Newfoundland and Labrador has the oldest demographic in Canada, due in part to the outmigration of younger adults. As a result, the needs of the growing population requiring gerontological care is not being met with a similar influx of qualified care personnel, particularly nurses.
Although RNs are paid at parity with RNs working in acute care, it is harder to recruit and retain them in the long-term care (LTC) sector. In LTC, the average age of the province’s RNs is 48, compared to 42 in acute care. RNs working in this area need to broaden their scope of practice and take on stronger leadership roles, in part due to the increasing importance of LTC, and the expanding complexity and type of interventions it requires.
Recognizing these issues, the Newfoundland and Labrador Nurses’ Union, the Newfoundland and Labrador Department of Health and the Central Regional Health Authority (CRHA) proposed the adoption of an 80/20 RN staffing model, an idea developed by the University Health Network in Toronto. (Bournes and Ferguson-Paré, 2007) This model has been shown to enhance nurse satisfaction and respond to calls for patientcentered care.
Carmelite House (CH) was chosen as the implementation site for the project. The 64-bed LTC facility is located in Grand Falls-Windsor, a town of about 15,000 in the Newfoundland interior. The 80/20 staffing model at CH provided project participants with the opportunity to spend 80% of salaried time in patient care and 20% in various professional development activities such as distance-based learning and clinical skills training.
Six RNs and one LPN participated in the project. During the planning phase, the project coordinator conducted an assessment to identify how the 20% time would be best utilized based on the needs of the participating nurses. Educational resources and supports were then developed. A similar-sized LTC facility within the CRHA was selected as a comparator site for the pilot project.
The 80/20 model was implemented in two six-month phases. In Phase One, three participants engaged in a distance-based university course, one completed a post-basic gerontology diploma program, two attended the 5th Canadian Conference on Dementia and one developed a falls prevention program for CH. In Phase Two, two participants continued work on distance-based university courses, one participant worked on a Diabetes Educator diploma and the LPN participant worked on courses to transition into a Bachelor of Nursing program. Four participants continued work on developing a palliative care policy for CH. This policy was very timely as the CH opened a palliative care suite which is utilized by the community palliative care program. In addition, participants were able to attend a variety of conferences and workshops including: a palliative care seminar, the 2010 Nursing Leadership Conference, a provincial palliative care conference, a skin and wound care conference, a foot care course and a seminar entitled “A Closer Look at Long-Term Care.”