COVID-19 has highlighted the longstanding cracks in Ontario’s long-term care (LTC) system. With increased attention on the sector, and the Ontario government commiting to launch an independent commission to examine key issues, WeRPN will be pushing for meaningful change to ensure all residents have access to excellent quality care. Currently, RPNs account for over two-thirds of the nursing staff in long-term care and have a robust body of clinical knowledge and experience. So we wanted to ask those on the frontlines delivering care what is working well and what ideas they have to improve quality of care. Here is what some Ontario RPNs had to say about what they’d like to see change:
“I love my job and couldn’t see myself working anywhere else.”
Taneshia Harrison, RPN
“Currently in the midst of the COVID-19 pandemic, what is working well in LTC, is the care, compassion, teamwork, dedication, and commitment to gold standards of care by front line workers. After 10 years working in the sector, and despite the intensity of care needs, I love my job and couldn’t see myself working anywhere else! The close knit and intimate nature of LTC homes often means residents and their families think of nurses as family – and vice versa. LTC is a specialty that many nurses overlook, but it is one where you can make a genuine difference. It gives you the chance to develop valuable experience in assessment and critical thinking skills while building meaningful relationships (horizontally and vertically) across the continuum of care.
There is a need for increased operational funding by provincial, territorial and federal governments and operators to improve physical and organizational characteristics and to enable homes to increase the number of health care workers. This includes staffing ratios, staff training and specialized staff orientation education. This will give staff sufficient time to devote to the needs of each resident with an advanced level of comfort and skills in care provision.
Maintaining certain pandemic infection control measures is more essential than ever. This includes limiting health care workers to one workplace to reduce cross contamination between facilities or cohort staffing to units and resident home areas to reduce unnecessary resident exposure to contagions.
I’d also like to see more resident, family, and physician engagement to really think about the needs of the residents, and explore how nurses can play a stronger advocacy and navigator role in managing expectations.”
About Taneshia Harrison
Taneshia Harrison, RPN is a geriatric nurse, patient advocate, and nurse leader. She earned her nursing diploma from Centennial College. For the past 10 years, she’s overseen nursing care and her experiences as a Director of Health and Wellness, Resident Care Services Coordinator, Documentation Nurse/RAI Coordinator Backup, Clinical Practice Nurse, and Staff Nurse have shaped her practice to specialize in bridging healthcare gaps. She discovered her love of teaching through nurse leadership. As a Certified Professional Resume Writer, she helps others put their best foot forward.
“Everyday we make things happen behind the scenes in LTC.”
Emilija Stojsavljevic, RPN
“Every day we make things happen behind the scenes in LTC. We have passionate professionals caring whole-heartedly for our vulnerable sector. The creative approaches to care that nurses and personal support workers (PSW) deliver in the LTC sector is remarkable. Every day is rewarding and particularly challenging. We are constantly learning. As the complexity of medical diagnoses evolve, residents’ care needs are changing and increasing. We need the sector to evolve in response.
I believe it is time to review, reassess, and make changes happen in the LTC sector. Firstly, we need to assess appropriate staff levels to ensure we have the right mix of PSWs, RPNs, and RNs available to meet the individual needs of our seniors and provide safe, quality care to our residents. With complex medical diagnoses, current threats to seniors’ health such as COVID-19, and exacerbations in those with chronic conditions, now is the time to ensure the appropriate staff levels and mix of skills needed to provide safe care. Staffing levels must take into account the personalized needs of residents. For example, residents with mobility issues may require the assistance of two people. Fall prevention is an increasing priority. Alarms can’t replace people. In fact, equipment might be ineffective without the staff available to respond to alarms and address residents’ needs appropriately and in a timely manner.
I would also like to see the sector implement a full time Nurse Practitioner role in all facilities. Seniors admitted to LTC homes require a well-established, collaborative approach in their care. Having a full-time Nurse Practitioner in LTC homes provides daily opportunity to immediately address sudden health status changes in residents. This would alleviate the need for transfers to hospital, reduce resident and family stress, and reduce the strain on our acute care sector.
Finally, the COVID-19 pandemic has highlighted the need for more designated Infection Control leads. These experts could focus exclusively on infection prevention and control implementation, education, and ongoing monitoring of IPAC practices for all departments in LTC.”
