Delivery of long-term care (LTC) in Canada has been compromised for years, partly due to an ageing population and heavy workloads. In 2017, the Canadian Medical Association commissioned a report that revealed 199,000 additional LTC beds will be needed by 2035, costing billions of dollars. But how can we care for so many more patients in these facilities when LTC nursing staff are already stretched thin?
“The nursing workforce has been facing shortages for a long time, with the Canadian Nurses Association once predicting that we will be almost 60,000 nurses short by 2022,” said CHÉOS Scientist and UBC School of Nursing assistant professor Dr. Farinaz (Naz) Havaei. “These shortages have been exacerbated by the pandemic.”
Looking specifically at LTC, many nursing staff previously worked across several care facilities; however, with the advent of COVID-19 management policies, they had to make the tough decision to choose a single care facility to work at throughout the pandemic. In addition to its impact on individual staff members, the single-site employment policy had a notable effect on care facilities as a whole, with their pool of staff suddenly shrinking.
This hasn’t been the only LTC issue that the pandemic raised.
“The strict visitation policies prohibited family, friends, and volunteers from assisting residents with some of their day-to-day needs or even just socializing with them and comforting them, so these responsibilities fell solely to staff and hugely impacted their workloads,” explained Dr. Havaei. “In addition, enhanced infection prevention and control practices, like donning on and off PPE or having new residents in a 14-day isolation, being cared for on a one-to-one basis, impacted the amount of time staff had for other important duties.”
Dr. Havaei reflected that this has not just been an issue for the LTC nursing staff, but also the residents, many of whom are cognitively impaired. They may not know where they are, what’s going on, why they can’t see their loved ones, and why they can’t see peoples’ faces.
Improving workload management, improving care
What some knew before the pandemic, everyone knows now — something has to be done to improve the working environment for LTC staff, so that they can effectively meet residents’ needs.
“At present, LTC staffing decisions are based on arbitrary standards and economics rather than resident needs,” said Dr. Havaei. “Nursing shortages are a global issue, so recruiting new staff isn’t really a feasible option right now. To overcome this, we are trialling an intervention called the Synergy Staffing Tool (SST), which works with the existing staff and workloads rather than increasing them.”
The SST facilitates safe staffing and workload management through identifying and quantifying individual patient or resident needs and assigning staff based on their capacity and ability to meet them. The original model details a number of patient characteristics that demonstrate their needs, such as level of stability and vulnerability, along with a selection of predetermined nursing competencies, including clinical judgement and caring practices. The nursing competencies may be determined based on a nurse’s professional designation (e.g., registered nurse, licensed practical nurse, or care aide) and years of experience (e.g., new graduate nurse, mid-level nurse, or highly experienced nurse). Patient characteristics must align with the nursing competencies to achieve the best outcome possible.
The SST has already been successfully used in the hospital sector. A systematic review published in 2020 highlighted that, when used in acute care settings, the SST enabled positive care delivery experiences and outcomes for patients and health care providers, while reducing the cost of health care delivery. Further research in 2021 demonstrated how the tool helped nurses identify unsafe workloads and how, through quantifying patients’ priority care needs, it empowered them to provide the most suitable and safe care.
Dr. Havaei and her team are very familiar with the tool, having applied it in several Canadian acute care settings themselves, including BC Women’s and Children’s Hospitals and Regina Emergency Departments. They are perfectly positioned to adapt, implement, and evaluate it in LTC settings.
“This tool is really driven by theory and the philosophy that one way to improve workload management in LTC settings is to essentially match resident needs with nurse competencies and skills,” she said. “The resulting synergy will enable optimization of existing health human resources.”
The research team have partnered with three LTC homes in the Vancouver Coastal Health and Fraser Health regions of B.C. After adapting the SST in one of these homes, they will implement it in all three. They will then work collaboratively with nursing staff and other LTC health care providers, home leaders and managers, residents, and informal caregivers to gather a full range of perspectives on the effectiveness of the SST and inform the direction of the research.
It’s hoped that this study will produce a validated, ready-to-use tool that can easily be adapted and implemented across LTC facilities in Canada, enabling them to measure residents’ needs and optimize available LTC human resources to provide better resident care.
The study is currently going through ethics review. Stay tuned for more details.