Registered nurses at long-term care homes may not have direct supervision, especially outside regular hours when managers aren't working
A woman walks into the Caressant Care facility in Woodstock, Ontario on Tuesday, Oct. 25, 2016. (THE CANADIAN PRESS/Dave Chidley)
Registered nurses at long-term care homes are close to the top of the food chain when it comes to dealing with patient health – but who’s watching the nurses?
It turns out registered nurses, especially when they’re working overnight, really only have to call supervisors in case of an emergency.
“There should always be somebody on backup call,” said Dawn Prentice, chair of the nursing department at Brock University. “There would be somebody they could call if there was a disaster, if the place started to blow up or something.”
But that’s only for emergencies.
Ordinary care for residents in a long-term care home could go on without anyone looking over a registered nurse’s shoulder. And that includes giving medications – though there should always be a paper trail to show what was given, when, and why, Prentice added.
Both RNs and registered practical nurses (RPNs) can give injections and provide medications.
Police confirmed that in the case of the eight victims allegedly killed by former registered nurse Elizabeth Wettlaufer, a drug was administered. But they wouldn’t say what that drug was, noting only that many medications are available at a nursing home.
Elizabeth Wettlaufer. (Facebook photo)
After Tuesday's shocking news, politicians are extremely concerned.
“The alarm bells have been ringing for some time now,” said France Gelinas, NDP MPP and long-term care critic. “It adds another really heavy chapter to an already sad situation in our long-term care homes.”
She slammed the province for a lack of attention and funding to maintain quality care in nursing homes.
“Let’s put this into perspective. There’s (76,000) people in our long-term care homes. If any town of 76,000 people had seen that level of homicide, that would trigger resources coming out of every level of government to keep people safe, to change things, to make sure the oversight was appropriate.”
NDP MPP Teresa Armstrong raised the issue during Question Period on Tuesday, asking the premier “how do alleged murders go undetected for nearly ten years inside any long-term care home?”
In an interview, she noted that’s it’s not the first time her party has raised questions about oversight.
And it's not that nurses are to blame, Armstrong said.
"Frontline workers are doing their best with what they've got," she said.
It's likely that Wettlaufer is a very small minority in an otherwise dedicated and compassionate field of professionals.
But for those "bad eggs," there may not be much day-to-day supervision. RNs are basically on the top rung of the ladder when it comes to patient care. And they’re trying to do more with fewer resources, too, said Kevin Woo, assistant professor at Queen’s University school of nursing and an RN.
“Long-term care facilities are hiring less and less registered nurses in facilities. They are particularly doing a lot of the quality control, administrative, and doing more complex care for residents in long-term care,” he said.
What does that look like?
A RN might be called for more serious considerations, like when a patient has a fall or a heart attack, Woo said. They’d be part of managing those crises and putting modifications in place to prevent another fall, for example.
When asked about direct oversight for RNs within a long-term care facility, Woo said there’s not much to fall back on.
“Often the physician is off-site, and of course the physician isn’t really the supervisor for the RN,” he said.
That task falls to a manager or director of care.
Those people usually work a 9 to 5 schedule, said Prentice.
That may leave families whose loved ones are depending on nurses in a long-term care home rather concerned.
Bill Walker, PC MPP and long-term care critic, said he expects more from the government, particularly in the way of frequent inspections for nursing homes.
“You can always have a bad person doing bad things, but if you’ve got processes in place, they should catch these things,” he said.