Nursing shortage forces emergency room closures across Canada

Burnout from the COVID-19 pandemic, abuse from patients and salary discontent have seen nursing staff quitting their jobs in droves

By AFP
October 11, 2022

Canada is facing an acute shortage of nurses. Photo: AFP/ file

OTTAWA: An acute nursing shortage is clogging or even closing hospital emergency rooms across Canada, pushing an already stressed national health system to the brink with potentially severe consequences for patient care.

Burnout from the COVID-19 pandemic, abuse from patients and salary discontent have seen nursing staff quitting their jobs in droves, and experts say the situation is only likely to worsen.

The impact on emergency care is such that Ottawa police recently had to take a shooting victim to hospital in their squad car, rather than wait for an ambulance, and an elderly woman who fell and broke her hip was forced to wait six hours for help from paramedics based 100 kilometers (62 miles) away.

Over the summer and into the fall, staffing shortages meant dozens of emergency rooms were forced to close - sometimes for a night or a weekend, sometimes longer.

Wait times to see an ER doctor have soared to 12, 16, 20 hours -- or more.

"They're numb, deflated and feeling hopeless," said Cathryn Hoy, president of the Ontario Nurses' Association. Herself a nurse for 20 years, she described the situation as "critical."

Amelie Inard, 32, was taken to an ER in Montreal this week, in extreme pain and peeing blood.

The place was packed, and an overwrought nurse told her to describe her condition "in one sentence, really quickly, because of how busy they were," Inard said.

She eventually left in frustration, without seeing a doctor.

Hospital workloads are rising, Hoy said, along with patients' exasperation over extended wait times, leading to a spiking of violence against nurses.

Several nurses told AFP they had been punched, scratched or spat on, and had trays, dishes and feces thrown at them.
'Crazy conditions'

In the capital Ottawa, ambulances were unavailable on more than 1,000 occasions from January to July, as paramedics were stuck waiting to unload patients at crowded ERs.

A hospital in Peterborough, east of Toronto, in the past week was forced to treat patients on gurneys in the parking lot because its ER was full, said Hoy.

In Manitoba, doctor Merril Pauls said there had been "multiple times throughout the summer when we had to shut down beds in the emergency room" at Winnipeg's Health Sciences Centre because of the nursing shortage.

On one recent Sunday, he said, "We had too many people coming in and had no place to put them. We literally were double-bunking critical patients in a resuscitation bay.

"Our nurses are really working in crazy conditions."

It's a "really significant phenomenon going on across the country," the doctor added, and it's "getting worse."
High turnover

A recent survey by the Canadian Union of Public Employees, the country's largest labor union, found that 87% of nurses have considered leaving their job "because of the thankless and grueling working conditions."

"Even new graduates are quitting," Hoy said.

Federal health minister Jean-Yves Duclos has vowed to make it easier for foreign credentials to be recognized. That could help 11,000 internationally trained doctors and nurses get jobs in their field in Canada.

But that won't be nearly enough, with 34,400 nursing positions now vacant, according to government data.

Compounding the problem, many Canadians - like Inard - don't have a family doctor and turn to emergency rooms for care.

"It's just so difficult to find a family doctor," she said.

And a frequent shortage of regular hospital beds often means long waits to transfer patients out of ERs to wards.

Ontario passed a bill at the end of September permitting transfers of patients awaiting long-term care to facilities up to 150 kilometers away.

Provincial Health Minister Sylvia Jones said it would "ease pressures on crowded emergency departments."

But critics say it could force frail, elderly people into care homes far from their loved ones.

For now, almost everyone needing treatment is eventually seen. But delays can pose long-term consequences for patients' health.

"If a stroke patient doesn't get access to a clot-busting medicine fast, brain cells will die and the patient will end up being more disabled than they would have been," Pauls said.

Serious infections can be deadly if not treated in time. So, too, can cancers and other diseases, he added.

Pauls recalled routinely telling discharged patients "to come back if things get worse."

"But now they laugh at us. They say: 'You're crazy. There's no way I'm going to go through this again."

Emergency room at Ontario hospital closing until December due to staff shortage

South Bruce Grey Health Centre says the Chesley hospital emergency room is closing today with a scheduled reopening date of Dec. 2.

By Holly McKenzie-Sutter

The Canadian Press
Fri., Oct. 7, 2022

A rural Ontario hospital is closing its emergency department until December due what the health-care organization running it calls a “critical shortage of nurses” and a series of off-and-on closures that have become unsustainable.

The Chesley hospital emergency room closed on Friday, with a scheduled reopening date of Dec. 2. Other areas of the hospital like diagnostic imaging services, the inpatient unit and community lab collection will remain operational.

The decision to close the ER for two months follows a series of short-notice, temporary closures that the South Bruce Grey Health Centre said are “not a sustainable approach for our staff or the communities we serve.”

“A further reduction in service is necessary for the safety of our patients and staff,” the organization that runs the hospital said in a news release.

