CDN/US Covid-related political discussion

[mariomike]

This worked for a brief period of time when the Boomers were still working and we didn't have shortages in labour. We also didn't train many people for a few decades because we had those positions filled with Boomers who were quite secure in those jobs. Now we no longer have those employees as they have retired, and we don't have the replacements needed because we set the bar too high for too long.

Times have changed since this "boomer" hired on.

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The 'Baby Boom' generation is aging. As it does so, all of those 'boomers' become net consumers of health care, driving up demand for services. Simultaneously, all of those 'boomers' employed by the service in the early 1970s are reaching the end of their careers and retiring. Since subsequent generations are typically much smaller, the service is experiencing difficulty in recruiting suitably trained replacement staff, just as demand for services is increasing.

The "Surge" has been a long time coming.

 

[PMedMoe]

Only because we make it require a 4 year degree.

There is no reason we could not have a apprenticeship style program (worked for at least 100 years), as a society we CHOOSE to require a 4 year degree. Much like the skilled trades, these shortages are self made. We have set the requirements too high to get people into them, to pay for a education based economy which doesn't need to exist (the 4 year nursing degree is basically a 4 year apprenticeship we make the students pay for instead of being paid a wage well getting trained).

This worked for a brief period of time when the Boomers were still working and we didn't have shortages in labour. We also didn't train many people for a few decades because we had those positions filled with Boomers who were quite secure in those jobs. Now we no longer have those employees as they have retired, and we don't have the replacements needed because we set the bar too high for too long.

This is all solvable, it just requires some sacred cows to be slaughtered.

Well, it's probably not going to change overnight, just because people think it should (or not).

Interesting article: A change in who can offer degrees aimed to stave off Ontario’s nursing crisis. Here’s why it might not be that simple

 

[brihard]

So, I’ll just throw out there that if you don’t realize that bare completion of a nursing degree and being a brand new RN is not interchangeable with an experienced and qualified critical care nurse, maybe you aren’t the person who should be trying to say “here’s what they need to do”.

They HAVE been training and upskilling new nurses at all levels. A good buddy of mine is a CAF nurse, completed his critical care training during the pandemic and is working in a civilian ICU. The thing is, this training stream isn’t like ramping up a battle school. We can throw a bunch of 17 year olds at a gaggle of 21 year olds supervised by a 28 year old, with some ground sheets and a MILCOTS, and a month later the system shits out another 30 infantry soldiers. Training critical care nurses is marginally more complex than that.

I imagine that, difficult as it would be to ramp this training up at the best of times, it’s probably harder still when you need every qualified body you’ve already got to work the ICUs.

 

[lenaitch]

Only because we make it require a 4 year degree.

There is no reason we could not have a apprenticeship style program (worked for at least 100 years), as a society we CHOOSE to require a 4 year degree. Much like the skilled trades, these shortages are self made. We have set the requirements too high to get people into them, to pay for a education based economy which doesn't need to exist (the 4 year nursing degree is basically a 4 year apprenticeship we make the students pay for instead of being paid a wage well getting trained).

This worked for a brief period of time when the Boomers were still working and we didn't have shortages in labour. We also didn't train many people for a few decades because we had those positions filled with Boomers who were quite secure in those jobs. Now we no longer have those employees as they have retired, and we don't have the replacements needed because we set the bar too high for too long.

This is all solvable, it just requires some sacred cows to be slaughtered.

Such is the nature of changing society. A hundred years ago, a nurse probably changed beds, changed bandages, took your temperature and little-to-no initiative regarding care decisions. Now there are nurses (NPs) who can prescribe drugs. Fifty years ago, an 'ambulance attendant' had basic first aid and scooped you up for a drive to the hospital.

In Ontario a Registered Practical Nurse is a four semester (two year) college program. If we want nursing to return to an 'on-the-job' apprenticeship, we need sufficient certified nurses in the hospitals to teach, monitor and mentor. No doubt the learning part has shifted from hospitals to schools, but at least those that hit the floor of the ward aren't 'day-oners'.

 

[Czech_pivo]

Is the bolded section perhaps part of the nursing shortage problem?

Did we raise the bar too high when times were good, expecting times would never be bad?

