Free education for PSWs, but at what cost?

The Ontario government plans to train 6000 to 8,000 new PSWs by December 2021, offering free tuition, textbooks and a paid practicum. Given the devastating effects of COVID in Ontario LTC facilities, increasing the work force will help to ensure that all older adults receive excellent care.

This funding will undoubtedly help people to enter the PSW program and will help unemployed people to train or retrain and find new work opportunities. For some who enter the PSW program and then the workforce, they may discover the joy and the rewards that come with caring for elders, with sharing laughter and tears and stories. 

This funding raises many questions.  What about the PSWs who are already in the workforce? In Ontario there are PSWs who are unemployed. There are PSWs without full-time work who used to be able to meet their financial needs by working at more than one facility. For some, their full-time pay is not sufficient to support themselves and their families and the benefits are too often non-existent.

Ontario PSWs responded to this funding announcement with,
“What about us? We need jobs. We need better pay. We need better work conditions.”

This July 2021 report about LTC identifies challenges that PSWs encounter in their work. It leaves me concerned that the following challenges for PSWs will not be addressed by the new funding.

Challenge: Keeping PSWs in the workforce

Did You Know? 40% of PSWs leave within within one year of training.  For every 10 people who graduate, 4 of those leave the profession in the first year.

Working conditions and burnout are the main reasons PSWs leave.

  • 50% of PSWs are retained in the health care sector for fewer than 5 years
    • 43% left the sector due to burnout or working short staffed
  • 25 % of PSWs with two or more years of experience leave the sector annually

 Changes that would help to retain PSWs are:

  • Improved Staffing: Staffing levels need to change so that PSWs can realistically meet the care needs of residents without the risk of burn out. I hope that the government will now provide  increased funding for LTC staffing.
  • Valuing PSWs: A key change would be to integrate PSWs fully into the team, including the way that PSWs are treated. PSWs need to be SEEN and HEARD and VALIDATED! As fully integrated members of the team, they would have opportunities for leadership and education. 
  • Supporting PSWs: With increases in wages and benefits, and full-time jobs possibilities. I hope that the government now provides  increased funding for PSWs to encourage them to stay in their chosen field of work.

Challenge: Preparing PSWs

PSWs need education and training so that they can be prepared to care for people who are living, but are also dying. The report acknowledges that “most residents reach end of life in LTC.” New PSWs must graduate with the skills and knowledge for providing palliative and end-of-life care, and how to integrate a palliative approach.

To fully prepare PSWs to care for people who are living and dying:

  • Provide sufficient education in core curriculum for PSWs to know how to provide palliative care, and integrate a palliative approach.
  • Provide continuing education opportunities on providing palliative care and integrating a palliative approach.

 

In closing, I raise my hands to PSWs, the work that they do and the care they provide. I hope that this free education will be followed with other changes that will benefit all PSWs, and that PSWs will be best able to provide excellent care.

 

How do you infuse love in your organization?

Several years ago I was inspired as I read writings from Stephen Post and Thomas Kitwood defining love in dementia care.

“Love within the context of dementia care includes comfort in the original sense of tenderness, closeness, the calming of anxiety and bonding.” (Kitwood, 2003)

“Altruistic love involves both a judgement of worth, and a related affirmative affection. Love is manifest in care, which is love in response to the other in need; it is manifest in compassion, which is love in response to the other in suffering; it is manifest in companionship, which is love attentively present with the other in ordinary moments.” (Post 2003)

As I reflected on their writings, I thought of my esteemed colleague Misha Butot – Fourteen years after graduating as a social worker, while working as a counsellor, educator and yoga teacher, she recognized that love was a theme in all of her work. As a masters student Misha approached people across Western Canada who were involved in social justice work. She asked them if love was relevant in their work and what love in professional practice looked like for them. Even though they were diverse in age, gender, work and focus, ten common themes emerged. Fourteen years later, I approached Misha and asked if we could revisit those themes and translate them into plain English.

As we worked on this “translation” we were inspired by the stories from the research participants, we reflected on our own lives and we wrote a personal commitment to love in our professional practice.

This year, as we consider the most important theme of cultural safety in health care, I am inspired by the thoughts of Dr. James Makokis, an indigenous physician, “Racism is hate. The opposite of hate is love.” and he asks, “How will you infuse love into your organization?”

Racism is hate. The opposite of hate is love.” and he asks, “How will you infuse love into your organization?

Dr James Makokis

In this month of February, as many celebrate Valentine’s Day, love and friendship, I invite you to consider:

What does love look like in your practice?

How do you infuse love into your organization?

I’d love to hear your thoughts.

Teaching Tip: Using reflective writing to learn about beliefs and baggage

We often think of writing as a way to present our ideas to others, to answer questions, and to illustrate what we know.  However, Laurel Richardson suggests that she writes in order to LEARN!

I write because I want to find something out. I write in order to learn something that I didn’t know before I wrote it.  I was taught, however, as perhaps you were, too, not to write until I knew what I wanted to say, until my points were organized and outlined.

