[Sharon]

Health Care Reform – How does it affect nurses?

[Jamie]

Health care reform – How does it affect nurses?

As a nurse with 26 years of experience, I have witnessed healthcare reform many times throughout my career. Each wave of reform has significantly affected my job and the way I provide patient care. Changes in healthcare policies have increased documentation requirements, introduced new technologies, and shifted the focus toward quality improvement and patient outcomes. While many reforms have improved access to care and promoted better standards of practice, they have also increased workloads and administrative responsibilities for nurses.

One reform that stands out is Ontario’s implementation of the Local Health Integration Networks (LHINs). The LHIN structure was designed to improve coordination, planning, and funding of healthcare services at the regional level. As discussed by Osborne (2008), this model aimed to integrate services and improve patient access by encouraging collaboration among hospitals, long-term care, home care, and community agencies. In practice, however, many nurses experienced increased organizational changes, restructuring, and evolving reporting requirements as healthcare organizations adapted to the new system. These changes reinforced the need for nurses to be flexible while continuing to advocate for quality patient care. The LHINs assumed responsibility for planning, funding, and integrating many health services across Ontario, changing how organizations coordinated care and were held accountable.

Healthcare reform has required me to adapt continually by learning new policies, procedures, and technologies. It has also reinforced the importance of flexibility, teamwork, and lifelong learning in nursing. Although these changes can be challenging, they have strengthened my ability to provide safe, evidence-based, patient-centered care. My years of experience have taught me that nurses play a critical role in the success of healthcare reform because we are on the front lines, implementing changes while advocating for our patients every day.

[Marilyn]

Hi Jaime,

I completely agree you. Your career thus has really stood the test of time. This is such a great example of health reform and the reality of what happens when policy meets the bedside. It is one thing for administrators to design models like Ontario’s LHINs (do you remember when they were called CCAC?) to improve regional coordination, but it is another thing entirely to be the frontline nurse navigating the resulting organizational shakeups, shifting reporting lines, and endless structural changes. Your experience highlights a frustrating paradox in modern nursing: reforms aimed at improving “quality outcomes” and “efficiency” almost always translate into heavier documentation burdens and rapid-fire technology rollouts. What resonates most is the resilience it takes to thrive through these transitions and you’ve managed to absorb every new policy, new systems etc, all while keeping your patients safe, comforted, and cared for. This is a clear example the nurses are not just passive participants in healthcare reform, we are foundational to the entire system.

[Jessica]

I like how you speak about resilience through transition, and it sounds like Jamie has experienced just that.
I worry about the Nurses who were unable to manage the transitions and ended up leaving their profession due to challenges they experienced through these transitions.
I believe change is necessary, but support is even more important in ensuring staff are adequately prepared to navigate the ongoing changes of healthcare.

[Jamie]

Marilyn

I remember when it was called CCAC. Even now, I still have trouble calling it Care Ontario. I often find myself reverting back to calling it CCAC or the LHIN. Change is never easy, especially when it involves organizations and processes that have been familiar for so many years.

At my current employer, we are going through staffing cuts while taking on additional responsibilities. It has been a challenging adjustment. The one thing that always gets me through is reminding myself that I am there for the patients and that I can only complete one task at a time.

Over the course of my career, I have also come to realize that not everything has to be completed during my shift. Some tasks can safely be passed on to the next shift. As long as my patients are safe, comfortable, and receiving the care they need, that is what matters most.

[Marion Catherine]

Thank you, Jamie, for your contribution to this discussion. As a new nurse with less than 2 years experience, I am relying on the experiences of others in order to discern the impact health care reform has on nurses. In saying that, it appears that your comments and experiences support the conclusions I have made in responding to this assignment.

[Marilyn]

Hey Marion,

As a nurse with less than two years of experience, what changes have you observed during this time, and what future changes do you think are needed based on current workplace trends?

Thanks,

Marilyn

[Jessica]

What Quality measures does your organization/unit/department measure?

