Sudbury District Nurse Practitioner Clinics

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Ontario Hansard- 10-December2015

MmeFrance Gélinas: It is my pleasure, this morning, to add a few comments on the record regarding Bill 144, the budget bill. The first thing I want to put on the record: I will quote from a letter from Jennifer Clement, a nurse practitioner from my riding who is the director of the very first nurse practitioner-led clinic. I'm very proud that the very first nurse practitioner-led clinic was in Sudbury. It is a great place. They do great work. They look after thousands of people who did not have access to primary care before, and they do this in a way that is rated top-notch. Whenever they do a survey of their clients, it always comes out that clients love them, the system loves them and the clinic works.

But we have an issue-and I'll quote from Jennifer. She had discussed with me the problem the clinic had "recruiting a nurse practitioner for a vacant maternity leave position which has necessitated the entire team pitching in to cover that patient load and the strain it has placed on the team. We also discussed the fact that due to financial constraints, our budget has remained unchanged for over six years yet costs around us continue to rise due to cost-of-living increases."

Things have not improved. Throughout the system, one in five nurse practitioner positions in primary care is vacant. Why is that? It's because the government made a promise during the last election campaign. They promised that they were going to look at the salaries and compensation of nurse practitioners. Nurse practitioners working in primary care haven't seen a penny of change in their compensation for the last eight years. Yet, during those eight years, the scope of practice of nurse practitioners has changed dramatically.

You will remember, Speaker, that they used to prescribe from a list-I don't know who ever dreamed that up, but it certainly did not work. They now have open prescribing, and prescribe whatever is most appropriate, except for narcotics. They never used to be able to look after a patient in the hospital; now they are often the primary providers of care in our hospitals. They work in our emergency rooms. They work in our CCACs. They work in our long-term-care homes.

But the problem is that as new positions were created in our hospitals, in the CCACs and in our long-term-care homes-those salaries were basically rolled out with an understanding that they should be paid more, given that the scope of practice and responsibility had increased. But the salaries of the ones in primary care, the ones who give us access to the rest of the health care system, have been frozen for eight years, and that's wrong. If you look through the different primary care models, whether it be community health centres, aboriginal health access centres, community-led nurse practitioner clinics or community family health teams, their salaries have not moved.

All of the primary care sector has been frozen. I highlighted nurse practitioners, but things are no better for dietitians. If you go through the health care system and you look at the number of vacant positions for a nutritionist or dietitian, it is really hard for an interdisciplinary team to do their work the way they're supposed to when they cannot recruit. Why is that, Speaker? It's because they have not seen a penny increase in one sector of the health care system, that is primary care-while the other sectors haven't seen a bonanza or anything like that; don't get me wrong. We're talking about a very modest increase. But over the eight-year period, those modest increases make a discrepancy of over tens of thousands of dollars sometimes between what you would get for Jennifer, who has been a nurse practitioner for the last eight years.

Had she stayed in her position at the hospital as a registered nurse, she would have better wages, she would have a good pension plan with HOOPP, and she would have a good set of benefits. She has chosen to go back to work, pay for her schooling, become a nurse practitioner, offer access to thousands of people who did not have access to primary care before by working in an underserviced area, and yet how do we compensate her for that? Less than she would have made. This has to be changed. We have a budget coming, and those issues have to be addressed.

I'm not the only one saying this, Speaker. We have received-and I'm sure all of us have received-hundreds of emails. We've received letters from physicians. Dr. Lori Chalklin, Dr. Stephen Duncan, Dr. Alicia Gallaccio, Dr. Dana Pintea, Dr. Kim Walsh, Dr. David Wallik, Dr. Chris Williams-and the list goes on and on, Speaker-all say the same thing: that if you want primary care to do what it's meant to do, to offer access, to help with disease prevention and health promotion, to help people take charge of their own health, then you need to fund those teams in a way that allows them to do recruitment and retention of their highly capable staff. But none of this is happening in Bill 144, in the budget bill.

