The Ontario Nurses’Association (ONA) issued a press release yesterday announcing the publication of an unprecedented 91 recommendations to improve patient care and work conditions on the 3C Acute Medical Short Stay Unit at Sault Area Hospital.
“We have never had an Independent Assessment Committee in this province that has resulted in this many recommendations,” remarked Vicki McKenna, ONA vice-president.
Composed of an expert panel of nurses, the Independent Assessment Committee (IAC) developed a 100 page report containing 91 recommendations that include: that hospital increase staffing on the 3C unit- 4 permanent full-time RN positions and 4 relief RN positions; a review of 3C admission criteria to ensure appropriate and timely admissions; a six-month trial run for an educator on 3C to be followed by re-evaluation for permanency; and the provision of adequate staffing on 3C when students are present on the unity to ensure a positive learning environment.
The IAC report provides that on average every month the Sault Area Hospital experiences 876 admissions into the hospital. Of those that enter through the Emergency Department 265 patients require admission to one of two medical units in the hospital. The medical short stay unit- 3C, staffs 30 beds with 10 beds in the same area for patient overflow. At present 3C is always at 100% occupancy of beds, at times patients spilling into the overflow beds. Where nurse-patient ratios are ideal, an 80% occupancy is acceptable. Currently, 3C is staffed by 13 part-time RN’s and 24 full-time RN’s. The number of nurses scheduled per shift depends upon patient volume and patient need.
The release of IAC findings and recommendations are hopeful for Sault Ste. Marie nurses who have been sounding the alarm of the urgent need to improve patient care on the Short Stay unit for 6 years.
McKenna remarked, “The report indicates that Sault Area Hospital RN’s had started voicing and trying to work with management regarding practical workload concerns since 2010. Initially, they thought working through that they would be moving into an IAC in 2012 but the hospital put that hearing on hold because the hospital indicated that they would start to make some changes.”
According to McKenna, the promised changes weren’t implemented and the RN’s went back to the table with the employer to re-visit concerns in 2013 and 2014, going as far as hiring a mediator to find some solutions.
“The nurses finally said we have to do the IAC, we have to call in the experts because the risk is just too high,” explained McKenna. “In this particular unit the nurse-patient ratio was a significant problem and just stretching nurses beyond their ability. The RN’s just felt that their patients were at such risk that they had to continue to push forward in this way.”
IACS are a last resort for staff and administration and typically not a place where professionals want to end up. The Sault Area Hospital has the distinction of being the first and only hospital in Ontario to have undergone 3 IAC’s. The first IAC was conducted in 2011 for SAH’s Renal and Hemodialysis unit and the second, in 2012 for SAH’s Emergency Department. The most recent IAC was conducted between April 4th-6th this year, for the 3C Medical Short Stay Unit.
Nurses have a professional responsibility to the College of Nurses of Ontario to maintain standards of care and to advocate on behalf of the patients. And that’s just what Sault Area Hospital 3C nurses did. Dozens upon dozens of Professional Responsibility workload complaints were submitted by the unit’s nurses, expressing concern with the nurse to patient ratio and patient acuity- the complexity of care a patient requires.
“In this particular unit the nurses felt that they had way too many patients that was safe for the patients as well as themselves,” commented McKenna. “Nurses weren’t getting breaks, they were working long hours. Some were going without meal breaks and some describe barely being able to get to the bathroom because they didn’t want to leave or couldn’t leave the floor.”
Glenda Hubley has been a nurse for 36 years and is full-time RN first assist in the Sault Area Hospital operating room. Hubley has also served as the Local 46 Bargaining Unit President full-time for 24 years.
“All the nurses at the Sault Area Hospital go above and beyond to give excellent care. But unfortunately sometimes it is at the expense of themselves and their families. The Sault Area Hospital management has to start dealing with this because our nurses should not be working like they are working but they are because they are such dedicated individuals to their patients and to the community. The employer needs to stop relying on that. The employer needs to start respecting them as the professionals that they are, as the excellent caregivers that they are. And they need to look at these 91 recommendations and say to themselves ‘how can we make it better for our nurses and our patients’.”
