, Judith Shamian, Michael
Villeneuve, 2000, p. 16. Nurses are sicker than any other worker
in the country. In fact, 8.4 per cent of nurses are absent from
work due to illness each week thatıs twice the national
average.
[9] Health Affairs, May/June 2001, Linda Aiken et al., Nursesı
Reports on Hospital Care in Five Countries, Exhibit 1, p. 46.
Nurses are quitting their jobs at a remarkable rate too. This
five country study of 43,000 nurses found that one-in-six
Canadian nurses working in hospitals plan to quit in the next
year. Even worse, among nurses under 30, that figure rises to
almost one in three.
[10] Michael Rachlis, MD, et al., Revitalizing Medicare: Shared
Problems, Public Solutions, Tommy Douglas Institute, January
2001, p. 6
[11] Dr Gordon Guyatt, The Globe and Mail, 9 April 2001. Guyatt,
MD, is a spokesperson for the Medical Reform Group and a
professor of medicine at McMaster University in Hamilton,
Ontario.
[12] The New England Journal of Medicine, S. Woolhandler & D.
Himmelstein, 1997, ³Cost of Care and Administration at
For-Profit Hospitals in the US²; 336: 769-74
[13] Globe and Mail, ³Canadians choose nurses over tax cuts,
poll shows², 31 May 2001, A7 national edition. Ipsos-Reid is one
of the largest pollsters in the country and the officials poll
taker for the Globe and Mail and CTV
[14] The Fiscal Monitor, Department of Finance, The Government of
Canada, May 2001, p. 1
[15] Like the victims of big tobacco companies, the cost of
helping, healing and compensating the victims of toxic poisoning
from the now defunct coke ovens at Sydney, Nova Scotia will be
born by taxpayers and, of course, the individuals themselves.
Prominent economists have argued for years that these costs
should be seen as an integral part of the cost of production and,
therefore, should be charged against profits. In effect, this
would ³internalize² the heretofore ³external² cost. Itıs
also argued that this approach to cost accounting should be
extended to all polluting processes.
---------------------------
<http://www.stuff.co.nz/inl/index/0,1008,855692a1934,FF.html>
by Lois Watson
07 July 2001
The health sector is haemorrhaging staff as medical professionals
quit New Zealand to escape the stress of long hours, too few
workers, and not enough funding.
Nationally radiotherapists, anaesthetists, psychiatrists,
emergency medical specialists, some surgeons, junior doctors,
rural doctors, and nurses are in short supply.
Some hospitals are being forced to cut back services because of
the staff shortages and patients in some specialist areas,
including oncology, are being left languishing on waiting lists
for months.
New Zealand's premier heart hospital, Green Lane, is struggling
to find enough house surgeons (first-level junior doctors) to
cover shifts and is facing legal action over its plans to put
registrar doctors on call for 48 hours at weekends.
Resident Doctors' Association general secretary Deborah Powell
said Auckland's public hospitals were short of about 20 house
surgeons, but other areas were suffering more.
Christchurch Hospital is short of nine junior doctors, but chief
of medicine Kelvin Lynn said that was not unusual for this time
of the year.
The start of winter usually heralded an exodus of young doctors
to the United Kingdom and it was often two or three months before
replacement doctors came on board.
Dr Lynn said the shortage of junior doctors was not impacting on
the hospital's ability to deal with the heavy winter patient
load.
"It's not had an adverse effect on our ability to open extra
beds at Christchurch Hospital and Princess Margaret," Dr
Lynn said.
Association of Salaried Medical Specialists executive director
Ian Powell said the nationwide shortage of house surgeons was
impacting on the ability of senior doctors to do their job.
"Having registrar support is one of the most critical things
you need to do the job properly and to reduce the stress of the
job," Mr Powell said. "Senior doctors are finding they
have less cover and less support than in the past."
The lack of staff and the severe funding constraints placed on
the public hospital system meant frustration levels were running
high. That made it hard for senior doctors to say no to the
"seductively tantalising offers" they received from
overseas.
Mr Powell said the shortage of medical specialists and other
health professionals in New Zealand was a side-effect of the
failed health reforms of the 1990s and the lack of workforce
planning during that period.
If the Government was serious about stemming the tide of health
professionals leaving New Zealand, it had to look seriously at
improving public funding for hospitals, reducing student fees,
and improving employment conditions.
Nurses' Organisation president Diane Penny said low pay rates for
nurses meant many were leaving the profession or heading overseas
to take up lucrative contracts.
That left hospitals here increasingly reliant on inexperienced
nurses, who lacked the skills necessary to deliver high-quality
care.
Experienced nurses still working in the public hospital system
were placed under enormous pressure and a growing number were on
indefinite sick leave because of stress-related illnesses.
"Nurses have many, many skills that they can carry to other
careers and they are increasingly doing so," Ms Penny said.
İ Independent Newspapers Limited 2001. All the material on
this page has the protection of international copyright. All
rights reserved
---------------------------
Don DeMoro: Engineering a crisis: How hospitals created a
shortage of nurses
Revolution Magazine, March-April, 2000, Vol.1 - No.2
<http://www.revolutionmag.com/newrev2/engineering.html>
-----------------------------
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