Also, how much of the issue with getting, and retaining nurses is conditions of work? I've been told that in some provinces new nurses get stuck on-call, or only working night, weekends, and holidays. How do you attract, and keep talent when they get treated like that?

This is what hospitals in Windsor, and mostly likely all border regions, have to compete with. When is the last time (or any time) a CDN hospital paid this type of bonus for a RN?

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At least 1,500 Canadians work in healthcare in Michigan.

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Hmmm, wonder what another 1,500+ healthcare workers could do for Ontario. I dare say another significant amount cross over to Buffalo/Niagara Falls NY daily.

 

[Blackadder1916]

I imagine that, difficult as it would be to ramp this training up at the best of times, it’s probably harder still when you need every qualified body you’ve already got to work the ICUs.

One of the other factors to consider in nursing (and medical) education is the requirement for a comprehensive practicum (more so for medical specialty training). While there may be plenty to do in hospitals during the pandemic, the focus (or at least the public attention) is on a singular condition - Covid19. Here is one journal article that discusses the issue.

What is the impact of the COVID-19 pandemic on residency training: a systematic review and analysis - BMC Medical Education

Background The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and...

bmcmededuc.biomedcentral.com

The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns in all fields. Although the publication of original studies investigating the effect of the COVID-19 pandemic on residency training is increasing, as of this writing, no study has compared the learning outcomes of residents between prepandemic and pandemic periods. Further study should be focused on the learning outcomes of residency training during the epidemic and evaluate the effectiveness of assisted teaching methods.

 

[Jarnhamar]

We can throw a bunch of 17 year olds at a gaggle of 21 year olds supervised by a 28 year old, with some ground sheets and a MILCOTS, and a month later the system shits out another 30 infantry soldiers.

Like pressing [M] on Starcraft.

 

[Brad Sallows]

All arguments about the difficulty of "X" accepted. None are excuses for not starting now.

 

[YZT580]

If you consult the roster of any of the hospitals in the Trenton area you will find that the staffing numbers for full-time are far below what are required. Hospitals maintain a minimum of positions and fill out the rosters with occasional workers: not even part-time. This way they can save on benefit costs. Well guess what-it doesn't work during a pandemic. If hospital managers had introduced proper staffing levels even 2 years ago when all this started we could be seeing daylight at the end of the tunnel. They didn't. Teachers got, what, an 8% raise. Nurses got 1. Nurses had their leave cancelled. Nurses have ordered to report for work, regardless of COVID testing results. You reap what you sow.

 

[brihard]

Teachers got, what, an 8% raise. Nurses got 1.

God no. Bill 124 capped teachers too, they’re limited to 1% raises as well, and I believe most if not all of the Ontario teachers unions have signed new collective agreements under this.

With inflation at 4.4% and pay raises limited to 1%, our provincial government has effectively cut nurses’ pay by about 3% per year in a pandemic (and teachers too). They’re not getting my vote again, not if they think that kind of slap in the face to our nurses is the right thing to do.

 

[Eaglelord17]

So, I’ll just throw out there that if you don’t realize that bare completion of a nursing degree and being a brand new RN is not interchangeable with an experienced and qualified critical care nurse, maybe you aren’t the person who should be trying to say “here’s what they need to do”.

They HAVE been training and upskilling new nurses at all levels. A good buddy of mine is a CAF nurse, completed his critical care training during the pandemic and is working in a civilian ICU. The thing is, this training stream isn’t like ramping up a battle school. We can throw a bunch of 17 year olds at a gaggle of 21 year olds supervised by a 28 year old, with some ground sheets and a MILCOTS, and a month later the system shits out another 30 infantry soldiers. Training critical care nurses is marginally more complex than that.

I imagine that, difficult as it would be to ramp this training up at the best of times, it’s probably harder still when you need every qualified body you’ve already got to work the ICUs.

Obviously a new RN is not interchangeable with one which is experienced. Here is the problem though, we lack the experienced ones and the only way to get experienced ones is to have a new one at some point who can grow to become experienced. Will they be as competent immediately? No. Is it better to have someone learning than no one at all? Yes.

Our training system in this country for most skilled trades is broken at best, be it Nurses, Millwrights, Mechanics, Machinists, etc. These shortages didn't appear overnight and they were decades in the making. Now we are shocked and awed that it is actually happening.