During the closure, the organization said it will consider the future of its service offerings that can be “safely provided” across its four hospital sites southern Grey and Bruce counties in southwestern Ontario, northwest of Toronto, given that health staffing in the province is expected to “remain a challenge for the foreseeable future.”

The news release also noted that the hospital has been relying on agency nurses to fill shifts, but that solution is costly and not ideal. It said agency nurses are “not committed to our hospital sites,” and are paid more than staff nurses, making them feel undervalued.

 

A rural Ontario hospital is closing its emergency department until December due to a shortage of nurses.


“SBGHC would much rather be putting the extra cost spent on agency nurses into the pockets of our own staff, who have worked tirelessly to support our organization and our communities. The unfortunate reality is that without using agency nurses at this time, the organization would be looking at additional closures and reductions in service,” the release said.

Recruitment has been difficult, it added, but the “pool of available nurses is very limited” as hospitals across Ontario contend with staff shortages of their own.

The shutdown follows a spate of temporary emergency room closures at hospitals across Ontario over the last several months due to lack of staff, particularly nurses.

Rural hospitals have been hit harder by the problem. All of South Bruce Grey Health Centre’s hospitals are serve rural communities in Chesley, Durham, Kincardine and Walkerton. The organization’s website said it serves approximately 44,000 people, as well as thousands of season residents and tourists.

The organization has scheduled a community information session for Oct. 18 with staff and physicians.

A union representing Ontario nurses said people should demand action from their elected representatives in light of the Chesley closure announcement.

The Ontario Nurses’ Association said “announcements of ER closures are becoming all too common and ... they must not be accepted so casually by the government.”

France Gélinas, health critic for the provincial New Democrats, also called on the Progressive Conservative government to take immediate action to recruit and retain health-care workers, saying closing an ER can have “dire consequences, especially in a rural community.”

In a statement, she said the province should scrap a bill that caps nurses’ annual wage increases, raise wages to keep and attract workers and increase hospital budgets.

“We need to incentivize health-care workers and treat them with the respect they are owed,” Gélinas said.

A spokeswoman for Ontario Health Minister Sylvia Jones pointed to previously announced spending on health-care recruitment and emergency department support.

Hannah Jensen said the government is planning to add up to 6,000 nurses and personal support workers in the next phase of its plan, with the goal of freeing up hospital beds and expanding models of care to avoid unnecessary emergency department visits.

“Our plan will support the healthcare system to address the urgent pressures of today while preparing for a potential fall and winter surge so our province and economy can stay open,” she said in an emailed statement.

This report by The Canadian Press was first published Oct. 7, 2022.

‘Disaster Mode’: Emergency Rooms Across Canada Close Amid Crisis

A nationwide shortage of nurses has caused dozens of emergency rooms across Canada to close temporarily and forced some patients to wait days for a bed.

The Montfort Hospital, which mainly serves Ottawa’s French-speaking community, is one of several Ontario hospitals that temporarily closed its emergency department.

Credit...Ian Austen/The New York Times

By Vjosa Isai
Published Sept. 15, 2022

One night in March, an understaffed hospital in Red Lake, a tiny town in northwestern Ontario, took the drastic step of shutting down its emergency department. Road signs bearing the ‘H’ symbol to guide drivers along the 60-mile route toward the hospital were covered up. The next hospital was more than two hours away.

Sue LeBeau, the chief executive of Red Lake Margaret Cochenour Memorial Hospital, took a picture of the covered hospital road sign. “This is something that moved me to tears when I saw it,” she said.

It was the first unplanned emergency room closure in Ontario since 2006, and it signaled a growing crisis, not just in one province, but across Canada. Since then, dozens of emergency rooms across the country have been forced to close, usually for a night, but sometimes for a weekend, because they don’t have enough workers.

A shortage of nurses — who have been driven away from the profession by unsafe working conditions, wage dissatisfaction, and burnout from the pandemic — has pushed Canadian hospitals to the brink.

With an underfunded public health system, Canada already has some of the longest health care wait times in the world, but now those have grown even longer, with patients reporting spending multiple days before being admitted to a hospital.

Nurses’ unions and other medical organizations are pushing for provincial governments, which administer health care in Canada, to declare the situation a “state of emergency” and direct more funding to address it.

“I don’t use those words lightly,” said Dr. Paul Parks, president of the emergency medicine section of the Alberta Medical Association, an advocacy group representing about 14,000 physicians in the western Canadian province.

An ambulance crew walking out of Mount Sinai Hospital in Toronto in January, during a spike in Covid-19 cases in the country.

Credit...Cole Burston/Reuters

“It is really a disaster mode because the definition of disaster in medicine is that the demand outstrips the ability to supply the care,” he said. “That’s what’s happening every day in our hospitals across the country.”

The United States and other countries, including England, are grappling with similar issues. Some U.S. states have tried raising nurses’ wages and Oregon called in 1,500 National Guard to help overwhelmed staff, in desperate attempts to fill the gap.

In Ontario, Canada’s most populous province, the shortage of nurses has recently forced 16 emergency departments to close, according to Ontario Health, the agency that oversees health care administration in the province.