This week I had the opportunity to talk with the occupational therapists. They have put forward a very good model that would make interdisciplinary rehab teams-so think physiotherapists, occupational therapists, speech-language pathologists, kinesiologists, and I am missing one that will come to me shortly-and make sure that those teams are available to people who live in long-term-care homes. The way the changes have been made to physiotherapy payments has wiped out access for the people in long-term care to an interdisciplinary rehab team. But they make such a big difference, Speaker. If you can give the patient in long-term care access to an interdisciplinary rehab team, people who need to be fed will be able to feed themselves because the occupational therapist will show them adaptations they can make so that they can hold their fork or their spoon and they can hold their bowl and feed themself even if they are hemiplegic or had a stroke. They have a lifetime of knowledge and skills that help people stay as functional and independent as possible.

It's the same thing with-rather than having a two-person transfer, if the person can help themself, you only need a one-person transfer. It's the same thing with toileting, transferring in and out of the tub; it's the same thing with a number of activities of daily living that occupational therapists, physiotherapists, speech-language pathologists certainly-you know, we look at how frustrating it is for people who cannot communicate what their needs are. If you can't communicate, no wonder you get angry and act out, and then they get overmedicated and we spend millions of dollars on anti-psychotic drugs for people who just need an opportunity to communicate.

This is what speech-language pathologists do. They give people who cannot communicate an opportunity to say what they want, to be heard, to be understood. And all of a sudden, once you're able to communicate, the frustration goes away. The acting out goes away. The need for anti-psychotic medication-that was not needed in the first place-goes away-and the number of falls. They make a huge difference.

But yet again, we have a budget that has changed the way rehab dollars are allocated, in the worst possible format, so that none of those services are available to people living in long-term-care homes anymore, and that's wrong.

This budget bill had an opportunity to right this wrong, and it needs to be changed so that the funding model-we're not asking for more dollars here, Speaker. I want you to fully understand that. We're not asking for more dollars. We're asking for dollars that already flow, to be accessible in ways that are not accessible right now, so that it would change the level of activity, the level of independence, of tens of thousands of people in our long-term-care homes. But this budget bill does not allow us to do that.

I have to put a little bit on the record regarding the OMA and physician compensation. Speaker, nothing good comes from a unilateral agreement. Nothing good comes when you refuse to talk. What they're asking for is the same thing as every other workers' group. Yes, I know that physicians are well compensated, and, yes, I know that they are part of the 10%. This is not what the discussion is about. The discussion is about a group of very important workers in our communities-physicians-being able to have an opportunity to negotiate an agreement-an agreement that nobody will like, but everybody will be able to live with.

This is wrong. The fact that the government won't let them have their say, won't let them have a chance to negotiate, is bringing all sorts of unrest into our health care system that is not good. I know the Minister of Health will be interested in changing that. He understands the importance of having a good and trusting relationship between the care providers and the patients. You do this by bringing forward respect. You do this by bringing forward opportunities to be heard and to settle things so that everybody has an agreement they can live with.

Speaker, I also have to bring forward that flatlining the budgets of our hospitals for year after year-we're looking at year five and year six-is causing a lot of hardship. Some of our bigger ones are still managing relatively okay, but most of our community hospitals are having a tough time. What has been happening is that anything that is not acute hospital care is being shifted into the community, where it has no oversight, where it has no accountability, where it has no transparency. We're not opposed to transferring care into the community where it makes sense, but we are opposed to having it done when there is no framework for transparency, accountability, and maintaining quality.

I have nothing but respect for the College of Physicians and Surgeons of Ontario. They're trying hard. But their mandate for out-of-hospital services is very narrow. To have this one agency that is supposed to be the guardian of quality care, of transparency, of accountability-this is not happening, Speaker. CPSO does a good job; they do a good job within their mandate.

But what we had before in our hospitals, with freedom of access of information, with Ombudsman oversight-which I hope will come pretty soon-with boards of directors, with being able to have a person or a department in place that looks at your complaint-all of this is gone.

I cannot FOI the out-of-hospital premises. I cannot be sure that there will be a person there who will handle a complaint if there is one. I certainly know that you cannot escalate this anywhere. There is no transparency; there is no accountability. This is wrong. It has to be fixed. This bill would allow us to make those kinds of changes because of the number of bills that it opens up, but it is not in there.

