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Election Priorities 2018 nbnursingmatters.ca.

Coming together, representing 8,600 registered nurses and nurse practitioners in New Brunswick--the largest group of health professionals in the province--the Nurses Association of New Brunswick (NANB) and the New Brunswick Nurses Union (NBNU) have partnered and identified the following five election priorities and proposed questions to party leaders on how they intend to address these challenges within our healthcare system.

We met with Kris Austin, Leader of the People's Alliance Party on Wednesday August 22, 2018.

We met with Jennifer McKenzie, Leader of the New Democrat Party on Wednesday August 22, 2018.

We met with David Coon, Leader of the Green Party on Thursday August 23, 2018.

* A meeting has been scheduled with Brian Gallant, Leader of the Liberal Party on Wednesday September 5.

** A meeting is still to be confirmed with Blaine Higgs, Leader of the Progressive Conservative Party.

NURSING MATTERS: ELECTION PRIORITIES 2018

What will you and your party do to address mental health and addictions issues in New Brunswick?

Recommendations

INVEST IN mental health services and supports to ensure adequate? mental health access for all New Brunswickers.

RESEARCH, FUND and improve access to treatment for drug addictions to address epidemics such as the current opioid crisis.

IMPROVE MEASURES and increase the role of registered nurses and nurse practitioners in mental health / addiction prevention strategies and treatments.

Rationale

IN A 2017 New Brunswick Health Council survey on accessing health services. 19% of respondents self-identified as having a menial health issue, while only 33% of that group were able to access mental health services.

IN 2017, naloxone was administered to 232 suspect opioid overdose patients, of which 152 responded to naloxone (53.9%).

THERE WERE 103 Emergency Department visits related to nonsuicidal opioid overdoses, with an average of 13.5 visits per month between May and December 2017.

Supporting Evidence

UP TO 25% of disability costs associated with mental health problems could be avoided by taking action.

READMISSIONS for mental health patients to hospitals is higher in New Brunswick than the national average.

IN AUSTRALIA, research found an average positive ROI of $2.3 for every dollar invested in workplace mental health initiatives.

If elected, how does your party plan to improve access to primary health care services in New Brunswick?

Specifically, access to primary health care in recognition of the urbanization of our province and the current underutilization of Nurse Practitioners?

Recommendations

CREATE a five-year, sustainable public program for access to primary health care by direct creation of Nurse Practitioner (NP) positions in the long-term care sector, as family care providers and in mental health sector.

PROVIDE DEDICATED funding for Nurse Practitioner positions.

INCREASE NUMBER of Small community family care clinics led by nurse practitioners and with an interdisciplinary team for example; social workers, dietitians, pharmacists, etc.

EXTEND THE Medical Liability Protection Reimbursement Program to provide NPs the same professional liability protection subsidy mechanism used by physicians.

The Canadian Nurses Association defines Nurse Practitioners as "registered nurses with additional educational preparation and experience who possess and demonstrate the competencies required to autonomously diagnose, order and Interpret diagnostic tests, prescribe pharmaceuticals and perform specific procedures within their legislated scope of practice" (CNA, 2006).

"Primary Health Care (PHC) is a philosophy and approach that Is Integral to Improving the health of all Canadians and the effectiveness of health service delivery in all care settings, PHC focuses on the way services are delivered and puts the people who receive those services at the centre of care. The essential principles of PHC, as set out in the World Health Organization's Declaration of Alma-Ata, are: accessibility; active public participation; health promotion and chronic disease prevention and management; the use of a ppropriate technology and Innovation; Intersectoral cooperation and collaboration." (CNA Position Statement on Primary Health Care)

Rationale

20,000+ nb residents on Patient Registry for periods of more than two years; potential to reduce number of persons waiting for a family health provider by more than 50%--several other Canadian jurisdictions currently implementing Nurse Practitioner strategies to improve access to care,

NPS fastest growing health profession sector in NB--less costly and as effective as other family care providers.