I work in the infection control department of an acute care hospital. As an infection control professional we track a number of quality measures which are reportable to ministry and the public. The organization remains accountable and transparent by reporting these quality measures and having them available on their website. Quality measures related to infection prevention and control include; hospital-acquired Clostridium difficile infections, new hospital-associated methicillin resistant staphylococcus aureus (MRSA) and Vancomycin resistant enterococcus (VRE) bacteremias, central line-associated primary blood stream infection (CLI) rates, Ventilator-associated Pneumonia (VAP) rates, Targeted surgical site infection (SSI) rates (hip and knee replacements), and hand hygiene compliance rates (Moment 1 and 4).

Public reporting of these patient safety indicators are just some of the quality measures mandated by the province across all public hospitals https://data.ontario.ca/en/dataset/patient-safety-indicators

[Marilyn]

Hi Jessica,

I love that you’ve connected your learning to current practice and trends. Thank you for sharing the link, but it seems to be broken or no longer active. Do you have an updated link or another reference we can use as a takeaway?

[Jessica]

It seems to be working on my end. Here is the information I was referring to:

This dataset contains rates of nine hospital-associated infections and patient safety measures:
Clostridium Difficile Infection (CDI).
Methicillin-resistant Staphylococcus Aureus (MRSA) bacteremia.
Vancomycin-resistant Enterococcus (VRE).
CIHI’s Hospital Standardized Mortality Ratio (HSMR).
Hand hygiene compliance (HHR).
Central line infection (CLI).
Ventilator-associated pneumonia (VAP).
Surgical site infection prevention (SSI).
Surgical safety checklist compliance.
*[CIHI]: Canadian Institute for Health Information

[Marion Catherine]

As I do not have a history in nursing to speak directly to the impact health care reform has on nurses, I am providing some of the thoughts raised while studying the various articles presented.
In reflecting on the readings for this module, a synopsis of the Health System Funding Reform (HSFR) video shows that the shift from a global provider funding model, where hospitals receive the same yearly percentage increases, to a patient based funding model, where funding is based on groupings of medical diagnoses and standardized practices, the impact on nurses is profoundly negative.
As patient care funding is tooted as resulting in a +/- 1-3% variances in funding (HSFR Video) what actually happens on the ward/unit does not match the Reform’s intent, unless increasing finance and administration staffing is the objective. However, for nursing, the Reform cuts deep into the soul of patient care and patient advocacy.
In addressing the evidence based funding requirements, facilities must develop monitoring models of illness and track nursing interventions and patient care needs. So, facilities to hire administrators to develop, monitor and account for funding dollars. It cuts nursing staff in order to pay for the administration costs in order to present a balanced budget before HSFR funds are transferred.
Patient-centered care is taught, in recent nursing school programs, as seeing the patient as a person first, someone with an illness. The intent is to meet the wholistic needs of the patient while treating the illness/disease. From the HSFR video, patient based funding is based on medical diagnoses and the standard treatment plans that coincide with the illness. The patient is still secondary to the disease, placing nurses in positions of addressing the fiscal needs of health care funding first then address treatments and nursing interventions for the people in their care. It appears that the negative impact of the actual patient care ratio, funding $:patient care needs, is hidden in the presentation of statistical projections.

[Marion Catherine]

