GREY-BRUCE – A virtual panel discussion Wednesday evening, Dec. 15, on the local nursing shortage, raised more questions than it answered.
The discussion dealt mostly with the “why” and the “who;” still unanswered were the “when” and the “where” – what gets cut, when, at which hospital site, and for how long.
That was answered Monday at noon. South Bruce Grey Health Centre announced in a press release it will be closing the Walkerton emergency department from 8 p.m. to 8 a.m. daily, and converting Chesley hospital to a 20-bed alternate level of care unit, effective Dec. 27, for an indefinite period.
These measures will free up registered nurses to cover vacant shifts with a bit of room for sick calls and patient transfers; the press release noted ALC patients no longer require acute care and a staffing model with fewer RNs can be used.
Other options were discussed, including the Durham hospital’s in-patient services and the Walkerton hospital’s birthing centre. The latter will not see cuts, and the on-call surgeon at the hospital will remain available should there be a need for a C-section.
The hospital in Chesley had its emergency room hours cut back in 2019 “temporarily.” The situation shows no sign of improvement.
Brockton council held a special meeting at the same time the press release was issued and passed two motions, the first, to oppose the reductions in service, and the second, to work with the County of Bruce and other affected municipalities (i.e. Arran-Elderslie and South Bruce) to hire a consultant for conducting a third-party review into the nursing shortage in the area.
Peabody credited Coun. Kym Hutcheon and Arran-Elderslie Mayor Steve Hammell with the idea. A figure of up to $10,000 for the consultant was discussed. Brockton Mayor Chris Peabody said there is a local resident who is a highly qualified and experienced health care labour negotiator, with whom he has discussed the situation.
The ripple effects of the service cuts were a clear concern. Coun. James Lang, a member of the Walkerton Fire Department, noted that the fire department is called in when an ambulance is delayed – and that would happen with ambulances going to Hanover and Owen Sound.
Coun. Steve Adams expressed concern not only for the local hospital but for the hospital in Hanover, which is “also under siege.”
“Hanover has had no increase in their resources,” commented Coun. Dean Leifso.
The mayor said the OPP is quite concerned, especially about staying with patients having a mental health crisis in a hospital outside their coverage area.
Also concerned are local MPPs Lisa Thompson and Bill Walker. Peabody said Thompson plans to take the matter to the regional representative of Ontario Health in London.
The mayor further noted that SBGHC would work with municipal partners on the third-party review.
Panel discussion
Wednesday evening’s panel consisted of SBGHC’s board chair Bill Heikkila, chief of medical staff Dr. Lisa Roth, CAO Michael Barrett and acting chief nursing executive Stephanie Metcalfe.
SBGHC has 60 beds spread across four hospital sites, including both acute care beds and chronic care beds, and does not have enough staff to deliver the level of service it currently provides.
Barrett explained the staff shortage, especially in nursing, has been experienced for about five years.
He described a number of close calls “where we almost had an unplanned emergency room closure” and told of managers working a full week and then a front-line overnight weekend shift. “We’ve been keeping services open on the backs of our front-line staff,” he said.
The cause is a combination of things – a shortage of registered nurses that has reached the crisis point provincewide, people burnt out from the pandemic and challenges of front-line nursing, opportunities for nurses to get better hours and pay in non-hospital settings, the unique nature of rural nursing, and younger nurses.
The fact that the average age of SBGHC RNs and RPNs has dropped to 35 indicates “we have a strong future,” said Barrett, but it also means maternity leaves. In 2021, 28 per cent of the RNs and 24 per cent of the RPNs were off on maternity leave.
As for rural nursing, Barrett noted that “the same trauma case that comes through the door at a Toronto hospital also comes through the door in Chesley or Walkerton,” except here, there’s often no respiratory therapist or even ward clerk to assist. “They (nurses) do it all,” Barrett said.
Then there is the pressure of all four hospital sites operating at or above capacity, in part due to COVID guidelines in long-term care. Nursing homes that used to allow three or even four residents per room are limited to two, meaning 147 fewer long-term care beds in Grey-Bruce.
Add to that the immediate challenge of three departures of nurses just before Christmas – two resignations and one maternity leave that came earlier than planned – and the result was a schedule starting Jan. 2, 2022 that had too many holes in it.
To address the nursing shortage, more full-time positions have been created. SBGHC has also implemented a team-based model of nursing care utilizing nursing students and nurse’s aides.
Even with that, the present situation means it’s not possible to maintain services without putting patients and staff at risk.
The only answer was service reductions. Heikkila said 12 options were looked at, and these were narrowed down to four. The press release confirmed that the hospital’s board of directors wanted to ensure key programs, like the Family Birthing Centre, where mothers deliver over 450 babies each year, was protected.
“What is non-negotiable,” Barrett said, “is we cannot provide care that is unsafe or further deteriorates staff.”
The panelists answered a number of questions from the public and discussed several suggestions to improve recruitment and retention of nurses.
Heike Berger, an area midwife, suggested hiring midwives at the birthing centre in Walkerton, a suggestion that was very well-received.
Kym Hutcheon suggested a number of ideas including in-house daycare to aid with staff retention.
The possibility of providing higher pay was discussed – the problem is the provincial cap of one per cent for pay raises, which applies to nurses but not police officers or firefighters.
There was a question asked about COVID vaccinations. Barrett said that SBGHC is one of the few hospital corporations in the area that has not mandated vaccinations. That said, an extremely high percentage of the staff (95 per cent) is vaccinated.
One person expressed surprise that nursing staff hadn’t been surveyed to find out what could be offered to increase retention.
Among those present for the meeting was Andrew Williams, Barrett’s counterpart with the Huron Perth Healthcare Alliance. Clinton’s hospital has had reduced ER hours, as has the hospital in Chesley. Williams commented, “These are gut-wrenching conversations we’ve been having.” He added, “We can’t keep competing with each other,” stressing the need to work collaboratively.
Roth commented, “We’ve known about this for years but the schools are not training enough (nurses); someone higher up than us has to start making changes.”