About Emilija Stojsavljevic
Emilija Stojsavljevic is an RPN working in the long-term care sector in a role of a Resident Care Coordinator. Responsible for education and quality initiatives, Emilija makes countless contributions to resident care initiatives, mentors team members, embraces challenges, and plays an instrumental role in change with innovative ideas and her notable leadership skills.
She is focusing her strengths and energy to what matters the most – safe, compassionate, and excellent care for all.
“We use a multidisciplinary team approach when it comes to resident care.”
Sandra Osbourne, RPN
“In my setting, one of our strengths is the team approach and frequent huddles we have when resolving issues. This is key to delivering excellent care. We use a multidisciplinary team approach when it comes to resident care so the outcomes of our residents are much better. Families are regularly engaged and are ultimately happier with the care their loved one receives. Staff are much happier and feel valued when they can add to the discussion about the care needs of their residents. Staff also work better when they can quickly call a meeting to discuss any problem they have so that a delivery care plan of action can be implemented to benefit all.
Falls and aggressive behaviours of residents in long-term care homes are increasingly challenging situations we experience. Falls put residents at greater risk of injuries, or even death. Similarly, residents with aggressive behavior are at greater risk to themselves and others when triggers or potential risks are not properly identified.
I believe that to improve quality of care, a designated staff with added training in these areas should be assigned to the given situation. This staff could do the necessary overall assessment and investigation, working alongside the rest of the team to identify triggers or potential causes. The designated staff could then implement strategies based on findings and work with the team to help manage behavior and risk factors.”
About Sandra Osbourne
Sandra Osbourne is an RPN, teacher, leader and advocate. She has been working with City of Toronto Long-Term Care Homes and Services at Cummer Lodge for the past 23 years providing compassionate care on the behavioral unit for residents with dementia and their families. Her education and years of experience have equipped her to deliver exceptional care with a gentle persuasive approach. Sandra has been recognized with awards and is known as a “behavioral champion” at her workplace. She loves her job and is always committed to delivering excellent nursing care.
“More health professionals are required to provide the care our seniors need.”
Karen Bakker-Stephens, RPN
“Long-term care is a great environment as it provides many opportunities for RPNs to practice side-by-side with RNs as valued members of the healthcare team. One role for RPNs that is underutilized but works well is as admission and discharge coordinator. RPNs in this role use their assessment skills when reviewing potential files of new residents to ensure the resident being admitted can be cared for regardless of which registered staff is eventually assigned. This is a pivotal role that ensures that admitted residents have their care needs match the skill base of the staff in the home. The clinical judgement of RPNs can support any required interventions needed to support the new resident as they transition into the LTC setting. The collaborative approach for this role has provided an opportunity to increase the value of the RPN role within the leadership team.
Going forward, I would like to see more RPNs provided with growth and leadership opportunities in the sector. Having RPNs at the leadership table as Associate Directors of Care, or educators, or even Executive Directors provides the team with a more inclusive lens to ensure care is provided appropriately to residents.
RPNs provide a specialized, cost-effective option for delivering resident care in LTC. It is well known in the sector that more health professionals are required to provide the care our seniors need. RPNs generally outnumber RNs in many LTC homes and representation is crucial at the leadership table to ensure leadership success. The LTC sector has slowly provided leadership by giving RPNs opportunities to educate fellow nurses and personal support workers.
I would also like to see more RPNs receive their Geriatric Certification to validate their role and practice expertise.
It would be amazing if all RPNs were certified to assure the public that their care provider has taken the time to obtain the education to provide a very high standard of care to the residents they serve.”
About Karen Bakker Stephens
Karen Bakker Stephens is a nurse and educator. She has been an RPN since 1996 and is currently Executive Director of an LTC home in the Hamilton Area. Throughout her career, Karen’s nursing practice has focused on senior care in both the community setting as well as long-term care. Karen has also been a longstanding member of the Gerontological Nurses Association and WeRPN. Recently, she was part of the team that supported the development of the first-ever National Certification Exam for LPN and RPNs, focused on Gerontology and delivered by the Canadian Nurses Association.
