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Health Care Policy:

Effects of Recession on Nursing Care and Medical Emergency Services

Essay should consist of 50 percent theory and 50% research

Author: Sana Ullah

Student ID: 0524681

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Prof.: Andrew Goodman

Course: Public Policy
Life and, to some extent, disease are unpredictable. You will never know when
and how you will die? You will never know in whom hands you will die; nurses or
emergency staff at the hospital? The focus of this essay will be on nursing care and
medical emergency services during recession. Will these services experience the
effects of recession as the auto and other industries are experiencing during the 2009
recession period. This paper will take into consideration previous recessions of 1980
and 1990 to prove the hypothesis that nursing care and medical emergency services
will be reduced during 2009 recession period.
Before proceeding ahead, lets take a look at the definition of nursing care,
medical emergency and recession. Nursing is a process in which nurses process,
assess, plan, implement and evaluate patient care. In short, they are responsible for
taking care of the patients in the absence of a doctor. On the other hand, medical
emergency is an injury or illness that is acute and poses an immediate risk to a persons
life or long term health. Lastly, recession refers to a significant drop in economic
activity (Economic Concepts, 2009) resulting in high unemployment rate and low gross
domestic product (GDP). In the past, recessions lasted from few months to years during
which, many service providers had to declare bankruptcy or cut back on employees to
fight the effects of recession. The 2009 recession has seen many service providers
declare bankruptcies and/or cut back on their employees to stay in business. Most of
these service providers were private such as the automotive industry. Nursing care and
medical emergency services are provided by the government and thus are believed to
be recession proof as the funding to provide these services comes from the
government. In the past recessions, government put a freeze on new hiring and pay
increases (Kines & Shaw, 2008) in the public sector so save money during the

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Nursing care is usually done in hospitals (course book), senior homes and if
necessary at private homes of patients. Nursing care is a profession which is thought to
be recession proof. As long as there are patients there will be nurses. This may be true
to some extent but when we look at nurse patient ratio, it becomes evident that nurses
profession is at risk during 2009 recession period. Carecor, who provides qualified
licensed nurses to hospitals, said that Ontario government is decreasing funding for
hospitals during the 2009/2010 fiscal year. (Yeo, 2008) Carecor further said that the cut
in funding postponed additional 9,000 nurses in Ontario. Everyone who works in the
hospital knows that the nursing shortage is very real. (Yeo, 2008) The cut backs in
health care budget are due to financial difficulty. Ontario governments revenues will be
going down from taxes because business is not going well. People are laid off and the
pressure of the government to spend to stimulate revenues is going up and there will be
significant pressure on the health care budget. (Lem, 2009) The shortage in health care
budget is causing shortage in nursing which in return will affect how perform their
Todays nursing shortage is very real and very different from any experienced in
the past. As a huge segment of the population, the baby boomers, enters their senior
adult years, the demand for health care is expected to grow in response. (Rosseter,
2009) The need for care comes at a time when nursing schools are struggling to
maintain enrolment levels and a large percentage of the RN [Registered Nursing]
workforce is close to retirement. (Rosseter, 2009) According to health Canada 2009,
during the 1990/92 recession period, the nursing patient ratio was 1:119 patients, in a
12 hour shift, but it increased significantly to 1:133 in 2001, a 12 percent increase. This
increase in nursing patient ratio has hindered nursing care negatively as many nurses
are now forced to work long stressful hours and attend more patients. Furthermore, in a
recent study it was concluded that hospital sector(s)... have seen cuts in nurses [and]
are seeing a reduction in the number of nursing hours in hospitals by 2,000 hours due to
budget constraints." (Lem, 2009) In addition there are "fewer and fewer new recruits
able to enter nursing... and more and more nurses (are) leaving the profession or the
country, an even more critical shortage is inevitable unless action is taken." (Health

