Short-staffed
Doctor, nurse shortages causing ER closures, impact on services
SYDNEY — Health officials say physician vacancies are not the only reason for emergency department closures but significant nurse shortages province-wide have been an issue as well, including at the Cape Breton Regional Hospital.
“Most of the emergency room closures are due to physician coverage challenges but we also have closures due to nursing coverage,” said Madonna MacDonald, vice president of operations for Nova Scotia Health for the eastern zone.
There is currently about a 30 per cent vacancy rate for nurses alone in emergency rooms in the eastern zone.
“We have nursing, physician and other health human resource vacancies across the zone,” she said, adding they are not alone. “There's a nationwide shortage of physicians and nurses.”
Nova Scotia Health says province-wide the first quarter of 2020 there was a vacancy rate of about seven per cent in staff at regional hospital emergency rooms and in the first quarter of this year, vacancy rates rose to about 20 per cent.
MacDonald said they've been seeing a rising demand for care, a high occupancy rate within their hospitals and high volumes of demand for services including their emergency departments, which does challenge their ability to respond.
NURSES
Barb O'Neil, emergency services director for the eastern zone, said they'd need at least 15 full-time nursing positions to fill the full-time and temporary vacancies at the Cape Breton Regional Hospital emergency department.
O'Neill attributed nurse vacancies to a variety of reasons: retirement, nurses moving to other areas and maternity leave.
“The life of an emergency nurse is difficult,” she said. “As they are there for numerous years maybe they also look at something that's not as challenging.”
As well, generally, there would be seven physicians over 24-hours in the emergency department at the regional but now most days are down to five.
“That slows down the speed we could see patients and as well if we happen to be working with a nursing shortage which we are many, many days, those things all contribute to the wait times for sure,” she said.
Patient visits to the regional hospital emergency room over the past few years averaged 120-130 per day, now peaking at 150-160 a day.
O'Neill said a person having a heart attack or stroke will have virtually no wait time while someone with a nonlife-threatening illness could wait seven to eight hours.
In order to help with these challenges, Glace Bay Hospital's emergency room staff have all been reassigned to the regional hospital to support the vacancies.
O'Neill said the regional hospital emergency departments cannot close.
“We have to mitigate the vacancies and keep things moving as smoothly as we can,” she added.
EMERGENCY ROOMS
There are 13 emergency rooms in the eastern zone. New Waterford is closed for maintenance and North Sydney is also closed with plans to reopen in the fall with a new emergency service type of coverage.
The Strait Richmond emergency room is closed until Sept. 7 and Victoria Memorial until Sept. 11, both due to lack of physician coverage.
MacDonald said vacancies have not impacted patient beds significantly but interventions during high-pressure times include a reduction in services such as some surgical slowdowns and a reduction in ambulatory visits.
They've also added nurse practitioners to regional emergency rooms to see patients with less complex care needs to help move them through faster.
“The shifting of staff from Glace Bay to the Cape Breton Regional has been vital in addressing the gap in emergency department at the regional,” she said.
PHYSICIAN CHALLENGES
Dr. Don Brien, an orthopedic surgeon and medical executive director of the eastern zone, said right now it takes seven physicians to keep the Cape Breton Regional Hospital emergency department open, which is significant manpower.
“Right now we're probably down to about five and sometimes less,” he said.
Brien said as staff plan leaves over the summer months they anticipate a reduction in services to help with emergency department challenges but this year they've seen a significant increase in demand in services.
“I haven't seen the emergency department and surgical department as busy in quite some time,” he said.
He said they are focusing all their resources on the regional hospital to ensure they can provide the best possible care at the regional.
In the upcoming months, he said there will be issues providing anesthesiologists for services for the same reason, they don't have the numbers they will need or would like.
Brien said they understand everyone's frustrations. They have people coming in the next month to fill some gaps in the system so there will be some improvement.
“It's just getting through the next four to six weeks, that will be the difficult time,” he said.
“We're just asking the public to be patient with us,” he said. “The individuals that are here are working extra shifts and working extra time. They are going above and beyond to provide the care that we need.”
COULDN’T WAIT
On Sunday at 5:04 p.m. Robert Newman, 42, of Glace Bay who has a heart condition, called an ambulance after his heart rate began to rapidly increase.
“Driving in like that wouldn't be feasible for me,” he said, adding heart issues are hereditary in his family, he has dealt with them since age 14.
Newman said they gave him Aspirin at the emergency department, checked him, got his history and then did an EKG.
He was told his EKG was fine and was sent into the waiting room.
“Knowing my heart history that I've had all these years, they then sent someone who is high risk to the waiting area,“he said.
After waiting about five hours, Newman said the anxiety was getting to him, he called a taxi and went home.
As well, Newman said he's not protected from COVID19, can't get the vaccines due to his heart condition until the cartologist determines which one is appropriate.
“To sit there unprotected when I have a two-year-old and three-year-old child at home, I'm not taking that risk,” he said.
Newman said he has since contacted his family doctor.
He said if other emergency rooms are being closed to help with the overflow at the regional hospital, why is there still a backlog in wait time?
He said the onus lies with the provincial government.
“There's flaws in the system that can be fixed,” he said. “People are at risk.”
EXCEPTIONAL STAFF
Lorrie MacNeil of North Sydney took her mother to the regional hospital's emergency room last week and had a six-hour wait. Her mother, 82, was experiencing pain in her back. MacNeil said it was tough waiting and the doctor issue needs to be addressed.
However, seeing the packed waiting room, her heart went out to the health-care staff.
“The regional staff are so kind, exceptional,” she said. “Despite the massive amounts of patients they had to deal with, a nurse came to check on my mother throughout the evening.”
NOVA SCOTIA NURSE’S UNION
Janet Hazelton, president of the Nova Scotia Nurse's Union, said the shortage of nurses province-wide is critical at this point.
“We have hundreds of shifts not covered in some units,” she said.
Hazelton said many of their nurses did not get their vacation this year or had their vacation interrupted and others are working more overtime than they want to.
“Nurses are trying to keep their emergency rooms and other units open but it's very, very difficult,” she said.
Hazelton said the problem is we're not educating nurses quickly enough. She said as a nurse retires they need to ensure there is another one to replace that nurse.
She said a strategy is vital for a way forward out of this. Hazelton said conversations are needed with the health authority but also nurses themselves about things they see that could improve the system.