Exodus in the Emergency Department

In the not-so-distant-past, most Nova Scotians felt that if they experienced a medical emergency, they would be able to access the care they needed. That isn’t the case anymore.

The public’s confidence in our health care system has been understandably shaken in recent years: more than 130,000 people are on a waitlist for a family doctor, there aren’t enough ambulances or paramedics to provide care, and our own Health Minister has admitted that we could use another 1,600 nurses in the acute care system.

There is no doubt now: the crisis in health care that our frontline workers have been warning us all about is now upon us.

While the crisis has permeated virtually every aspect of the health care system, it is perhaps most evident in our emergency departments. It is through those doors that people enter on their worst days: after they’ve been in a car accident, suffered a heart attack, been violented assaulted, or experienced another form of trauma.

These days, more and more people are turning up at the emergency department (ED) with health concerns that they are unable to have addressed elsewhere, because they simply don’t have access to primary care. They usually wait longer than they should to have to be seen by a medical professional because they know they shouldn’t be going to the emergency department with their complaint because it isn’t technically an emergency. So, they “tough it out”, and what was a minor issue turns into a major one they can no longer ignore. Then, they have to go to the ED, where they are sandwiched into a crowded waiting room, filled with more people who are having very bad days.

At the same time, stretchers filled with patients offloaded from ambulances are lining the hallway, while staff are run ragged trying to make sure the most critically ill patients are being seen.

The ED at the Halifax Infirmary is the largest trauma centre in Atlantic Canada. Last year, there were more than 70,000 visits to this ED alone. At the same time, experienced staff are leaving this area in droves. There are currently just 74 Registered Nurses (RN) working various positions in the ED. They are short 31 full-time nurses.

Rather than invest in addressing this shortfall properly, Nova Scotia Health (NSH) now has a roster of 15 travel nurses who are on the ED schedule. On any given shift, there are up to five travel nurses working in Atlantic Canada’s major trauma centre. Many of these temporary nurses have little to no experience working in major trauma centres, have limited access to critical computer systems, and no familiarity with where instruments and equipment are located in the department. At the same time, they are paid almost double the hourly rate of experienced staff nurses, plus travel and accommodation expenses.

In December, health care and nursing members working in this ED reached out to the union to raise their serious concerns about ongoing critical staffing shortages. After meeting with the members, on January 9th, NSGEU President Sandra Mullen sent the employer, Premier and Minister of Health a letter outlining the concerns, and a detailed document that included 59 suggestions from frontline staff on how operations within the ED could be improved, both for patients and staff.

At the same time, our letter and recommendations went out, The Chronicle Herald published a story about the tragic death of a young woman, Allison Holthoff, in an ED in Cumberland County. Shortly after, another woman, Charlene Snow, died at home after leaving an ED in Cape Breton.

Media coverage of the crisis in Nova Scotia EDs were swift and intense.

In response, the Minister of Health and Wellness and the CEO for NSH announced a number of changes for Nova Scotia’s Emergency Departments, including changes to staffing complements, the introduction of new technology, increased scopes of practice, and other steps that will hopefully alleviate the incredible burden that our health care workers are shouldering on the front lines of the ED.

In March, The Premier announced nursing bonuses and retention incentives for permanent, full-time nurses. However, they still refuse to address the key issue our members have outlined: their inability to retain skilled, experienced nursing staff in the ED.

On January 23rd, nurses working in the Halifax Infirmary Emergency Department (ED) wrote a letter to the Premier, Minister of Health, and CEO of Nova Scotia Health. That letter expressed the nurses’ deep distress following the government’s failure to address the retention crisis in our ED.

It is the union’s position that the employer must provide incentives that will allow them to effectively keep experienced health care professionals in areas of high turnover and specialized need, such as the province’s largest trauma centre.

January 23rd, 2023
Honourable Tim Houston, Premier of Nova Scotia
Honourable Michelle Thompson, M.L.A, Minister of Health and Wellness
Karen Oldfield, President and CEO, Nova Scotia Health
Dear Premier Houston, Minister Thompson and Ms. Oldfield,
We are writing to you with grave and sincere concern for the citizens of Nova Scotia accessing care at the Charles V. Keating Emergency and Trauma Centre at the QEII in Halifax. We, the front-line Registered Nurses in the ED, have bore witness to the ongoing health care crisis with beginnings far outdating the pandemic. Now, as we stand on the other side of that pandemic, it’s in an unraveling and hazardous health care landscape that’s experiencing a “brain drain” of skilled RNs. The recent press conference on ED improvements instilled one last glimmer of hope in our RNs. We envisioned our calls for help were finally answered. To everyone’s bitter disappointment, it is now clear that the Nova Scotia government is completely blind to the needs of and issues facing RNs in our collapsing ED.
The measures announced do not address one of the major issues contributing to increased morbidity and mortality in the ED: retention and recruitment of skilled RNs. Our ED now operates RN staffing levels at an average of 50-60%. With patient to nurse ratios worsening, the burnout experienced by RNs has ballooned. This is affecting our ability to retain and recruit RNs. It is driving our existing RN staff to move to casual positions, sign lucrative travel nurse contracts or leave the profession altogether. Our daily operations are now totally dependent on casual staff and travel RNs, with our core staffing being begged to cancel their vacation, come in for overtime or extend their shifts. The QEII ED is a revolving door for RNs. As soon as our new hires complete their orientation, they realize their licence to practice nursing is at risk by being forced to do the impossible with limited resources, and they leave the department. Without immediate action and interventions focused on RN retention, we fear unnecessary suffering will continue in the ED. We simply cannot be expected to spread ourselves any thinner.
We implore you to save lives and our EDs: implement RN recruitment and retention strategies immediately. Every experienced RN that leaves the ED is taking invaluable experience and expertise with them. The suggested incentives include higher wages, retention bonuses, improved night/weekend shift premiums and work short premiums. These incentives in the ED will entice RNs who have left to return, and will help to retain the few skilled ED RNs who remain. Without these incentives, the “brain drain” will continue, and it will undoubtedly sink our community EDs.
Sincerely,
The Registered Nurse group, Charles V. Keating Emergency and Trauma Centre

*This article appeared in the spring edition of The Union Stand.