Nurses, allied health workers join doctors in exposing crisis conditions at CancerCare Manitoba By: Tyler Searle Posted: 6:51 PM CST Wednesday, Dec. 18, 2024 Last Modified: 9:32 PM CST Wednesday, Dec. 18, 2024 Updates

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Fresh allegations of a toxic work environment have been levelled against CancerCare Manitoba, a day after the Free Press published a slate of physicians’ complaints detailed in an internal report.

Nurses and allied health workers are the latest professionals to speak out over conditions within the provincial cancer agency — where new documents obtained by the Free Press suggest nursing staff levels dipped to dangerous lows in some clinical departments in recent years.

“Our workloads are so ridiculously heavy we cannot sustain them,” a CancerCare nurse said Wednesday. “It needs to be made public that the nurses have expressed ourselves continuously to leadership.”

The woman, speaking anonymously for fear of reprisal, described a work environment in which nurses are routinely brought to tears as they struggle against high patient loads and chronic turnover.

The issues were outlined in a formal plea for help, sent by nurses to the CancerCare board in a Jan. 17 letter. The woman said the document was submitted by the Manitoba Nurses Union on behalf of approximately 300 nurses across all clinical departments in the agency.

“Nurses at CancerCare Manitoba are hereby bringing forward our concerns regarding difficulties with nurse retention, particularly among clinic nurses. This has led to vacancies in some clinical departments to greater than 50% of their baseline staffing requirements,” the letter said.

“This cannot continue. We are concerned that critical incidents may occur involving patient care, and thus feel compelled to speak up.”

The letter pointed to a spike in workload staffing reports. Such documents are used to identify workload and staffing concerns, and track when a nurse has drawn management’s attention to an unsafe, or potentially unsafe environment, it said.

According to the letter, the number of workload staffing reports filed at CancerCare reached “record high levels in all clinic areas” over the past two years.

More than 75 reports were filed with CancerCare in 2023, a 400 per cent increase over the 15 filed the previous year, it said.

The letter said staffing issues at the time were most pronounced in the hematology department, but said “several clinics face similar crises.”

“Thus far, the lack of resources has been addressed de facto by making nurses in clinics such as hematology cover multiple assignments. This is neither just nor feasible,” it said.

Board chairman Jeoff Chipman responded to the letter two months later.

“We recognize the urgency of the situation,” he said in an email. “We are actively working to implement concrete steps to alleviate workload pressures and improve nurse retention.”

In an email statement Wednesday, CancerCare’s director of communications Twylla Krueger outlined the positive steps taken over the past 11 months.

“These actions include further developing our care models, increasing staffing levels for specific disease site groups, enhancing expertise across all sites, and actively engaging with staff,” she said. “The vacancy rate has been steadily decreasing. We regularly meet and collaborate with all the unions represented at (CancerCare).”

Krueger said the agency had an overall staff vacancy rate of 7.3 per cent as of September. She said the vacancy rate for positions held by nurses’ union members was 4.1 per cent.

By union, the highest vacancy rate (10.6 per cent) was for positions held by members of the Canadian Union of Public Employees.

The nurses’ union and Manitoba Association of Health Care Professionals each confirmed their members have complained about conditions inside CancerCare.

“The low morale, the burnout, the heavy workload and the distrust of executive leaders is something we’ve been aware of for a very long time,” said MAHCP president Jason Linklater, whose union had a vacancy rate of 7.3 per cent, based on the September data.

Nurses’ union president Darlene Jackson agreed.

“It’s an entire program issue,” she said. “We’ve been hearing of extremely high burnout for nurses, and extremely low morale. We are also seeing high turnover of staff.”

The unnamed nurse who spoke to the Free Press acknowledged staffing levels in hematology improved after the letter was sent, but said chronic turnover persists within the agency.

The woman reached out after Doctors Manitoba launched an examination of CancerCare.

The physicians’ advocacy group announced the probe in September after numerous doctors complained of burnout, heavy workloads, recruitment challenges, lacklustre communication, favouritism and distrust in the executive leaders.

It said it had been hearing such complaints for up to 18 months prior.

“It’s an entire program issue … We’ve been hearing of extremely high burnout for nurses, and extremely low morale. We are also seeing high turnover of staff.”–Nurses’ union president Darlene Jackson

“When this first came out in September, we were so happy,” the nurse said. “I thought it’s time you hear from the nurses, as well, because we’ve been shouting really loud and we are getting nowhere.”

The physicians’ grievances were brought to light in a final report by Doctors Manitoba published internally Monday. The 14-page document compiled feedback from 57 doctors connected to the facility, finding their complaints were credible.

“There were very little redeeming features of that report and it validated our concerns,” a CancerCare physician said, also speaking anonymously.

“This is not coming from a disgruntled few people. You have to have major parts of every department to say this…. It was a broad sampling of the doctors in the organization, and that’s the most important thing.”

The doctor said the the report ignited discussion among his colleagues Monday, as they pored over its findings and the subsequent response from CancerCare executives.

Chipman and CancerCare president and CEO Dr. Sri Navaratnam each issued missives to staff members acknowledging the report’s release. They thanked physicians for voicing their concerns.

“We have heard your feedback. While there are aspects of the report with which we may not fully agree, we acknowledge the concerns raised and are committed to working collaboratively,” Chipman said.

Navaratnam followed up in another email to staff Wednesday.

“As you may have read the news in the Winnipeg Free Press, there is media attention regarding a recent report from Doctors Manitoba,” she wrote. “I regret that you are exposed to this negative commentary about our organization.”

Navaratnam said she was troubled that there are unhappy physicians at the agency, and invited them to reach out to her with questions or concerns.

The agency leader noted “workload and burnout are a concern across the health care sector.”

“We are all here for our patients, and we know the headlines may be unsettling for them. If they express concern, please assure them that they will continue to receive excellent care here,” she said.

The anonymous physician said he, and some of his colleagues, viewed Chipman and Navaratnam’s comments as dismissive.

He acknowledged the complement of CancerCare physicians has grown in recent months — with some new doctors added and others recruited to replace those who have left — but said the workloads remain oppressive.

“Physicians are scrambling to do extra clinics on a Saturday to make up for the shortfall of CancerCare doctors and to make sure the wait lists are not growing beyond a reasonable number,” he said.

“This has been going on for the last two months or so… and is causing distress.”

Doctors Manitoba has asked the Manitoba ombudsman to review CancerCare, saying its review uncovered additional, unspecified allegations that were “more serious” and beyond the scope of its authority to investigate.

The doctors’ group has declined to comment on the report, which it said was confidential.

—With files from Chris Kitching

tyler.searle@freepress.mb.ca