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Canadian Journal of Public Health

, Volume 97, Issue 3, pp 230–232 | Cite as

Surge Capacity and Casualization

Human Resource Issues in the Post-SARS Health System
  • Andrea O. BaumannEmail author
  • Jennifer M. Blythe
  • Jane M. Underwood
Policy

Abstract

In Ontario, the unpredictable funding climate of the 1990s led health care organizations to look for ways to reduce costs. Adopting a just-in-time staffing policy, they employed fewer full-time workers, scheduled part-time workers to work regular shifts, took on more casual staff, and became increasingly reliant on agency nurses and overtime to cover shifts. These policies resulted in higher costs and reduced surge capacity, and placed the health of nurses and patients in jeopardy. Fewer staff meant more overtime. Stress-related absenteeism increased. Some nurses reacted to casualization by working for multiple employers.

During the SARS (severe acute respiratory syndrome) epidemic in Toronto, nursing resources were stretched to their limits. An exploratory investigation, based on relevant literature and interviews with 13 nurse administrators who held key positions during the epidemic, confirmed the lack of spare capacity in the health care system and indicated that community and long-term care sectors had less capacity than acute care. Low surge capacity in these sectors increased the vulnerability of the entire health care system. Capacity issues should be addressed as part of a larger human resources initiative to create a more flexible workforce. Since SARS, a number of government and organizational initiatives have been developed to increase nursing capacity.

MeSH terms

Severe Acute Respiratory Syndrome health manpower nursing staff personnel staffing and scheduling 

Résumé

En Ontario, l’imprévisibilité budgétaire des années 1990 a amené les établissements de soins à trouver des moyens de réduire leurs coûts. Optant pour une politique de dotation « juste à temps », ils ont embauché moins de travailleurs à plein temps, affecté leurs travailleurs à temps partiel à des postes de jour, embauché davantage d’employés occasionnels et fait massivement appel à des infirmières engagées par des agences et aux heures supplémentaires de leurs propres employés pour compléter les équipes de travail. Ces politiques ont entraîné des coûts plus élevés et réduit la capacité de gérer l’imprévu, et elles ont compromis la santé des infirmières et des patients. Avec un personnel réduit, les heures supplémentaires ont augmenté. L’absentéisme lié au stress a augmenté lui aussi. Certaines infirmières ont réagi à la précarisation de leur emploi en travaillant pour plusieurs employeurs.

Pendant l’épidémie de SRAS (syndrome respiratoire aigu sévère) à Toronto, les ressources infirmières ont été étirées au maximum. Une enquête préliminaire fondée sur des études pertinentes et sur des entretiens avec 13 infirmiers et infirmières cadres qui occupaient des postes clés pendant l’épidémie a confirmé l’absence de capacité d’appoint dans le système de soins de santé et montré que le secteur communautaire et celui des soins de longue durée avaient une moindre capacité que le secteur des soins actifs. La faible capacité de gérer l’imprévu dans ces secteurs a accru la vulnérabilité de tout le système de soins. Les problèmes de capacité devraient être abordés dans le cadre d’une initiative générale de mise en valeur des ressources humaines qui viserait à produire une main-d’oeuvre plus polyvalente. Depuis le SRAS, un certain nombre d’initiatives gouvernementales et organisationnelles ont été élaborées pour accroître les ressources infirmières.

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Copyright information

© The Canadian Public Health Association 2006

Authors and Affiliations

  • Andrea O. Baumann
    • 1
    Email author
  • Jennifer M. Blythe
    • 1
  • Jane M. Underwood
    • 1
  1. 1.Faculty of Health SciencesNursing Health Services Research Unit, McMaster UniversityHamiltonCanada

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