Though nurses are unrecognized by the provincial government as ‘first responders’ like police officers, paramedics and firefighters, the nature of their work exposes nurses to human suffering and trauma as well as experiencing workplace burn-out, putting them at risk to experience myriad physical and mental injuries. Understaffing and low morale –as experienced by Sault Area Hospital nurses, exacerbates the risk to injury.
RELATED A Nurse’s Story: Mental Injury, Broken Hearts, Hope for Soldiers and First Responders
“Nurses are first responders,” supports McKenna. “I think people have no understanding of what they might see and what they might be exposed to. And the issues around chronic staffing and the senses of hopelessness and nothing is changing and every day is just such a struggle to get through the shift, really does wear on nurses and can put them at risk for all kinds of things. This is often where you see an increase in injury rate because of the fatigue, you see increased illness because people are working too much overtime, there’s no breaks, they’re working too hard. But the other thing that happens to nurses is chronic exposure to traumatic events. And this happens to nurses in every setting but certainly some more so than others.”
Hubley contributed her thoughts on the matter of mental injury to nurses. “We call that Moral Distress. Nurses go through moral distress every day because of the work environment that they are being placed in. Moral Distress is when I have a patient crashing in one room and I have a patient bleeding out in another room- my moral distress is what patient do I go to first? How will I live with myself if something happens to the patient that I don’t go to first? That’s the moral distress that we face because of the work environment that we face day in and day out at the hospital. That impacts on nurse’s mental and physical well-being. Also when we work seven 12 hours shifts in a row because the unit is short and the employer is calling us and we go in, that eventually has to play on us. Not at the time, but further down the road we become exhausted, sick. Those are all factors that we face as nurses at the Sault Area Hospital.”
With an annual operating budget of 171 million dollars, Hubley boils down the challenges faced by the 3C nursing staff to misguided appropriation of budget lines by the administration.
“The budget comes first,” Hubley angrily asserted. “I would ask the employer why they would hire supervisors and remove direct patient care nursing hours to create 13 hospital supervisors. By doing that they’ve taken away direct patient caregivers –RN’s, RPN’s, PSW’s. When you have a human resource department that has more human resource people in it than a nursing unit has nurses on it – I have big concerns. When you start eliminating infection control practitioners, I have big concerns. That’s why we’re going to go through outbreaks in this hospital. So, when balancing the budget becomes more important and you eliminate direct patient care hours, I have a big problem. Eliminate from the top, eliminate if from anywhere else but don’t eliminate it from direct patient care hours –RN, RPN or PSW’s.”
Hubley expressed that there was, in her experience, an unparalleled demonstration of support for the nurses on 3C by the entire nursing staff at the Sault Area Hospital during the 3-day IAC investigation/research process.
“I had nurses coming and going for three days, supporting the 3C nurses chosen to be representative,” remarked Hubley. “I had nurses from ICU, nurses from 3B, nurses from renal, nurses from ER- that is unheard of. Every day that room was full of nurses, that sends a very clear message to me that my nurses have had enough and that my nurses want to tell the employer that enough is enough. Patient care must come first.”
Though the 91 recommendation made in the IAC report are not binding, it is expected that the employer and nurses will meet as soon as possible to discuss an action plan to implement the recommendations.
“It’s now in the hands of the employer to review and go through the report in detail. But we would be expecting to meet very quickly. We would be ready to go any time to be back at the table to discuss the recommendations and implementation,” commented McKenna. “I’ll be honest with you, sometimes that’s a really difficult thing to do – getting the employers to the table to develop action plans and begin to move forward.”
At this time a pre-scheduled time for the employer, the IAC and nurses to meet has been set for June 14th.
The Sault Area Hospital serves a total catchment population of 120,000 in the Algoma District.
“The Sault Area Hospital is a facility that’s relied upon by not just the community of Sault Ste. Marie but a greater surrounding area,” summarized McKenna. “It is the place for healthcare in that area and the nurses want to be proud to work there. When they leave work, they want to feel like they did a good job at that hospital. That’s what they want. That’s what’s most important to them.”
