Recommendation to replace higher-educated nurses with cheaper staff could backfire, nurses warn

Nursing experts say some cost-saving recommendations put forward in an external review of Alberta Health Services could lead to worse patient outcomes.

Cheaper care doesn't mean better care, says United Nurses of Alberta president

Nurses are speaking out against an external review of AHS which recommends reducing staffing levels and using more LPNs and health-care aides in place of RNs. (Jean-Paul Pelissier/Reuters)

Nursing experts say some cost-saving recommendations put forward in an external review of Alberta Health Services released Monday could lead to worse patient outcomes.

"I believe the recommendations they made are going to be counterproductive," Mount Royal University nursing professor Cathy Carter-Snell said.

"I absolutely agree that costs have to be reduced … but making the changes the way they're suggesting will actually, the research has shown, cause an increase in workload and increased costs indirectly in terms of length of patient stay and complications."

The review of AHS, conducted by consultants Ernst & Young, contains 57 recommendations and 72 savings opportunities.

If every recommendation was implemented — which the health minister has said won't happen, as recommendations include items like shutting down hospitals — AHS could save up to $1.9 billion per year, the review states.

One recommendation is to reduce the number of registered nurses (RNs) in favour of licensed practical nurses (LPNs) or healthcare aides, or reduce staffing levels overall, which could save up to $322 million. 

Carter-Snell said while RNs are more expensive, they have two years more education than LPNs which helps with the complex multi-system problems many patients have — especially the elderly. 

She said a simple example is a situation where a patient appears to be going into shock. An LPN would know how to administer the fluids and monitor vital signs, but may not recognize a patient has a heart-valve problem which would change some details of the intervention — or lead to complications and further care being required.

Carter-Snell said LPNs receive two-year training that RNs used to receive. 

"I've worked with some wonderful LPNs and this is not a put-down of them at all," she said.

"We're not recognizing that with the RNs versus the LPNs, they work wonderfully together, but they have different skill sets. They can both do the same tasks in most cases, but it's the critical thinking, the complex problem-solving and the deeper path of physiology and pharmacology that they're applying to these acute patients."

Here's how much is spent on health care, per capita, across Canada, according to Ernst & Young's Alberta Health Services review. (Ernst & Young)

"We're already at peak workload," she said, adding that she's writing a letter to the health minister outlining her concerns.

United Nurses of Alberta president Heather Smith also voiced concerns with the review.

She said some issues like reducing overtime have already been tabled during bargaining. 

"It's very discouraging and I think will anger a lot of nurses and other health-care workers that the government seems to be using this vehicle to take aim at health-care and other public sector workers," she said. 

"It's not simply a matter of an accountant saying if we change this, we can get cheaper care. That doesn't mean you're getting better care. In fact, I suggest you won't but you will get perhaps cheaper care."

You have to pay [nurses] what the going rate is in the labour market.- Gil McGowan, AFL president

Smith also pointed out that while health-care workers in Alberta are paid more than their counterparts in other jurisdictions, that's true of many industries in the province. 

That's a statement Alberta Federation of Labour president Gil McGowan agrees with.

"This notion that we can pay nurses, for example, what they get paid in New Brunswick, it's ridiculous. You have to pay what the going rate is in the labour market — you're not in a fantasy labour market," he said. 

The review also found AHS has higher levels of staffing across all units when compared with leading practices and other provinces. 

Ernst & Young said the staffing level comparison looked at three factors: National Health Services benchmarks in the U.K., internal variation across AHS, and Ernst & Young's experience with similar clients. That finding was validated by Canadian Institute for Health Information data in Ontario, B.C., New Brunswick and Nova Scotia, a provincial spokesperson said in an emailed response.

AHS has said it is looking at all the recommendations and opportunities in the report and will develop a detailed plan by May. 

Health Minister Tyler Shandro has said any savings found will be reinvested in health services.

With files from Jennifer Lee