There is good reason why a nurse cannot leave her ward if there is not another nurse to relieve her, even at the end of her shift, even if that means staying on her feet for 24 hours -- patient care is not optional. But it also makes abundant sense that a nurse working a double shift is more likely to make mistakes.
And that is confirmed by a Statistics Canada survey that questioned 18,676 registered nurses about medication errors in 2005. Almost 20 per cent of the nurses surveyed said that medication errors had occurred either occasionally or frequently in the last year. (Among Manitoba nurses surveyed, 15 per cent reported observing errors in medication.) Nurses who said they usually worked overtime were more likely to say a medication error had occurred: 22 per cent, compared to 14 per cent of those who didn't usually work overtime. Nurses who reported carrying too heavy a workload or did not have good working relations with other nurses or doctors also reported a significantly higher rate of medication errors.
Medication mistakes account for a big piece of medical errors in hospitals. As intuitive as it seems that working extended shifts will affect the quality of patient care, neither the Manitoba Nurses' Union nor the regional health authorities have done good tracking of how often a nurse works a double shift. Indeed, the tracking of critical incidents -- an error in patient care that has a serious impact -- is a bit of a public policy sleeper: The Winnipeg Regional Health Authority compiles data on voluntarily reported critical incidents, but does not post its annual reports on errors on its website. That makes it difficult to know whether progress is being made on the work done to improve the way health systems work to cut down on mistakes. Further, patients can't decide for themselves if their odds are better at one hospital or another.
Nurses in Manitoba complain that they, unlike other professions, cannot refuse to stay when their shift is done if a replacement cannot be found. It is a dangerous practice in a health care setting, but leaving a ward of sick people short of workers also is not an option. Health authorities and the provincial government are working to recruit nurses to fill a chronic shortage, but so is all of Canada. Both they and the nurses' union ignore the fact that with a disproportionately large number of nurses here working part-time, Manitoba must naturally employ, and also recruit, many more bodies to cover the system's needs. In exit surveys, University of Manitoba nursing students continually complain about the difficulty of finding full-time work here.
Hundreds of nursing jobs are vacant in Manitoba, underscoring the urgency of an aggressive recruiting strategy. But fundamentally, Manitoba needs a better balance to its part- and full-time nursing workforce. More immediately, health authorities owe patients better information on how often and, in which hospitals, nurses are working long after their shift expired.
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