It is driven by unions trying to keep the jobs exclusive/pay high, teachers who are trying to protect their jobs, and employers who don't want to train employees rather hire someone who is already trained.

Apprenticeships work. They have always worked. Many of the boomers who have retired did apprenticeships for their nursing, not a degree. If it worked for them why can it not work now? And obviously it isn't going to fix the problem today, the skill gap is to large. But it can reduce the problem even if it means the basic tasks get covered by the apprentices freeing up the trained nurses for the more skilled tasks.

 

[mariomike]

Fifty years ago, an 'ambulance attendant' had basic first aid and scooped you up for a drive to the hospital.

Guess it depends on the province, and municipality.

The municipality I joined fifty years ago, come this September, required advanced first-aid to apply. Once hired, you took their four-week 160-hour training course that became standard in 1967.

Admitedly, that wasn't much. But, the next year, 1973, required a one-year community college course. Then two years mandatory. Now four. I don't think the four-year course is mandatory, yet. But, it helps your application.

My ex-wife is a nurse ( still working ) and has all sorts of degrees. I lacked her ambition.

In Covid news, the mayor announced today that "Toronto’s paramedic service had an “unplanned absence rate” of 13.1 per cent Tuesday".

That's pretty high. But, at one point years ago, there were slightly over fifty per cent of us on quarantine.

 

[Booter]

I won’t support any legal requirements for vaccination. I am all about the vaccines and the science etc. I’d do anything to assist my elderly family members, who are also vaccinated. I use my sanitizer and masks and I support vaccines for people working with vulnerable populations or in peoples houses and the like.

But I don’t support this legal stuff. I don’t care if it’s not holding folks down. I don’t dig on this new talk at all.

There is no place or alternative to escape the state- so I don’t support this.

 

[Furniture]

So, I’ll just throw out there that if you don’t realize that bare completion of a nursing degree and being a brand new RN is not interchangeable with an experienced and qualified critical care nurse, maybe you aren’t the person who should be trying to say “here’s what they need to do”.

They HAVE been training and upskilling new nurses at all levels. A good buddy of mine is a CAF nurse, completed his critical care training during the pandemic and is working in a civilian ICU. The thing is, this training stream isn’t like ramping up a battle school. We can throw a bunch of 17 year olds at a gaggle of 21 year olds supervised by a 28 year old, with some ground sheets and a MILCOTS, and a month later the system shits out another 30 infantry soldiers. Training critical care nurses is marginally more complex than that.

I imagine that, difficult as it would be to ramp this training up at the best of times, it’s probably harder still when you need every qualified body you’ve already got to work the ICUs.

Nobody here was claiming to be an expert in nursing, but it doesn't take an expert to see the system failed us. When a system fails, people ask questions.

One of the first things we ask in the CAF when the training system isn't producing enough of ____ is; can we make the training shorter, and still maintain the essential skills?

Can initial nursing training be made shorter, while still maintaining the essential skills? Is a four year degree required? Could some academics be cut, to provide more focus on practical? If so, it could help get more people in the door, to start on the long road to becoming critical care nurses.

I don't pretend to have the answers, I'm simply asking questions.

 

[brihard]

Nobody here was claiming to be an expert in nursing, but it doesn't take an expert to see the system failed us. When a system fails, people ask questions.

One of the first things we ask in the CAF when the training system isn't producing enough of ____ is; can we make the training shorter, and still maintain the essential skills?

Can initial nursing training be made shorter, while still maintaining the essential skills? Is a four year degree required? Could some academics be cut, to provide more focus on practical? If so, it could help get more people in the door, to start on the long road to becoming critical care nurses.

I don't pretend to have the answers, I'm simply asking questions.

What you’re describing sounds like the “Registered Practical Nurse” licensing. In Ontario that’s a two year program offered by most of the established colleges. They have a lesser scope of practice than the degrees RNs, although during the pandemic my understanding is that the province or the nursing College have looked to expand that. So yes, it does already exist and is in play.

In the ICUs, for quite some time now, non-critical care nurses have been filling in under a model where trained critical care nurses help supervise them through nursing tasks they can do. A lesser number of critical care nurses are still on hand. This is a significant reduction in the standards of care - it’s supposed to be on critical care nurse per patient - but they’re making do as best they can under the exigencies of the situation.

