When do we reach the Tipping Point?

Hugh Pedersen, CLPNA President, with Linda Stanger, CLPNA Executive Director/Registrar

The “tipping point” is a concept first identified by Malcolm Gladwell in 2000 as “the moment of critical mass, the threshold, the boiling point.”

For many years, we have heard about inadequate funding of the health system, serious provider shortages, our aging workforce, heavy reliance upon part-time and casual staffing, low morale and productivity, streamlining the health system, and improving the quality of health services, patient safety and access to the system. Numerous initiatives have been implemented, with some having success in improving the health system’s effectiveness and efficiency.

These initiatives and our work are set against the backdrop of the health system’s increasing lack of affordability and the fear that, at some point, we will “hit the wall.” The health system’s ever increasing costs are rapidly consuming other worthy public expenditures, particularly social programs such as education and training, personal and family supports, and community and recreation.

The recent Canadian Institute of Health Information (CIHI) report notes that health care costs have reached $5,800 per year per person. “Total spending on health care in Canada is expected to grow by more than $7 billion this year to reach a forecast $200.5 billion in 2011. Spending is expected to increase by 4% over last year, the lowest annual growth rate seen in the last 15 years. The average annual growth in health care spending between 1998 and 2008 was 7.4% – higher than inflation and population growth.

CIHI’s President and CEO, John Wright stated, “…In light of global economic uncertainty and efforts (in Canada) to address government deficits, it’s important to examine what’s been driving health care costs in order to better plan for the future of the health system” (CIHI).

When do we reach the tipping point – that is, when our expenditures on health care leave no room for any other public expenditures? Given that nearly three quarters of health care expenses relate to human resources, are there not possibilities to be far more effective and efficient? Can health care be delivered more safely and with higher quality at the same time?

The Health Profession Act’s fundamental concepts (in 2000) of competencies and overlapping authorities to perform restricted activities have yet to be realized. Instead, we continue to focus on “scopes of practice,” which often belie poor utilization of regulated nurses (LPN, RN and RPN), workplace issues, morale, collective bargaining and inter-professional tensions.

LPN’s could contribute far more regulated nursing competencies in the public health system. In the summer of 2011, one half of respondents to the CLPNA’s survey observed that they were fully utilizing their knowledge, skills and clinical judgment at work. This is a modest improvement from the CLPNA survey in 2002, when only one third of respondents indicated that they were fully utilizing their competencies.

The current circumstances are not fiscally responsible. They are not in the interest of quality care and safety. They reduce pride in the nursing professions, and contribute to significant and expensive burnout and turnover.

We must truly demonstrate progress on a system-wide, as opposed to “demonstration project” scale. Let’s begin by abandoning the old terminology – scopes of practice, turf battles, territoriality, my tasks versus your tasks, inter-professional rivalries, staff mix, etc.

The CLPNA is heartened in its recent discussions with Alberta Health and Wellness, Alberta Health Services, the three nursing regulatory colleges, educators and other stakeholders to create a compelling vision and action plan for collaborative practice.

We must avoid reaching the tipping point with our precious health system and nursing health human resources.

Canadian Institute of Health Information (CIHI) retrieved from www.cihi.ca.

15 Responses to “When do we reach the Tipping Point?”

  1. When do we create a safe concern for these private nursing long term or assissted living facilities? When is asking way beond the realm of safety and knowledge to much?

  2. good information ,we wouldnt be under staffed if the goverment would let foreign workers who have degrees in other countrys, get their LPN, RN, RPN, FASTER AND AT SUCH AND exuberant cost they take their training come over here and have to put out 20,000.00 to become an Lpn, and they already have the training and speak fluent english because thats what they take in school and traning

    • Why does Alberta have to go to foreign countries to recruit nurses when we are graduating in record numbers in other provinces and not able to find work? I know of a large number of LPNs in BC who have graduated up to a year ago and still can’t find work anywhere in BC. Why not just go there to recruit?

  3. I think this was a great report and agree with most of it. I have a few comments my self. 1 if the health ceo would drop all the bonuses given to management for bringing in the buget which is there job we could save money.after all is this not there job. do we get paid extra for doing our job.?

    2 have management that cares more for the staff instead of there egos and how they look.Ibelive this is why nursing is losing so many nurses of all groups.we do have some very good managers but not enough.

    3 qiut worring about the money and worry more about the the pt, and the staff giving care.

    as I said i think this was a very good article by linda great job.


  4. For years governments have been hiding their heads in the sand knowing that the bubble in the population-baby boomers would be requiring care for chronic and acute illnesses as they aged. This was ignored with cuts to the health system and refusal to spend what was needed to prepare, now agencies as well as government are scrambling to keep up as they know lack of care costs votes. Keep in mind also that almost 40% of the care workforce falls into the same age group. Politicians admit that the system is not sustainable at this level. A revolution in thinking and funding is required.

  5. Health care spending does take a lot of money. However, if we stop the abuse of health care, we could save millions of dollars. There are people who use emergency departments as their private physicians offices. Stop the abuse, and the rest will take care of itself.

  6. Once again upper management has become top heavy and to much time is spent at meetings where little is ever accomplished, while little help or direction is given to those working in the trenches. A lot of time in direct patient care is being taken up with more and more PAPER work in a misdirected plan by the powers that be to some how prove or justify that the work is being done, rather than allowing the evidence of hands on care or lack of be sufficient.
    The article was quite informative and well written by Linda.

  7. Its refreshing and encouraging to see an acknowledgement and intelligent response to the “white elephant” within Alberta’s health care system.
    The ever looming question is, how do we create awareness and acceptance of the LPN’s increased capacity to contribute in all areas of the Health Care system?

  8. Thanks for the oppertunity to voice my opinion.
    There are millions wasted with Pharmacueticals that being over prescribed ,especially in the seniors population or drugs that are wasted by poor prescribing practices by physicians. The pharmaceutical companies are raking in Billions. Maybe they could put something back in helping to solve some Problems.
    There has to be more accountabilty in this area. We also all have to recognize our own responsibility in not being wasteful but in a safe manner.
    I also think there shoud be more Focus on Disease prevention. The savings would be in the Future.

  9. How come the new hospital in the south of Calgary is not hiring LPNS? That would save a lot of money.

    • CLPNA has had many discussions with Alberta Health Services (AHS) related to staffing models at the South Health Campus in Calgary. We are very pleased to see a new commitment to include LPNs in almost all areas of the facility. Watch for info about those positions on the AHS Job Board: http://www.healthjobs.ab.ca/default.aspx.

  10. Great article,and it’s time for viable solutions to the on going problems. My feeling is that everything is too big that the the right hand doesn’t know what the left is doing & instead of simplifying, things just get more complicated. Part of the problem is that individuals are afraid to just make the decisions & do it, because it might be wrong, or it might be someone elses job or decision. I believe we are agents of change and sometimes we do make mistakes, and sometimes it’s worth the risk to take it on and make the change, get it done, make it safer. I work with many Immigrant’s who have the training from their own countries and the cost in time & money for the upgrade is unfortunate but, there has to be some standardization. Since the whole healthcare issue will be a global concern maybe the solutions need to be global with satalite type education solutions in every country in the world, this might aid the fast track as well as create opportunity for communities. Thanks for the information and the voice.

    • If somebody complained about immigrants’ first country knowledge, it would be nice to say that many immigrants come to Canada having strong health care experience. Experience makes strong difference at working places. It’s hard to say that many immigrants with excellent skills and knowledge have to take lower working positions because there is alawys the same excuse: “Sorry, you do not have Canadian experience.”At the end many working places take advantages and abuse immigrants.