The lack of health care workers means it takes longer for doctors to transfer acutely ill patients to hospitals with more resources and those doctors are waiting longer to find a bed, said Christine Moon, a spokeswoman for CritiCall, a 24-hour consultation line for Ontario doctors, in an email.

It’s a scene playing out across Canada. In British Columbia, a province where almost one million people do not have a family doctor, there were about a dozen emergency room closures in rural communities in August.

In Newfoundland and Labrador, the emergency room at one community hospital in a region of more than 300,000 people closed from July 1 until August 29.

In Saskatchewan, the union representing nurses in the province said the emergency room at Royal University Hospital in Saskatoon was 200 percent over capacity in late August because of the nurse shortage. The situation was much the same when Tasha Jiricka, a 24-year-old with fibromyalgia, a chronic pain condition, arrived there by ambulance earlier that month.

With intense stomach pains and unable to eat or drink, Ms. Jiricka was assessed by nurses who thought she should be admitted, but for three days there were no open beds in the 407-bed hospital. She sat in the emergency waiting room, in pain, until one became available

“Honestly, the only thing that got me through were the other people who were waiting,” said Ms. Jiricka in a phone interview from her hospital bed.

An emergency room at the Humber River Hospital in Toronto in January during a surge in Covid-19 cases.

Credit...Carlos Osorio/Reuters

“We have a work force that is exhausted, demoralized, and looking at the door after toiling through the pandemic, suffering real wage cuts and working in an environment that is often unsafe for them,” Michael Hurley, president of the Ontario Council of Hospital Unions, said at a news conference in August.

To help address the crisis, the nation’s health authorities are trying to attract nurses from abroad and retain current or recently retired staff.

Jean-Yves Duclos, Canada’s health minister, announced last month that he was reinstating the position of chief nursing officer, a person who helps shape national policy, and a role that the government scrapped a decade ago.

“We need to support our nurses, make sure they are heard and that their challenges are met with solutions,” he said at a news conference alongside Leigh Chapman, a nurse and researcher who was appointed to the position.

Canada spends more on health care than all but four countries. Last year, the federal government provided 42 billion Canadian dollars for health care through a funding arrangement that increases by at least three percent per year to each of the country’s 13 provinces and territories.

But provincial leaders say that’s lower than the five percent yearly increase in the costs associated with delivering health care and are pressing the federal government to boost annual funding by at least 28 billion Canadian dollars.

Although provincial governments have ultimate control over financing for health care, including the power to raise taxes, their leaders say they can’t afford it.

In Ontario, the provincial government capped wage increases for most public sector employees in 2019, citing budget issues. Unions representing health care workers there blame the staffing shortage on the cap and the chronic underfunding of health care.

“Frankly, we need to make working in hospital better paid and safer,” Mr. Hurley, the hospitals’ union president, said, calling for financial incentives to increase the hiring and retention of experienced nurses and the addition of more full-time positions that would include insurance benefits. About 30 percent of Canada’s nursing jobs are part-time, according to data from the Canadian Institute for Health Information.

In Toronto, severe staffing shortages prompted the University Health Network, a group of five facilities that are home to some of Canada’s foremost health researchers, to issue a critical care bed alert, a warning to other emergency facilities that a hospital would not be able to readily accept transfers of critically-ill patients, said Dr. Kevin Smith, chief executive of the hospital system.

The warning typically lasts a day or so but at the health network’s Toronto General Hospital, the alert was in effect between July 22 and Sept. 2.

“Increasingly, I think many of us realize we are not going to, in the short term, train our way out of this,” said Dr. Smith. “We can’t produce nurses quickly, with the exception, possibly, of some foreign graduates.”

That’s an option that some provinces are turning to. Ontario’s health minister, Sylvia Jones, directed licensing authorities to “make every effort” to register health professionals who were internationally trained “as expeditiously as possible,” according to letters sent last month to those authorities.

Even before the pandemic, emergency departments were among the most dangerous work environments in hospitals.

Health care workers experience workplace violence at four times the rate of other workers, and half of those incidents happen in the emergency room, according to a 2021 statement by the Canadian Association of Emergency Physicians.

That violence, coupled with the increased level of risk that nurses are shouldering by serving more patients with less help even as the pandemic endures, has accelerated burnout.

“I think we’re just going to keep losing people because at a certain point, you don’t keep working in that environment,” said Dr. Carolyn Snider, the chief of emergency medicine at St. Michael’s Hospital, one of two trauma centers in downtown Toronto. “That is my biggest worry.”

In a 2019 parliamentary committee report on the issue of workplace violence, health care workers said that fewer staff led to more violence because patients and family members become frustrated with the lack of attention.

It’s something Cathryn Hoy, president of the Ontario Nurses’ Association, hears about regularly from the members of her union: punching, spitting, kicking, and two stabbings in the last six months, she said.

“Nursing is the backbone, and the heartbeat of health care,” she said. “Unless health care touches you, you don’t think about it.”

Vjosa Isai reports for The Times from Toronto. @lavjosa