Monday, May 4, 2009

First downsizing, now "downskilling"??

I think I've just invented a word. It's not the first time for that, nor shall it be the last. Downskilling is a trend I've noticed with little proof other than a hunch. Within the healthcare and residential care sector, I've noticed nursing positions that were once deemed to require candidates with a certain set of credentials has now been given some slack to include those one or two rungs down the ladder. For example, Registered Nurses (RNs) are being replaced by Registered Practical Nurses (RPNs). RPNs are being replaced by Personal Support Workers (PSWs), etc.

The other day I received the proof I need from a friend who boldly announced via his Facebook status that he was removing the City of Thunder Bay from his Christmas card list because they were doing just this very thing with their City-run long term care facilities.

You don't have to be a healthcare insider to know that funders are tightening the purse strings, expecting more from less, and want lots of positive 'outcomes' for clients. Maybe I'm blind to it all, but I really don't think so. I just don't see how this is going to benefit either care recipients or their providers.

P.S. Apparently I did NOT invent the word downskilling. Here's the official definition: Downskilling© refers to a process of reducing the talent or skill level of a position, job, or vocation primarily for the purpose of decreasing short-term cost (see this guy for more info )


  1. Hi Jill,

    I decided to check out your blog and I somewhat disagree. Nurses' skillsets are changing. RPN's are now trained to do more skills than they were in the past and RN's have new skills too. For example, RPN's were never allowed to do intramuscular injections in the past. Now they can. RN's couldn't insert PICC lines, now they can. PSW's are also learning skills that used to belong only to nurses, such as dressing changes. It is a shift up. It does help cut costs, but it gives doctor's the additional assitance they need. Just a thought...


  2. Although I agree that their skill sets for these various designations have expanded, there still remains a significant gap in learning. What I’m seeing are homecare and LTC staff who are caring for clients who are, on average, older than in the past and with more complicated medical/need profiles than in the past. Another big problem is the staffing ratios. Although there are set ratios in place, staff report to me that they regularly work short-handed and work 1:20 or more. Management from at least a few LTC facilities in this area have told me that there is no policy requiring the backfilling of absent staff. So, what you end up with are staff who are asked to do more with fewer skills for clients who require heavier care. In fact, the Senate Committee on Aging has been hearing witnesses over the past three years to assist in the development of a list of recommendations targeted at improving the experience of aging adults in Canada. In their final report, issued in April of this year, they addressed this issue specifically.

    In the vast majority of cases, I think staff are managing but I'm seeing increased requests for burnout talks. I do wish the Committee would have heard from actual recipients of care to find out their experiences.

  3. Burnout is a problem in all areas of healthcare and short staffing certainly doesn't help the issue. I agree that more work is being required of fewer people and it certainly isn't unique to the healthcare field. If homes are hiring the right people, lack of skills should never be an issue. You should never fill a nurses' spot with a psw, for example. If that is happening, that is poor management.

    As to staffing ratios, there shouldn't be a need to have backfilling policies when there are standards in place that dictate a ratio. If the by-laws stipulate a staffing ratio of 1:8 and absenteeism causes that ratio not to be met, it becomes a licensing issue. Homes are required to maintain that ratio at all times. Should a home have ratio issues, one call to the licensing commissioner will change all that. It's a shame that it would have to come to that, but that may be what it takes. Homes may need to hire more people to keep that met, and that is probably the biggest reason ratios are not being met. Hiring costs. I do not believe it is a skill-set issue, but a management issue.

    By the way, I'm enjoying your blog and this dialogue :)