Reflective writing helps students to become more aware of their “beliefs and baggage” – personal beliefs, their issues, values, preferences and fears, about dying, working with the dying, and their history with dying.

Student might find that reflective writing can help the writer bridge the inner and outer world, and connect new knowledge with practice. They might find that their writing helps to create new meaning and results in personal and professional growth.

Students may be new to caregiving and may be concerned that they have “nothing to write”, that they have “no work experience” in this area.

A person burdened by their beliefs and baggage

When you are unaware of your beliefs and baggage, they can weigh you down

Students are invited to write reflectively.  Naomi Goldberg (Writing Down the Bones) provides the following guidelines for writing practice, that can be adapted here for reflective writing:

  1. Keep your hand moving
  2. Lose control
  3. Be specific
  4. Quell the critic (silence the critic)
  5. Be easy about spelling or grammar
  6. Feel free to write junk
  7. Go for the jugular

Instructors will need to help students understand that this is not about right or wrong!  In fact, inform and remind them that reflective writings are not marked for content, but only for participation.  Students will need to adjust their mind set, to simply look at the statement or the question, and just write whatever comes to their mind.  If they want to take a notebook, they might find that writing without stopping for ten minutes provides more opportunity for issues and ideas to come forward than writing for just a few lines.

Sort your beliefs and baggage

Learn to sort through your beliefs and baggage with reflective writing

Instructors can go through the Workbook exercises with the learners and brainstorm reflective responses to the different questions posed.  Some questions such as, “list what you think would be a good death, a bad death for you” student respond to easily.  They may have experience with a loved one dying, a pet dying, or their experiences may be limited to death as they have seen it portrayed in the media or how they have imagined dying might be.  Any or all of their thoughts would be more than appropriate to write.  “I don’t know” and “I have never thought of it” are reasonable answers.  I would then ask the student to follow Naomi Goldbergs directions for writing, and see if any other ideas come forward.

Students may request permission to write their responses in their native language.  This would be fine.

As students reflect, it is hoped that they will become more aware of themselves, their concerns, fears, issues, values about dying, death, caregiving etc..  With the increased awareness of themselves, they may be better able to focus their care on “the other”.

An image that may be helpful: airport and many suitcases.  If you know which one is yours, you can pick up your own baggage.  But if you are not sure which baggage is yours, and which belongs to someone else, you may mix up the bags.  The analogy is, that if you are not aware of your baggage, you can trip over it, while trying to care for someone else with different baggage and different needs.

Baggage sorted and put aside before caregiving

Sorting your baggage prevents your beliefs from weighing you down

Please note: Students may have much experience with death, loss and grief. For a person who has immigrated to Canada, it may be that their experiences with death and dying occured in their home country before immigrating to Canada.  These may be extremely painful experiences and be painful for the person to recall and difficult to explore. Instructors can support students by offering support as they work through their experiences as they prepare to care for people who are dying in Canada.

 

University of Birmingham offers a “short guide” to reflective writing here that details different methods for developing a reflective writing practice. I encourage you to read it and share with your students as a way to help them consider the various methods of tapping in to their beliefs and baggage.

 

 

 

Learning with ELNEC in Hawaii

At the memorial

At the War Veterans Memorial in Honolulu, with Jeannie White

A few weeks ago, Ted and I had the privilege to be invited to attend the ELNEC 20th Anniversary Summit in Hawaii.  ELNEC, the “End-of Life Nursing Education Consortium (ELNEC) was launched in 1999 to improve palliative care. In the past 20 years more than 24,000 nurses have attended one of the ELNEC Train-the-Trainer courses and have then taught more than 726,000 nurses and other healthcare providers worldwide.

Dr. Betty Ferrell has been the visionary leader of ELNEC while Pam Malloy has filled the immense role of Project Director. Pam is preparing to retire in January and she will be missed. I have cherished my connections with Pam and Betty over the years. They have shown great generosity of spirit to Life and Death Matters, have provided testimonials for our nursing texts and resources, and continue to support our work in Latin America.

I delighted to meet again with Polly Mazanec who is working with ELNEC undergraduate, Diane Parker. Diane is helping promote palliative care in Uganda as well as being a dynamic force inmoving pediatric palliative care ahead in her home state. And of course, it was wonderful to meet other faculty and participants from all over the states.

I attended the CORE-ELNEC course, witnessed the challenge of trying to share a large volume of material in a two day course. I was impressed with the binders that each participant received, including materials to teach other nurses.

I look forward to continuing to work with ELNEC, supporting their courses, and being supported in our work. Thank you #ELNEC. And best of best wishes to you, dear Pam, as you explore what retirement will be for you.

Photos below – I really enjoyed meeting up with these incredible people!

With Betty Ferrell, PhD, MA, CHPN, FPCN, FAAN

With Diane Parker

With Pam Malloy, MN, RN, FPCN, FAAN We’ll miss you!