NPS are leaving N8 after being educated in publicly funded programs.

NPS already working in NB nursing homes with excellent patient outcomes: with potential for decreased ER and hospital admissions, decreased infection rates, decreased fall/ injury, improved monitoring of medications and side-effects, high levels of family satisfaction,

EARLY NP Intervention for youth challenged by mental health/ substance misuse can enhance opportunities for optimal health outcomes: fewer ER admissions/long hospital stays, return to education, decreased deaths due to overdoses.
NP Graduates From Both
UNB and UdeM

2017              10
2016              3
2015              18
2014              3
2013              7

NPs Without Sufficient Hours

2013              6
2017              3
2016              1
2015              2
2014              3

(NANB data)

Provincial Zones in Most Need
(GNB Feb. 2017)

Fredericton   5,995
Moncton       5,692
Saint John    6,011

Note: Table made from pie chart.


What will you and your party do to ensure the implementation of a national, universal pharmacare plan?

Recommendations

IMPROVE ACCESS to medication by including prescription drugs in the public health care system.

ENSURE EQUITABLE access to prescription drugs by establishing a national formulary.

CONTROL COSTS by systematically implementing bulk purchasing for patented and generic prescription drugs.

ENSURE THE appropriate use of prescription drugs by assessing the safety and efficacy of medications.

Body Count

How many Canadians lose their lives without pharmacare?

270 to 420 premature deaths of working-age Canadians with diabetes every year

370 to 540 premature deaths of Canadians with Ischemic heart disease every year

550 to 670 premature deaths from all causes among older working-age (55-64) Canadians every year

Up to 12,000 Canadians with cardiovascular disease aged 40+ require overnight hospitalization

Up to 70,000 older Canadians (55+) suffer avoidable deterioration in their health status every year

Rationale

26% OF Atlantic Canadians don't take their medications as prescribed because they can't afford to. (1)

A national universal pharmacare plan could save New Brunswick $273 million per year. (2)

THIS savings could be reinvested in home care, community health centres, long-term care and human resources

92% of Atlantic Canadian residents strongly support establishing a universal prescription drug plan to cover all Canadians. (1)

Supporting Evidence

$273 million in annual savings could be spent on:

* $101 million could be allocated to home care, of which $2 million could be allocated to 5,500 more home care visits to New Brunswick seniors.

* With another $101 million, New Brunswick could build 40 community health centres, providing 30,000 more residents with high quality integrated care to respond to both physical and mental health needs.

* $13 million could provide 250 more long-term care beds per year.

* That last $63 million could hire 800 registered nurses, which would reduce overtime and improve safety acrossthe board.

Failing TO adhere to prescribed medications leads to increased costs on the health care system as well as decreased well-being and lost lives.

(1) www.arigu5reid.org/prescription-drug5-canada/

(2) A Roadmap to a Rational Pharmacare Policy in Canada, M.-A. Gagnon, 2014
Prevalance of Cost-related Non-adherence (CRNA) in Canada and
Comparable Countries with Universal Health and Pharmaceutical
Coverage

              All Adults Aged    Adults Aged 55+    Adults Aged 65+
              18+ (2016 data)      (2014 data)        (2014 data)

Australia           6.3%               6.8%               4.4%
Canada             10.2%               8.3%               5.3%
France              3.9%               1.6%               1.5%
Germany             3.2%               3.7%               4.2%
Netherlands         4.4%               4.0%               2.9%
New Zealand         5.7%               4.8%               3.4%
Norway              3.4%               2.4%               1.9%
Sweden              5.7%               2.4%               1.8%
Switzerland         8.9%               2.9%               2.5%
UK                  2.1%               3.1%               2.4%

Sources; 2014 and 2016 Commonwealth Fund International Health
Policy Surveys


What is your party's plan for a comprehensive, long-term seniors care strategy?

How do you intend to implement this plan to maximize efficiency, given the multitude of organizations currently managing seniors care in New Brunswick?

