Public inquiry will lead to better care

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By Doris Grinspun

It was a tragic day for the nursing profession when news broke last October that former RN Elizabeth Wettlaufer would be charged with the murders of eight elderly Ontarians using a lethal dose of insulin in each case. She was also charged with four counts of attempted murder and two counts of aggravated assault. As details emerged about this serial killer, RNAO and its members were outraged that a colleague could commit such a gross violation of the most sacred principle of our profession – the unwavering commitment to ensure the well-being of patients and their families.

RNAO began advocating for a full public inquiry when the former RN pleaded guilty to the murders in early June. As the only nursing organization to issue this call, we spoke to the media, sent letters to political leaders, and circulated two action alerts urging members to voice their outrage. More than a thousand people joined us in demanding answers to what happened, how it happened, and what can be learned from an organizational, regulatory and system perspective to ensure nothing like this ever happens again.

On June 26, the same day Elizabeth Wettlaufer was sentenced to life in prison with no chance of parole for 25 years, the government announced it would launch a public inquiry. The details of that inquiry were revealed on Aug. 1, and nurses across the province are applauding the government for having the courage to put this tragedy under the microscope.

We are especially pleased that Premier Kathleen Wynne, Attorney General Yasir Naqvi and Health Minister Eric Hoskins have heeded our calls for an inquiry with a broad mandate. We are now urging Justice Eileen Gillese, a sitting judge with the Ontario Court of Appeal since 2002, to make full use of this broad mandate as the inquiry’s commissioner. She must look at anything and everything that might have contributed to this horrific tragedy. RNAO is also urging Justice Gillese to look beyond this particular case and make recommendations to address the failings of our long-term care system, including examining legislation and regulations, funding models and staffing, and any other aspects required to create a safer environment for seniors living in nursing homes.

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RNAO has received numerous calls from nurses who have revealed to us that things are just not right in their nursing homes. They have told us patients are not turned as often as necessary, and some sleep all night in the same soiled diapers. We have thanked each caller for their courage to disclose the truth. And we are urging others to continue to share their concerns with us. We know the vast majority of nurses – RNs, RPNs and NPs – go to work wanting to do good and wanting to deliver safe, quality care. The staffing circumstances, however, are deficient, if not deplorable.

Older persons deserve the best evidence-based care we can provide. Their vulnerability is greater than ever as they arrive in long-term care older and frailer, and with more cognitive deterioration. And yet, the funding and staffing models in the sector are archaic.

By legislation, only one RN is required per nursing home in Ontario. Some nursing homes have as many as 300 residents. This is outrageous and unacceptable.

Funding models in long-term care penalize nursing homes for improving patient outcomes. RNAO has been going into long-term care homes across this province for many years with best practice guidelines (BPG) that teach regulated and unregulated staff about preventing pressure injuries, preventing falls, managing incontinence, reducing the use of restraints, and so much more. These homes are funded on the basis of complexity of care. This means that when our BPG recommendations are implemented and patient outcomes improve, care becomes less complex and funding is decreased. This too is outrageous and unacceptable.

We need to bring funding and staffing models into the 21st century, and a public inquiry will help us do that. We also need to delve more deeply into when and how regulatory colleges tackle disciplinary issues. We now know that Wettlaufer was fired in 2014 for making a number of medication errors, but was not investigated by CNO at that time. A disciplinary hearing this July also revealed the former nurse was investigated for stealing medication in 1995. How was she able to continue to practise despite these red flags? We need to muster the courage to look in the mirror and learn.

The tragic murders of eight Ontario seniors will forever remind us that health professionals are in a very privileged position. Nurses enjoy higher public trust than any other profession. We must cherish that trust by leaving no stone unturned.  This public inquiry is our collective opportunity to do just that.

Doris Grinspun, RN, MSN, PhD, LLD (hon), O.ONT, is chief executive officer for RNAO. Follow her on Twitter @DorisGrinspun This column was originally published in the July/August issue of Registered Nurse Journal.