Supported by Health Canada, the eShift serves to resolve the shortage of community nurses by placing more personal support workers (PSWs) into long-term care facilities instead of community nurses. Up to four PSWs would then be monitored by one registered nurse (RN). The eShift would then allow nurses to perform their role more efficiently and with less burden; PSWs would then care for each specific patient and cater to their needs instead of assigning one nurse to care for four patients (Service Ontario, 2012).
As a student ‘soon-to-be’ nurse, my assessment of the positives and negatives of eShift may be bias therefore, I will evaluate eShift from the perspectives of both patients and nurses
As a Nurse
As a student nurse, I recognize that I have yet to truly understand the realities of nursing and the struggles of working 12 hour shifts 7 days a week. However, over the course of my studies, nursing theories have drilled the importance of therapeutic nurse-client relationship into mine and many of my classmates’ minds. The Collage of Nurses of Ontario reinforces the therapeutic relationship as a standard of nursing that must be met in order to meet optimal care (CNO, 2006). By implementing the eShift, this is no longer possible as nurses will not be able to have true interactions with the patient. Instead, the nurse will be providing care technologically though a PSW and making judgement retaining to the client’s health without recognizing the client’s medical preferences. It also takes away from client-centered-care as it neglects the holistic aspect of nursing – to consider the individuals needs outside of medical necessities. It may also harm the patient if any critical information is missed by the PSW that include observations as the nurse would be unable to identify these mistakes without seeing the patient personally.
Benefits of eShift would be that it allows nurses to work more efficiently at any location if the form of communication were provided to the nurse’s home. E-Shift can promote more jobs for PSWs and by allowing them to work in palliative care, nurses can then work in other areas of the hospital as well as palliative care, reducing the shortage of nurses.
Most importantly eShift would also allow time for nurses to rest properly without the burden of juggling 4+ patients and working with sleep deprivation as this can lead to more accidents or missed information (Johnson, Brown, & Weaver, 2010). Nurses should not be working in 24-hour setting but because of the demand for nurses, they must. E-Shift may allow nurses to work most efficiently and effectively when they are present to work. As stated by the service Ontario (2012), “without the innovations such as eShift to care for clients at home – especially overnight- we would see an increased reliance on the ER or even a return to hospital. That isn’t the best solution for many clients and it is not sustainable as a health system” (Service Ontario, 2012, p.2). This quote supports the intention of eShift to improve the healthcare system, the lives of healthcare providers (nurses), and patient outcomes.
As a Patient
As a patient in palliative care, I believe having a PSW to care for me – and me only – would be pleasant as they would be there if I needed him/her instead of having to wait for a nurse to be free to care for me. A main priority for individuals in palliative care is to be comfortable before passing. Having 24 hour care would be convenient for the patient however, it would also be important that the patient has a voice in his/her end-of-life care.
Things to Consider (When Applying E-Shift)
E-Shift is a “technology-based initative that connects an enhanced-skill Personal Support Worker (PSW) in the home with a registered nurse via a web-enabled iPhone (South West Local Health Integration Network, 2013). The South West CCAC uses eShift currently and according to their brochure, it is working well for both PSW/RN/RPNs and patients. The program states that it offers 24 hour care but, does not clarify whether or not the patient sees other healthcare providers aside from the PSW (Service Ontario, 2012). If the case is that the patient only sees the PSW, the eShift model must consider incorporating other health professionals to capture a more holistic aspect of the patient. Other improvements that could be made to the eShift program are creating rotational shift of PSWs at night and Nurses during the day. It would allow for the development of a healthy therapeutic nurse-client relationship as well as clarifies any additional questions the client may have that the PSW is unable to answer. The nurse can also clarify any observation that the PSW may have missed and document any additional information.
Sadly, the major flaw in the eShift is the possibility of an emergency where, the technology fails and the PSW is left stranded without help or the credentials to provide additional care. The loss of service or battery power often hinders the technology aspect of healthcare. This can directly influence the patients’ outcome as it can be very detrimental to the system if the nurse is unable to communicate effective with the PSW.
The Authors Thoughts
The overall idea of eShift is an effective program that allows PSWs and Registered nurses to work effectively and collaboratively together.
I feel that eShift does better the care for patients due to the fact that they are able to have someone at all times. However, the system needs to improve their protection and prevention program to minimize the possibility of mistake from transferring information from PSW to Nurse.
Nevertheless, the prime role of nurses is to be there for the patient at all times and to see the client as a whole, instead of another ‘sick patient’. Ideally the solution of eShift is to simply have enough nurses to provide care individualized care to each patient in ever department. However, due to the unfortunate circumstances, I think that eShift is a necessity that would work better with some alterations like rotational shifts. E-Shifts would also need to stay within palliative care as the risk that eShift could take-over all departments in clinical settings is a scary thought. Nurses would no-longer be the ‘caring’ figure in the hospital but, simply a technological figure that watches over PSWs.
Johnson, Arlene L, PhD,R.N., A.N.P., Brown, Kathleen,PhD., R.N., & Weaver, Michael T, RN,PhD., F.A.A.N. (2010). Sleep deprivation and psychomotor performance among night-shift nurses.AAOHN Journal, 58(4), 147-54; quiz 155-6. Retrieved from https://www.lib.uwo.ca/cgi-bin/ezpauthn.cgi/docview/205435799?accountid=15115
CNO Therapeutic Standard- http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf
South West CCAC Brochure: http://www.southwestlhin.on.ca/newsletter.aspx?id=60