Recommendations

EXPANDED HOME care services to allow seniors to stay at home longer, including:

* A safe-at-home policy;

* Seniors/patients' appropriate and timely registered nursing assessments and interventions supported by the full health care team;

* Coordination and oversight of care provided by a primary nurse to ensure timely and seamless access to care providers; and

* Education and support for all members of the team, including unpaid caregivers, and standard competencies for personal support workers/care aides.

VARIATIONS in nursing home staffing based on resident needs evaluated by RAI-LTCF data should be made on a home-to-home basis and include care hours set above minimum thresholds identified by research evidence:

* Minimum threshold for total nursing and personal care staffing of 4.1 hours-per-resident day {hprd}

* Minimum threshold for direct care registered nursing of 0.75 hprd

ENSURE BETTER coordination, communication, and collaboration between sectors and settings to avoid costly (in human, as well as financial terms) complications, including the provision of adequate care/beds/ providers in all sectors, with special attention paid to times of transition (e.g., transfers, discharge, admission). Team practices are particularly useful for chronic conditions and seniors.

NURSE PRACTITIONERS (NPs) possess the expertise to manage the chronic and acute conditions that are prevalent among LTC residents such as diabetes, hypertension and other cardiovascular diseases. (1)

Rationale

DESPITE A growing population of seniors. New Brunswick only spends less than 5% of total public health care spending on homecare.

CONTINUITY OF care is known to reduce the risk of adverse events and contribute to the delivery of safe care in the home, as well as enhancing the comfort and confidence of home care recipients. (2)

NURSE-LED models of care are most effective and equally or less costly than usual physician-led care. (3)

A STUDY by the Centers for Medicare and Medicaid Services looking at nursing homes with the greatest number of significant deficiencies took the position that 4.1 total hprd, of which 0.75 hprd were RN hours, were necessary to prevent harm or jeopardy to residents. (1)

RAISING RN thresholds of care to O.S hprd has been found to improve resident functioning. (5)

REDUCTION in hospitalization among residents admitted to nursing home from hospital is associated with higher RN staffing. (6)

A 2013 comprehensive literature review of advanced practice nurses (NPs and clinical nurse specialists) in LTC revealed that they improve or reduce decline in health status indicators like depression, urinary incontinence, pressure ulcers, aggressive behavior, loss of affect in cognitively impaired residents, restraint use, psychoactive drug use, serious fall-related injuries, ambulation, and family member satisfaction. (1)

(1) Donald, F., Martin-Misener, R., Carter, N., Donald, E.E., Kaasalainen, S., Wickson-Griffiths, A., Lloyd, M., AkhtarDanesh, N., DiCenso, A. (2013) A systematic review of the effectiveness of advanced practice nurses in long-term care. J Adv Nurs, Oct;69(10):2148-61.

(2) Blais, R. et al. (2013). Assessing adverse events among home care clients in three Canadian provinces using chart review. BMC Quality and Safety, 0,1-9, doi: 10.1136/bmjqs-2013-002039

(3) Browne, G., Birch, S., & Thabane, L. (2012). Better Care: An Analysis of Nursing and Healthcare System Outcomes. Ottawa: Canadian Health Services Research Foundation. P. 27.

(4) Kramer, A.M. and Fish, R. "The Relationship Between Nurse Staffing Levels and the Quality of Nursing Home Care." In Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes. Report to Congress. Phase 2 Final, Section 2. Washington. D.C., U.S. Department of Health and Human Set vices. Health Care Financing Administration, 2001, As cited in Harrington, C, et al., (201S), Technical Guide to the CalQLialityCare.org Ratings: Nursing Facilities (p.6).

(5) Dorr. D.A.. Horn. S.D.. Smout, R.J. (2005.) Journal or the American Geriatrics Society:53(S) 840-845.

(6) Decker, F. (2008). The relationship of nursing staff to the hospitalization of nursing home residents. Research In Nursing & Health, 31,238-251

According to the Canadian Institute for Health Information (CEHI), 41% of RNs in New Brunswick are eligible to retire in the next five years.