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Canada, 2009) Statistics show that during the 1990 recession period, there was an
increase of 11% in Canadian population and a decrease of registered nursing seats by
26%. Statistics also show that there was 46% decrease in nursing graduates which is
leading to shortage in nursing. The decrease in nursing seats during the 1990 was due
to the effects of recession. Hospitals were not hiring nurses due to lack of funding from
the government and nurses currently hired are overloaded with patients thus
dramatically decreasing nursing patient interaction time and quality of nursing.
Medical Emergency Services is another recession proof service because it
receives funding from the government. Even though it is a recession proof service, it is
also true that doctors, nurses and other staff working in the medical emergency
department will have to operate with the shortage of staff and increased number of
patients. During recession, hiring of more staff including nurses and doctors freezes,
thus increasing burden on staff already working in the medical emergency department.
In Ontario, the nursing shortage isnt just affecting home care for seniors, but also
hospital surgeries... There is a labour crisis, it has already begun. (AIMS, 2009)
Furthermore, there are many surgeons who are unable to operate on patients due to
shortage of nursing and other staff. They have no other option but to cut back on
surgical dates. (AIMS, 2009) Many of the patients who arrive at medical emergency for
treatment come with minor injuries which can wait or treated by family doctors or walk-in
Theory/Policy Model
There are many theories which help us understand how to improve on current
policies in place. For instance, nursing care is a profession which is responsible for
patient care in hospitals, senior homes and other institutions where they may be
required. According to one study, nurses spend approximately three quarters of their
time on work that does not contribute to patient care... this not only destroys
productivity; it also destroys motivation and pride. (Health Canada, 2009) The misuse
of nurses is costing government a lot more and the quality of work has decreased
greatly. A policy model which if applied during recession period will help save

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government a lot of money and increase the quality of work done by the nurses. The
policy model is called, Public health nursing intervention model. (Medscape, 2009)
PHNI model helps define more clearly the duties of nurses and creates a better work
environment for them in which they will be able to increase their productivity, motivation
and pride. The work not related to nursing care is taking away interest, pride and
motivation of nurses as they are not being given the chance to do what they were hired
for, which is to take care of the patients. Furthermore, clerical work is leading to
diminished knowledge of nurses thus they are unable to take care of their patients
effectively. Public health nursing intervention model will help reshape how nurses care
for patients in Canadian health system. It will allow them to give more attention to their
patients which would increase their self confidence and motivation which in return will
result in patient satisfaction.
Similarly, doctors in medical emergency services cannot operate on patients
effectively if there is a shortage in nursing staff that deal with minor cases and assist
doctors or surgeons during operations and other assistance. PHNI model applies to
medical emergency services as there are nurses who assist doctors and surgeons
during their operations.
In order to reduce burden on nurses and improve their quality of work, clerks will
be hired who will work along with nurses and take care of necessary paper work. This
would help reduce cost and will allow nurses to care for more patients.
To reduce medical emergency wait time and extra load, people will be educated
through media such as news papers, TV and pamphlets which will inform people about
when to go to emergency and when not to. People will be educated about the difference
between emergency and non emergency cases and if they are in doubt, they should go
to walk-in clinics first and let them refer you to emergency services.
Furthermore, hiring new graduates during with a less wage will further assist in
medical emergency department and in nursing care for the baby boomers. As there are

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many nurses who are retiring, hospitals can hire two nurses for the same pay during
recession. The hired nurses will be able to care for more patients thus reducing nursing
patient ratio from 1:133 currently.

Services which run privately are greatly affected during recessions as compared
to services which are funded by the government. Nursing care and medical emergency
services are funded by the government, thus recession has a least effect on these
services. There is a shortage in nursing in nursing due increased patients and lack of
budget to hire more nurses during recession period. This shortage is causing decrease
in quality of care provided by the nurses to their patients. By implementing policies
which will hire new graduates with less pay and hiring clerks to deal with paper work will
further help increase patient care at hospitals and other departments where nurses
provide care services. Similarly, medical emergency services will not be affected by the
recession as they receive the funding from the government. Medical emergency
department will not be able to hire new staff due to reduced budget from the
government. By opening new walk-in clinics, extended their working hours and
educating public on what is emergency and what is not will further help reduce burden
on medical emergency department, thus helping them focus on more serious cases.
The hypothesis that nursing care and medical emergency services will be reduced is
true even though these services receive funding from the government, the shortage of
staff in medical emergency department, shortage in nursing care staff and increase in
patients clearly support the hypothesis.

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AIMS. (2009). Despite recession, looming labour shortage big threat, Retrieved
March 29, 2009, from
Economic Concepts. (2007). Recession, Retrieved March 25, 2009, from
Health Canada. (2009). The Problem- What is Causing the Shortage of Nursing
Care?, Retrieved March
29, 2009, from
Kines, L. & Shaw R. (2008). Government freezes public sector wages, Retrieved April
08, 2009, from
Lem, S. (2009). Think the worst of the recession is over?, Retrieved March 29, 2009,
Medscape. (2009). Theoretical Framework for Health Case Management Role,
Retrieved April 08, 2009,
Rosseter, R. (2009). Nursing Shortage at a Glance, Retrieved March 29, 2009, from
Yeo, R. (2008). Nursing Agency Use During Economic Downturn, Retrieved March 29,
2009, from