HSC nurses step up to help ER dodge understaffing bullet

Nurses worked overtime and picked up shifts to help Manitoba’s main trauma hospital avert crisis over the weekend after it was forced to close half of its beds in the emergency department due to a severe staffing shortage.

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Nurses worked overtime and picked up shifts to help Manitoba’s main trauma hospital avert crisis over the weekend after it was forced to close half of its beds in the emergency department due to a severe staffing shortage.

As they pitched in to bolster staffing at the Health Sciences Centre’s ER, nurses reported unsafe working conditions.

“Wait times in our adult emergency department remained well above target levels but within recent norms over the weekend,” a Shared Health spokesman said Monday. Nearly 150 patients went to the department each day, which is near the average daily count over the past four months, he said.

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On Friday, the Free Press reported that of 69 total beds, only the ones for the most seriously ill patients would remain open at HSC because nursing shifts were operating at about 30 per cent capacity.

“Shared Health is grateful to these nurses – and all of our staff in the ED – for their enduring commitment to patient care despite challenging circumstances. We also are appreciative of unit managers who worked on the floor this past weekend to support and provide patient care.”

On Friday, the Free Press reported that of 69 total beds, only the ones for the most seriously ill patients would remain open at HSC because nursing shifts were operating at about 30 per cent capacity.

‘Code orange’ plan

Part of the reason the ER at HSC did manage was the lack of multiple traumas or a mass-casualty event.
If a “code orange” had taken place, system-wide protocols are in place to ensure care is provided to trauma patients, a spokesman for Shared Health said Monday.

Part of the reason the ER at HSC did manage was the lack of multiple traumas or a mass-casualty event.
If a “code orange” had taken place, system-wide protocols are in place to ensure care is provided to trauma patients, a spokesman for Shared Health said Monday.“It is an all-hands-on-deck approach,” he said.
“Depending on the severity of the event, hospitals throughout Winnipeg and possibly outside the city would participate in the response alongside municipal, provincial and federal agencies.”
In worst-case scenarios, lower-acuity patients would be quickly moved or discharged to create space. Those with minor ailments or injuries would be encouraged to seek care at a walk-in clinic or family doctor or return at another time. Hospital staff would be called in while those working in other units would possibly be reassigned, he said.

At that time, just eight out of the 24 nurses required to fully staff an emergency department shift were available. Doctors and nurses raised alarm about the unprecedented staffing shortage at the main trauma centre for Manitoba, northwestern Ontario and Nunavut.

Shared Health said the hospital could handle the situation with reduced staff but advised patients “with lower-acuity concerns” to expect longer waits for care while more urgent patients were seen.

Manitoba Nurses Union president Darlene Jackson said nurses who volunteered to take extra shifts or were mandated to work overtime were run off their feet responding to demand; 20 workload staffing situation forms were signed by 73 nurses over the weekend.

The reports are completed by nurses when they work in a situation they feel is unsafe or if they can’t meet their standards of practice under their college, Jackson said.

“It is eye-popping,” she said. “That is a number that I was surprised with because, despite how hard nurses at HSC worked this weekend with no breaks, et cetera, they felt the need to go the extra mile and fill that form out and say ‘this is not safe.’”

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Manitoba Nurses Union president Darlene Jackson said nurses who volunteered to take extra shifts or were mandated to work overtime were run off their feet responding to demand.

Thirteen nurses staffed the ER on Friday night, including two managers, the union said. On Saturday, the hospital was able to find 14 nurses to work the emergency room, or about 42 per cent below baseline. Staffing levels for Sunday were not immediately available.

Nurses described the emergency department as over capacity with unsafe workloads and a “less than adequate” nurse-to-patient ratio, the union said. They also reported the deterioration of patients and missed vital signs while working mandated overtime without breaks.

“It’s a mess over there,” Jackson said. “They still had a lot of vacancies.”

An HSC emergency doctor who spoke on the condition of anonymity said parts of the emergency department were closed but it wasn’t as bad as he’d anticipated. There was a lack of resuscitation nurses for many shifts and at least half of minor treatment beds were closed at times during the weekend.

“What I can say for sure is that there was still a staffing shortage and parts of the ED were closed but not to the extent (I anticipated),” he said Monday.

”Despite how hard nurses at HSC worked this weekend with no breaks, they felt the need to go the extra mile and fill that form out and say ‘this is not safe.’” – Darlene Jackson

Shared Health said the number of patients in resuscitation beds fluctuated, but its spokesman was unaware of any trauma patients requiring treatment in the hallway over the weekend, as the Free Press reported was the case last week.

Another doctor who works at HSC said the problem is that the health-care system is “borrowing from Peter to pay Paul.”

“When ER is this short-staffed, they will take nurses from all over the hospital to fill gaps,” said the doctor who spoke on the condition of anonymity.

“This leaves the other locations, particularly the medical and surgical wards with worsening shortages. By the way, these are the locations where sick patients need to go if they require hospitalization,” he said. “They need to find ways to retain staff and regain staff.”

“When ER is this short-staffed, they will take nurses from all over the hospital to fill gaps… This leaves the other locations, particularly the medical and surgical wards with worsening shortages.” – HSC doctor

Emergency departments are short-staffed across Canada, but the pain is being felt more acutely here and now because of the provincial government’s decisions to close ERs in the city, the physician said.

“The last 12 months we have seen a tipping point in a crisis that was already accelerated by the decisions of consolidation. We would’ve gotten here eventually even without COVID, just not this soon.”

For the week ahead, nurse staffing challenges in the emergency department will remain “significant” but not as pronounced as this past weekend, Shared Health said.

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Thirteen nurses staffed the ER on Friday night, including two managers, the Manitoba Nurses Union said. On Saturday, the hospital was able to find 14 nurses to work the emergency room, or about 42 per cent below baseline.

With a nurse vacancy rate of 32.3 per cent in the ER, the HSC will continue to fill various staffing holes in the same way it did in recent days, with staff callouts, overtime, managers working on the floor to support patient care and reassigning nurses from other areas, such as critical care, to help out when possible, the spokesman said.

“Longer-term, a staffing plan for the fall and winter respiratory seasons are in development,” he said.

In a statement, the NDP said the Progressive Conservative government should consider staffing shortages at HSC to be a “critical risk to patient safety.”

“They should be working mandatory overtime to get that department fully staffed within hours,” the NDP caucus said Monday.

carol.sanders@freepress.mb.ca

danielle.dasilva@freepress.mb.ca

Carol Sanders

Carol Sanders
Legislature reporter

After 20 years of reporting on the growing diversity of people calling Manitoba home, Carol moved to the legislature bureau in early 2020.

Danielle Da Silva

Danielle Da Silva
Reporter

Danielle Da Silva is a general assignment reporter.

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