If elected, what is your party's strategy to address health human resource planning and the current shortage of registered nurses in New Brunswick?

Recommendations

ENHANCE TRAINING and education programs to best meet the health and nursing care needs of NB residents. Given our aging population and the acute care needs of tertiary care centers such as cardiac and oncology, this is essential.

UTILIZE NURSE Practitioners (NPs) and Clinical Nurse Specialists to their full scope of practice. They are a cost-effective solution and have the potential to contribute significantly to resolving some of the current health care issues, such as access to delivery and coordination of services and improvements in health outcomes.

DEVELOP AN employment model whereby all graduates of registered nursing programs obtain permanent employment positions with paid benefits.

PARTNER with other countries to provide on-site education for return to service in New Brunswick,

ESTABLISH FORMAL Internationally Educated Nurses (IEN) assessment and bridging centre in New Brunswick--link to major employers and communities.

PROMOTE COLLABORATIVE opportunities between English and French nursing programs; leverage technology; manage student wait lists,

SET STAFFING minimums according to evidence-based research.

Rationale

AN INCREASE by one RN per patient/ day was associated with decreased odds of hospital acquired pneumonia, unplanned extubation, respiratory failure, and cardiac arrest in ICUs, and a lower risk of failure to rescue in surgical patients. (1)

A 2010 systematic review of 26 research studies in critical care found decreased staffing in intensive care units associated with increased adverse events in virtually all studies. (2)

CURRENT AND predicted nursing shortage: 300 vacancies per year over 10 years.

AGING POPULATION health needs.

HIGH NEED for mental health support, especially in youth sector.

A 2011 Australian study (1) found that under minimum nurse hours per patient per day (NHPPD) ranging between 1:6 and 1:5, depending on the unit, there were significant decreases In nine patient health outcomes that are dependent on care/ treatment delivered by an RN.

(1) Kane, R., Shamliyan, T., Mueller, C., Duval, S. & Wilt, T. (2007). The Association of Registered Nurse staffing levels and patient outcomes. Medical Care, 45(12), 1195-1204

(2) Penoyer, D. (2010). Nurse staffing and patient outcomes in critical care: A concise review. Critical Care Medicine, 38(7), 1521-1523.

(3) Twiyg. D-, Duflield. C., Bremner, A., Rapley, P. & Finn, J. (2011). The impact of nursing hours per pa lie ill day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data. International Journal of Nursing Studies, 43, 540-548.
Funded Seats
                   UNB    UdeM    Total

Funded Seats       281     184     465

2013               201     166     361
2014               181     130     311
2015               163     146     314
2016               162     144     306
2017               157     154     311

Graduates Registered with NANB

Registration Year           NB Graduates

2013 (Class Of 2009)            351
2014 (Class of 2010)            300
2015 (Class of 2011)            219
2016 [Class of 2012)            299
2017 [Class of 2013)            280

Age Distribution of RNs

Year       Under 25     45-49         50-54          55+

2013       197 (2%)   1,346(16%)   1,291 (15%)   2,077 (24%)
2014       190(2%)    1,305(15%)   1,345(16%)    2,065 [24%)
2015       191 (2%)   1,207(14%)   1,343(16%)    2,072 (25%)
2016       161 (2%)   1,149(14%)   1,334(16%)    2,077(25%)
2017       167 (2%)   1,056(13%)   1,342(16%)    2,072 (25%)

Membership Profile

Year         Registered   Employed    Full-time     Part-Time

2013           8,960       8,537     5,341 (63%)   2,071 (24%)
2014           8,835       8,471     5,188 (61%)   2.070 (24%)
2015           3,634       8,389     5,056 (60%)   2,055(25%)
2016           8,626       8,294     5,013 (60%)   2,009 (24%)
2017           8,603       8,280     4,955 (60%)   2,002 (24%)
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Date:Sep 22, 2018
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