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Cape Breton Post: Staffing shortages, threats from supervisors causing fear in Cape Breton ER nurses


Nurses in the Cape Breton Regional Hospital emergency department are worried staff shortages are going to lead to someone dying in the waiting room. SYDNEY, N.S. — Registered nurses working at the emergency department at Cape Breton Regional Hospital are terrified.

They are terrified that the staff shortages are going to lead to someone dying in the waiting room, waiting for care which isn't able to be delivered within expected timeframes.

Terrified they'll be reported by a supervisor for patient abandonment to the Nova Scotia College of Nursing if they don't agree to stay after their 12 hours shift when there isn't a replacement.



Terrified someone will leave the emergency department after waiting for hours to be seen and die at home; a fear that came to fruition on Dec. 30 when Charlene Snow left after a seven-hour wait and died at her Donkin home roughly an hour later.

"That hurts," said Dr. Margaret Fraser, an emergency department physician at the regional hospital whom the nurses asked to be their spokesperson.



Dr. Margaret Fraser sits in her office at Health Park which is next to Cape Breton Regional Hospital. One of the emergency department physicians, she told the Cape Breton Post during an interview on Thursday that the nursing shortage on the unit is critical and the nurses are worried about patient safety and their livelihoods. NICOLE SULLIVAN/CAPE BRETON POST - Nicole Sullivan


SPEAKING OUT


The nurses want the public to know their concerns and what it's like working in the only emergency department on Cape Breton Island.

However, they are afraid to speak to the media themselves, even with the promise of source anonymity, due to possible reprimand by the administration.

It isn't an unfounded fear. Fraser said the full-time nurses are often threatened to be reported to the college of nursing for patient abandonment if they leave at the end of their 12-hour shift when there is no replacement.


Even though those 12-hour shifts are so busy there is no time for the emergency department nurses to take any breaks; no breaks to eat, to drink and limited chances to use the bathroom. One clinical lead Fraser knows was forced to work 16 hours, then told she could "sleep in a call room" only if she returned to work in the unit if they needed her.

"Would you let a truck driver do that? You wouldn't because they might crash into a minivan or a granny," Fraser said. "But a doctor or a nurse they will because 'we need them to do that.' That is absolute bulls--t."

Fraser said it is her understanding that there are supposed to be 60 full-time registered nurses working in the Cape Breton Regional Hospital emergency department and there are between 15-17. Out of these, she said nine have applied for and been hired for other positions and are waiting to be released from the emergency unit.

"Morale is pretty low. Most of the nurses … would like to be able to stay in the emergency department. They like being able to help people. They like the acuity. They like the pace. They like the variety," said Fraser.

"But because of their concerns about the staffing levels and their concerns about potentially losing their licence, either because of an adverse event or an administrator reports them for patient abandonment, most of them are looking for other jobs."

Nova Scotia Health said they have 28 full-time equivalent positions filled at the Cape Breton Regional Hospital emergency department and 26.7 vacancies. Full-time equivalent positions can require more than one staff to fill the vacancy.



Hospital bed crunch Brett MacDougall, vice president of operations for Nova Scotia Health Eastern Zone: "From an administrative and leadership perspective we are completely supportive of the team down there."


NSH SUPPORT


Brett MacDougall, vice president of operations for Nova Scotia Health Eastern Zone, said they understand the challenges the emergency department nursing staff are facing in Cape Breton. He stressed NSH is here to support them.

"From an administrative and leadership perspective we are completely supportive of the team down there. We know how challenging the work is," said MacDougall, who has worked as an emergency room nurse in the 1990s and early 2000s.

The administration is working on short-term strategies that can be implemented within a few weeks to help with patient care in the emergency department and MacDougall said they recently had a meeting with project leads in the Eastern Zone to discuss Cape Breton Regional Hospital department specifically.

Some of the strategies discussed include having medical services and surgical services units work toward a goal of a 30 minutes timeframe to have a patient transported to an inpatient bed.

He also said they are working with other units such as diagnostics and lab services to cut down on wait times for these procedures for patients in the emergency department, which could lead to a faster discharge time.

When asked about supervisors threatening emergency department nurses being reported if they don't work longer than their 12-hour shift if a replacement isn't available he said, "If that's occurring we'd like to have the staff raise that with the director of that program or the executive director of that program.

"We do have a responsibility in a duty to care in relation to not leaving until the shift or a replacement is there and that comes from the college as well," he said. "But obviously there's a fine line there between handing over a report or trying to create an opportunity for staff to have the availability to go home. That is something we have to follow up with."



The Cape Breton Regional Hospital was indeed a busy spot in the weeks prior to Christmas with a 106 per cent acute care occupancy rate on Dec. 6 with 124 emergency room visits. - Cape Breton Post


TRIAGE STANDARDS MISSED


Fraser said the emergency department at the Cape Breton Regional Hospital is supposed to have two triage nurses, however, there is often only one on shift.

Along with triaging new patients, those who have already gone through the roughly five-minute assessment to determine what level of acuity they are need to be re-triaged.

Those triaged at level one, the most urgent cases such as heart attacks, need to be seen and Fraser said the department is doing well with that.

Those triaged at level two are supposed to be seen within 15 minutes and re-triaged every 15 minutes. At level three, the standard is seen within 30 minutes and re-triaged every 30 minutes. For level four is seen in one hour and re-triaged hourly and for level five, the non-urgent cases, seen within two hours and re-triaged every two hours.

In the waiting room, there can be anywhere from 25-40 patients assessed at levels 2-5 which the triage nurse is responsible for and Fraser said this makes re-triaging impossible.

Inside the emergency department are two zones. Zone one is for acutely ill patients who might be on ventilators, had a stroke or heart attack, and there are 12-14 beds.

Zone two could have 15-20 patients and care includes running intravenous medication lines, administering medications, monitoring pain management and at night changing incontinence diapers.

For each zone, Fraser said it's not uncommon to have only two nurses working and they aren't allowed to close beds when they are short staffed.

"Two people can not adequately (care for patients in these zones) for any period of time," she said. "It's just not possible."

MacDougall said along with nurse shortages in Cape Breton, it's a problem being experienced across the province and country. He believes it's even an issue across the continent.

"We might not be able to go out and hire emergency room nurses given those scarce resources (nationwide) but we think there are things we can do in the short term to help support the team.

"We understand the amount of pressure that they are under. We appreciate their dedication and we know they are trying to provide the highest level of care they can. We know it is a challenging situation. We're here to listen. We're open to any suggestions for solutions they might have."

- Nicole Sullivan is a multimedia journalist for the Cape Breton Post. Follow her on Twitter @CBPostNSullivan.

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