Another promise that was made through a budget-as you will remember, Speaker, when we were in a minority Parliament, we were able to negotiate a five-day wait time for people waiting for home care. We did not like many parts of what they had in their budget, but we agreed to support a Liberal budget on the promise that the tens of thousands of people who were waiting for home care would receive it within five days. Well, the Auditor General told us the result of that. The result of that is that people wait 195 days before they get home care.

For children waiting for children's services, we're talking over two years for speech-language pathology, and over two years for occupational therapy and physiotherapy. For a kid who is two, three or four years old, this is half their life that they have spent on a wait-list to get the services they need. Those are opportunities lost. This is a promise that is being broken each and every day.

We have an opportunity with this budget bill to fix that, to say that there will be a commitment that nobody who needs home care will wait more than five days. Most people are being discharged from hospital with the promise that home care will follow. But if home care doesn't follow, their needs don't go away. It's not because they've been discharged from the hospital that a miracle has happened going through the threshold of those doors and all of a sudden all is fine. They were discharged with a promise of a care plan that included home care, which doesn't show up.

If it does finally come together, the number of missed visits, the number of missed appointments, the number of appointments that do not come when they're supposed to come-because if you're supposed to be getting home care to help you get out of bed in the morning and it's 3 o'clock in the afternoon before the PSW shows up, it is no good. If you're supposed to get somebody to help put you to bed at night but the PSW comes at 3 o'clock in the afternoon, it's still no good. This is what we're facing.

We have an opportunity to commit to a five-day wait time for home care. This was a commitment that was made through a budget. This was a commitment that was made very publicly. This is a commitment that is being broken each and every day for the tens of thousands of people who are waiting for home care.

There are other things that I wanted to talk about but I see that time is going away. Right now, we have a campaign led by our midwives that says that we don't need to put antibiotics in the eyes of newborns. There are very limited cases where this could help, but most of the time-99% of the time-we should not do this. If we stop doing this, as the best practice is telling us, we would save $618,000 a year on medication that is not appropriate for newborns and should not be used.

The $618,000 means that-remember the $200,000 that the OPP is going to save by moving the helicopter from Sudbury to Orillia, putting the people of the northeast at risk each and every day? Lots of us like to go into the bush. Winter is coming. There will be snowshoeing, skiing, trappers and snowmobilers, and sometimes we get in trouble-and it's dark at 4 o'clock at night in my neck of the woods. This helicopter is going to be no good to us. Well, that $618,000 would pay for that helicopter three times, because they're saving $200,000.

There is lots of opportunity for saving. It is disappointing that it is not being acted upon and that the opportunity to make modifications to that bill is next to nil.

In the News

french_cover.jpgAprès l’obtention de son diplôme d’infirmière autorisée au collège Sault en 1998, Mary McGuire (B.Sc.Inf. 2005) a travaillé à temps partiel pendant deux ans. Ensuite, elle s’est installée à Berkeley, en Californie, où elle a occupé un poste à temps plein. En 2002, elle revient au Canada pour travailler à l’Unité de soins intensifs de l’Hôpital régional de Sudbury – mais là encore, elle ne travaille qu’à temps partiel. 2002, elle reprend le chemin de l’école et obtient en 2005 un baccalauréat en sciences infirmières et un certificat d’infirmière praticienne en soins de santé primaires à l’Université Laurentienne.

Forte de ses diplômes, de son expérience et de sa formation, elle se met à la recherche d’un travail à temps plein dans son domaine, mais la conjoncture canadienne reste sombre. Les infirmières praticiennes ne peuvent pas trouver à se caser. Le Grand Sudbury à lui seul en compte sept au chômage. Mme McGuire traverse encore la frontière, prend la direction de Washington, D.C., un contrat à temps plein en main.

