Canadians were reminded again today of a demographic reality - there will be a huge wave of retirement of nurses soon and young women are not entering the profession
"One in three nurses is 50 or older, says the report based on 2003 data. Only one in 10 is under 30, suggesting there are not nearly enough younger nurses to replace those who will retire. "If we don't do something now we really are going to have some pretty dire consequences," says Lucille Auffrey, executive director of the Canadian Nurses Assoc., commenting on the CIHI report.
The problem is far from new: it has been the subject of numerous reports since at least 1997. Yet governments have made little effort to deal with it, Auffrey said in an interview Tuesday.
"One wonders why the bureaucracy and political system . . . is not seeing what's right in front of their nose."
To compound the issue of front line delivery, the doctors are in the same demographic.
On PEI there have been vain attempts to recruit more nurses and Doctors. It is time to stop trying the impossible - that is to try and put PEI at the head of the staffing line up when our rural society and small size works against us and the demographic challenge is so extreme.
The wise way to go is to redesign the front line so that it needs less people but that it offers better service. A paradox, even impossible you say. Not so. Here is how it can be done.
Context - Over 80% of visits to doctors are mundane and are rooted in the need for reassurance. Colds, flue, sprains, pains etc. Most of the illnesses that we suffer from are not acute but chronic such as diabetes, arthritis etc. 50% of the lifetime costs are spent in the last year of life. Hospitals are not only expensive but dangerous places where it is increasingly likely that you will get an infection or a mistreatment.
If we had a phone triage service staffed 24/7 by a few doctors and nurses nearly all this load could be dealt with. You with the child with a high temperature would have the assurance that she was getting attention in minutes. You who had to have your insulin scrip renewed could do this over the phone. The foundation of this is a having our files available to the staffer. If the Pizza firms can do it so can we do this in medicine. You then add an internet version of this - the back end of the triage system works here as well.
We then add tele-medicine to this for more acute and serious cases such as when you leave hospital after surgery. PEI have already Beta tested a wonderful system that allows a nurse and you to chat on video. The tool has a number of testing systems as well. Blood test, blood pressure etc can all be taken and logged in the file. This enables you to get out of hospital quickly but gives you the assurance that you are only a moment away fro help.
We then add virtual hospice to this. On PEI we have tested this already. 50% of our lifetime costs are spent in the last year of life. Usually in the acute care system. If we make the shift to hospice we get the care we need and more without the panic about treating the untreatable.
We add community groups form those with chronic disease. No one knows better than a diabetes sufferer how to take up exercise, build expertise in foot-care, eat differently and use the blood tools and give injections. No one knows more about cancer treatment than cancer patients etc. These groups not only provide support but also become highly expert.
We take huge load off the system and we give the citizen a system that works for them. Now PEI has a delivery system that works.
We get immediate access. The doctors and nurses get predictability. The costs drop because we have taken 80% of the load off the face to face system and out of the hospitals. Now when you are really ill - cancer etc, there is room to treat you well.
Only a rethink like this will get us anywhere. Hoping to get more nurses or doctors without changing the workplace is a fools' errand