They will also be throwing nursing students (I read third year and up) who are willing into clinical roles, and expediting the accreditation of already trained international nurses. I think it’s fair to say ‘the system’ has been and is making considerable efforts to make this work and get through it.

Once this is over, I think a serious AAR needs to happen. One of the conclusions will likely be that the provincial government’s fierce quest for efficiency in our healthcare system (read: cost cutting) has left it less able to withstand a massive system wide pressure like this. They may have cut a bit too far and a bit too deep than was healthy.

 

[SeaKingTacco]

But, what do we do about about runaway health care costs? Most Provinces are already spending north of 60% of their budgets on health care, accelerating at an unsustainable 5-8% per year.

I think we need look at the whole thing and re-think how we do a whole bunch of stuff.

 

[brihard]

But, what do we do about about runaway health care costs? Most Provinces are already spending north of 60% of their budgets on health care, accelerating at an unsustainable 5-8% per year.

I think we need look at the whole thing and re-think how we do a whole bunch of stuff.

To an extent, I’d say that’s a demographic inevitability. The baby boomers have entered or are entering peak healthcare consumption age, and are largely out of the workforce. There were always going to be supply and demand issues there.

 

[lenaitch]

What you’re describing sounds like the “Registered Practical Nurse” licensing. In Ontario that’s a two year program offered by most of the established colleges. They have a lesser scope of practice than the degrees RNs, although during the pandemic my understanding is that the province or the nursing College have looked to expand that. So yes, it does already exist and is in play.

In the ICUs, for quite some time now, non-critical care nurses have been filling in under a model where trained critical care nurses help supervise them through nursing tasks they can do. A lesser number of critical care nurses are still on hand. This is a significant reduction in the standards of care - it’s supposed to be on critical care nurse per patient - but they’re making do as best they can under the exigencies of the situation.

They will also be throwing nursing students (I read third year and up) who are willing into clinical roles, and expediting the accreditation of already trained international nurses. I think it’s fair to say ‘the system’ has been and is making considerable efforts to make this work and get through it.

Once this is over, I think a serious AAR needs to happen. One of the conclusions will likely be that the provincial government’s fierce quest for efficiency in our healthcare system (read: cost cutting) has left it less able to withstand a massive system wide pressure like this. They may have cut a bit too far and a bit too deep than was healthy.

The problems with AARs, 'lessons learned', de-briefs, etc. include: (1) policy makers don't want to be accountable and will wrap themselves in privilege , (b) the folks at the bottom of the pile don't want to play because they know how things go, (c) if it a formal process everybody lawyers-up, and (d) they become public and any hint of 'we could have done X better' makes certain civil injury lawyers salivate. I can them possibly happening at a local level, like an individual hospital, as a management exercise, but not on a large-scale or coordinated way.

In my former life, we used to do formal de-briefs on major operations, until defence started demanding they be included in disclosure. We started holding them off until court was done but, given the speed of our justice system, they became kinda pointless.

 

[YZT580]

God no. Bill 124 capped teachers too, they’re limited to 1% raises as well, and I believe most if not all of the Ontario teachers unions have signed new collective agreements under this.

With inflation at 4.4% and pay raises limited to 1%, our provincial government has effectively cut nurses’ pay by about 3% per year in a pandemic (and teachers too). They’re not getting my vote again, not if they think that kind of slap in the face to our nurses is the right thing to do.

I'll call you on that. While it is true that the "salary" increase was limited to 1% they have broken things down into time in service so that the increases are annual and they are large. The following is taken from a web site called salary explorer.
An Elementary School Teacher with less than two years of experience makes approximately 57,000 CAD per year.

While someone with an experience level between two and five years is expected to earn 76,500 CAD per year, 34% more than someone with less than two year's experience.

Moving forward, an experience level between five and ten years lands a salary of 99,400 CAD per year, 30% more than someone with two to five years of experience.

So you see, teachers are being well compensated. Now lets get back to giving our nurses a decent salary.

 

[Brad Sallows]

With inflation at 4.4% and pay raises limited to 1%, our provincial government has effectively cut nurses’ pay by about 3% per year in a pandemic (and teachers too).

Cheer up. Private sector jobs have been hit with "effective cuts" (raises < inflation) most years going back to 2008 recession.