The trends I have seen are funding based. Government funding during Covid allowed facilities to hire more nursing staff to address the issues in care that were made very public. Once the Covid crisis state was over, funding stopped and nurses were laid off. This tells me that the funding is available but that the political will to sustain adequate levels of quality care are negotiable depending on the volume of public outcry and media coverage.
The changes that I perceive are needed is an extensive education and training programs for family/friends of those people who are in the hospitals and especially in retirement and long term care facilities. The baby-boomer generation is already here seeking admission to these facilities and more are on the way. The history of funding practices does not support the recruitment of more nursing personnel. So, in order to meet the needs of the people in nursing care, families & friends have to come to the plate and support their loved ones. It is not enough to pay the thousands of dollars per month to a facility and walk away, leaving the care to the nurses and PSWs.
Also, I perceive that research showing the effectiveness of alternative health and wellness models have on an individual or a community’s wellness and wellbeing would support the nonpharmaceutical interventions available. However, this may require considerable changes to what a nursing care plan can look like and how effectiveness is measured.
In order to adopt these perceptions, changes are needed in all sectors of the circle of care and agencies that fund health care. The change has to be supported with evidence based practices, a robust media plan and as usual lean on nurses to engage in the plan and to provide the evidence showing the merits to growing this type of change.
It has been an infrequent experience where actual patient-centered care is at the forefront of any wellness model because the political will and related funding is not onboard, yet, and the health care system is still very much attached to the medical model of focused care. Things seem to be changing, slowly like evolution, but the health care crisis we (the global community) is experiencing is evolving at rocket speed. There has to be a bridge between these to processes of evolution.

[Mary Ann]

1. How did Ontario’s LHINs differ from other provinces’ regional authorities? How were they the same?
LHINs mainly planned and funded services rather than directly managing hospitals which other provinces’ regional authorities do. Like other provinces’ regional authorities, they aimed to improve coordination, access, and regional health planning.
2. How do they impact decisions in your organization?
LHIN has an impact as they influenced funding, service priorities, care coordination, and performance expectations.
3. Who is driving health care reform and why?
Provincial governments, health agencies, and policymakers drive reform to improve quality, access, efficiency, and manage rising costs.
4. Is health care reform influenced by local issues or international experience?
Both. Local needs shape priorities, while international evidence and best practices guide policy development.
5. Where do different perspectives on the health care “crisis” and “sustainability” come from?
They arise from governments, health professionals, researchers, patients, and the public, each with different priorities and experiences.
6. What quality measures does your organization measure?
The common measures do my organization are through audits, reviews of patient safety, infection control, falls prevention, medication errors, patient satisfaction, skin and wound assessment.
7. How are this quality measures determined?
They are based on provincial standards, accreditation requirements, organizational goals, and patient safety priorities.
8. Pros and cons of tying senior executive salaries to quality metrics?
Pros: Encourages accountability and quality improvement.
Cons: May overemphasize measurable targets and overlook other important outcomes.
9. Should nurses’ salaries be tied to quality outcomes?
Generally no, because patient outcomes depend on many factors beyond an individual nurse’s control.
10. Example of health care reform affecting nursing or patients:
Expansion of team-based care and virtual care changed nursing roles, improved access for patients, and was influenced by government policy, healthcare leaders, and professional nursing organizations, with nurses contributing through advocacy and feedback.

[Heather]

Mary Ann: I agree that nurse salaries should not be tied to outcome until nurses have more of a voice in things
that directly affect patient outcome, such a nurse to patient ratios. How can a nurse possibly be measured in any sort of
way when the odds are against them being able to provide holistic care to double digit numbers of patients. I recently read a news
article about a nursing home in Kingston area where the home was always running out of supplies and even food for the residents.
Not sure if anyone else saw that.

[Heather]

Health Care Reform in my area and whether nurses had a voice in it.

The Ontario government invested over $6 million into primary care in waterloo to connect people with
primary health-care providers. The money was distributed to 124 heath care centres . The leader of the KW4 Ontario health team said the money should help reduce wait times, provide broader care for marginalized communities.

Although I am usually skeptical about health care reform actually doing so, in my current job, I have worked with a few of this initiative nurse practitioner clinics and have found that they were very helpful working with some of our bed bound patients and linking them to resources. Some of the nurse practitioners also did home visits along with other specialists that typically have very long wait lists.

I was pleased to see that clinics were led by nurse practitioners which hopefully will give a voice for
nursing and change the public view of nursing care being very beneficial and sometimes a better alternative to more expensive physician care.

On the other hand, my work is intstalling new technology which will come with challenges and likely will lead to it needing to be done very quickly and inevitably will lead to more documentation being needed and more time spent doing. it.

[Author]

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