« Obtenir le visa la première fois était un peu fastidieux et quitter mes parents était dur, dit-elle. Je n’y tenais pas. J’aime le Canada. »

« Devant un contrat assorti d’une rémunération aussi alléchante, le choix à faire était évidemment assez simple, dit-elle. À la signature du contrat de trois mois, j’ai eu droit à une prime de 5 000 $. Qui ignore le montant de dettes que peut accumuler un étudiant après ses études? Cette proposition était juteuse. Au Canada, je gagnais 20 $ l’heure. L’emploi que je convoitais aux États-Unis payait 30 $. La gamme des avantages sociaux a primé sur l’argent. »

Ce que notre infirmière voulait vraiment, c’était vivre et travailler
au Canada, et, en particulier, dans le nord de l’Ontario, mais elle ne voyait pas comment elle y arriverait. Ce n’est que lorsqu’elle a reçu un message électronique de Marilyn Butcher que les choses ont commencé à se préciser.

Entre-temps, la décennie de lobbying porte fruit. Le ministre de la Santé de l’Ontario, George Smitherman, annonce le financement d’une clinique d’infirmières et d’infirmiers praticiens que Mme Butcher a pour mission de mettre en marche. Reconnaissant le moment venu de tendre la main aux infirmières et infirmiers praticiens partis, elle commence à envoyer des messages électroniques à Mme McGuire pour lui dire que le temps est venu de rentrer chez elle.

« Je ne cessais de la tenir au courant de nos projets, se souvient l’infatigable Mme Butcher. Mary n’avait jamais pu décrocher un emploi ici comme infirmière praticienne. Je faisais de la suppléance (remplacement temporaire) au Centre médical de Chapleau et savais qu’elle voulait y travailler, j’ai pu la convaincre de m’y accompagner pour voir des patients. »

À la réception de l’invitation, elle était aux anges. Son contrat à Washington venait tout juste d’expirer. Au lieu d’accepter un poste à court terme en Floride, elle a choisi la suppléance. « Marilyn m’a offert d’être mon mentor et d’être à mes côtés la première fois où j’allais à Chapleau, affirme Mary. L’idée était que j’y entrerais pour combler le vide. Rares sont les infirmières praticiennes qui débutent un travail sous l’oeil vigilant d’un mentor prêt à les mettre dans le bain. Je ne pouvais pas laisser s’échapper cette chance. »

Lorsque les cliniques d’infirmières et infirmiers praticiens du district de Sudbury ont commencé à accueillir des patients au Centre médical de Riverside en août 2007, Mme McGuire était là.

« Sans la persistance de Marilyn, je ne serais pas ici. Depuis 1998, année où j’ai obtenu mon diplôme, c’était la première fois que j’étais employée au Canada et que je jouissais d’avantages sociaux. »

Le rapatriement dans le nord de l’Ontario de prestataires de soins de santé ne se limite pas aux infirmières et infirmiers praticiens. L’Hôpital régional de Sudbury recherche activement des infirmières et infirmiers de toutes disciplines ayant quitté la région.

L’hôpital affiche des possibilités d’emploi sur et Le personnel de recrutement a assisté à des salons d’associations professionnelles, notamment le congrès de mai 2008 de l’Association des infirmières et infirmiers autorisés de l’Ontario. Il a fait paraître des annonces dans l’une des publications de l’Ordre des infirmières et infirmiers de l’Ontario intitulée The Standard. L’Hôpital régional de Sudbury a aussi commencé à faire de la publicité dans les magazines des anciens et anciennes des établissements postsecondaires de la région (y compris le Magazine de la Laurentienne).

« Nous essayons d’entrer en contact avec quiconque est parti afin de répercuter la nouvelle, a déclaré Mme Ann-Marie Mills, conseillère au service des ressources humaines du bureau de recrutement de l’Hôpital régional de Sudbury. Si cela fait dix ans qu’ils sont partis, ils ne savent probablement pas que nous emménageons dans un seul emplacement et que la communauté dispose maintenant d’un hôpital universitaire et de l’École de médecine du Nord Ontario. »

« Nous avons étendu nos mécanismes de dotation en personnel à plein temps, dit-elle. Les gens ont certainement plus d’une possibilité, en particulier dans notre service de soins critiques. Nous ne négligerons rien pour recruter de nouveaux diplômés et des infirmières et infirmiers chevronnés. »

Il convient aussi de prendre en considération cet effet de vague. Selon Mme Mills, les campagnes de recrutement menées dans d’autres domaines ont eu des effets positifs inattendus. « Nous nous rendons compte que Vale Inco et Xstrata ramènent beaucoup de gens ici, dit-elle. Lorsque toute une famille revient, il arrive que les industries locales, y compris la profession médicale, accaparent le ou la partenaire. »

Le déblocage de fonds par le gouvernement constitue un autre stimulant : il est au coeur du rapatriement des professionnels de la santé, car il s’assure que ceux qui reviennent trouvent du travail dès leur arrivée. Dans son dernier budget, le premier ministre ontarien, M. Dalton McGuinty, a annoncé l’octroi de 38 000 000 $ pour l’ouverture de 25 cliniques d’infirmières praticiennes. Lors d’une récente visite aux cliniques des infirmières praticiennes du district de Sudbury, il a fait connaître le calendrier d’ouverture des trois prochaines cliniques.

Cet argent vient s’ajouter aux 87 000 000 $ que le ministre de la Santé et des Soins de longue durée a alloués pour le Ontario’s Nursing Graduate Guarantee. Ce programme, qui garantit des possibilités de formation sur place aux nouveaux infirmiers et infirmières dès l’obtention de leur diplôme a été lancé en 2007 et est prolongé pour une autre année.

Avant la mise en application de la garantie, 40 pour cent des infirmières et infirmiers autorisés de l’Ontario trouvaient du travail à temps plein; depuis février 2007, ils sont 89 pour cent.

Si ces données statistiques sont remarquables, la garantie de placement de travail ne dure qu’environ sept mois et représente une mesure provisoire d’aide à la transition en douceur des diplômés aux postes permanents à plein temps au fur et à mesure que ceux-ci se libèrent. (Il est important de signaler que, en faisant une recherche d’emploi dans HealthForceOntario dans le nord-est ontarien le 16 avril 2008, on a trouvé 45 emplois d’infirmières et d’infirmiers autorisés disponibles. De ce nombre, on comptait un permanent à temps plein à l’hôpital et un autre dans un établissement de soins de longue durée du Grand Sudbury.)

Quoique la situation ne semble toujours pas idéale, pour Mme McGuire, elle s’améliore.

« L’argent injecté dans notre système de santé semble commencer à créer des postes, dit-elle. Par rapport à il y a dix ans, on sent incontestablement bouger les choses. Si les infirmières et les infirmiers sont prêts à rentrer chez eux, ils devraient vérifier régulièrement les sites, car les choses changent. »

Pour Mme Mary McGuire, le retour au Canada a été nettement plus facile que le départ pour les États-Unis. Elle vit maintenant près de sa famille, de ses amis et de son fiancé Dave Geroux. Celui-ci habitait dans le nord de l’Ontario pendant qu’elle était aux États-Unis.

« J’ai l’impression d’être exactement là où je voulais toujours être dans ma carrière et dans ma vie, dit-elle. Si je n’étais pas revenue au Canada, je serais probablement toujours en train de courir le monde à la recherche d’un point d’ancrage. Cette grande paix ne m’habiterait pas aujourd’hui. »

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623 Main Street
Lively, ON  P3Y 1M9
Phone: 705-692-1667
Fax: 705-692-0177

SDNPC Sudbury Clinic

359 Riverside Drive, Suite 107
Sudbury, ON  P3E 1H5
Phone: 705-671-1661
Fax: 705-671-0177

Regular Hours of Operation

Monday – Friday 8:30am – 4:30pm
Phone lines open between 8:30am - 12:00pm, 1:00pm - 4:00pm

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Last Tuesday of Every month 12:30pm – 8:00pm
Phone lines open between 8:30am – 4:00pm, 5:00pm - 7:30pm

Summer Hours of Operation (July 01 – Monday following Labour Day)

Monday 8:30am - 4:00pm
Tuesday through Thursday 8:30am - 4:30pm
Friday 8:30am - 2:30pm
Phone lines open between 8:30am - 12:00pm, 1:00pm - 4:00pm (except Friday afternoons 1:00pm - 2:30pm)

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