Our team at the hospital hears and understands your frustrations with the ongoing closures of the emergency department. We know that this is frustrating. We know that this is scary. We know that this is not an acceptable way to continue.
What you may not know is the realities of why this is happening and all we are doing to try to address this. Some background information.
Our hospital is staffed by three types of people in direct patient care:
– Registered Nurses (RN). These are who most people think of when they think “nurse.” These are the people with the training and skills to assess and triage patients, administer medications and perform certain critical-care skills. There are certain treatments and medications they are allowed to give before receiving orders from doctors as part of their scope. These are the nurses who staff our ER, but not all RNs are trained/certified to work in the ER. By College regulations and for safety, RNs who do not have the training cannot staff the ER.
– Licensed Practical Nurses (LPN). These nurses are an often under-recognized part of health care. They are nurses who’s scope is not quite as broad as an RN, but they provide most of the day to day care for in-patients in our hospital. They do not have the certification to provide IV medications and initiate critical care interventions. They are often assisting in our ER, but are not trained or allowed (by College regulations) to be the sole nurse in ER.
– Physicians (doctors). These are people trained in diagnosis and treatment of multiple medical issues. The doctors in our ER are family physicians who have taken additional courses and training to be able to provide emergency care outside of a tertiary care facility (e.g., Royal Inland Hospital). Some of our covering doctors also have extended training to work in any level of ER. They work closely with the RNs and LPNs to provide care for patients.
On a fully staffed day, our hospital is served by: One LPN per shift, one day shift, one night shift; three RNs, one day shift, one night shift and one on ER shift from 9 a.m. to 9 p.m.; one doctor, on call for 24 hours from 8 a.m. to 8 a.m., and 48 hours from 8 a.m. Saturday to 8 a.m. Monday over weekends; and our locum doctors, who come to cover the ER work from 6 p.m. on Friday to 8 a.m. Monday.
If you look at those shifts, that means that in a given week, there are 14 LPN shifts, 21 RN shifts and six doctor shifts. RNs and LPNs typically work four days in a row per set (four 12-hour shifts = 48 hours per week). Our doctors are working at the clinic when they are not working at the hospital.
This means that at the barest minimum, you need six RNs and four LPNs to staff the hospital for one week. Our hospital is designated for eight RNs and four LPNs. Currently, we have four RNs and four LPNs.
We have postings for up to seven additional (full-time, part-time or casual) RNs and for two LPNs.
Please be clear on that point above: We have four RNs. We are supposed to have eight. We are operating at half our capacity for RNs. The ER cannot be open without an RN who is trained in emergency medicine care.
Our RNs also have duties on the acute care ward. An ER-trained RN cannot be replaced with any other health care practitioner. Physicians, LPNs, care aids, ambulance attendants, non-ER-trained RNs do not have the skills and knowledge to safely care for patients. You could put as many of those other practitioners in the ER but it is not sufficient.
So why the nursing shortages? It’s a complex answer. To be clear firstly: Dr. Helmcken Hospital did not lose any nurses — RNs or LPNs — to the vaccine mandate. The pandemic played some role. It was tiring and exhausting. We had to learn a whole new disease entity, its presentation, its treatments and how to keep ourselves and you as safe as we could.
Health care practitioners would sleep in their trailers and spare rooms rather than expose their family to possible infection with COVID. Patients were often scared or angry and it was our nurses’ jobs to care for you, providing reassurance and education, while still providing the medical care you required.
Our hospital is busier than ever. Pre-pandemic, a busy weekday in the ER would see between two and eight patients. Now, we are routinely seeing 12-18 patients a day. Some of these visits are simple, but many of them are for complex medical issues and patients who are very sick.
Many people have less patience and compassion for our staff when they are at the ER — they’ve waited longer in the ER, they weren’t able to get a timely visit at the Health Centre because we only have half our complement of doctors, they’re hurt and tired and sick. The nurse then becomes the person who takes the brunt of these frustrations because they are the ones there when people are feeling their worst.
None of this takes into account any of the personal life factors that affect someone’s decision to remain in nursing.
So what is our local health-care team doing to address this, to try and prevent hospital and ER closures? Again, we have posted multiple positions: RNs, LPNs and physicians. There are hiring bonuses to try and encourage people to come to Clearwater. Unfortunately, these shortages extend far beyond Clearwater and we are not the only community fighting to recruit the available health-care workers.
We have not given up on this. We continue to put a lot of effort into filling the vacant positions. We are expanding the training and skills for our LPNs wherever possible to help fill other care gaps. They will not be able to be the nurse covering ER, but they can offload other duties.
We are pulling nurses from other areas, temporarily sacrificing other services to keep the ER open. We have nurses from locum nursing agencies who come to help when they are available. We have pulled nurses from other facilities in Interior Health to keep our ER open. In the meantime, our local RNs and LPNs are going above and beyond to keep our hospital open. We are lucky in that all of our current RNs are ER-trained and can cover the ER when they are on shift.
Both RNs and LPNs are extending the hours of their shifts to cover until the next shift can get there. Our nursing managers are being pulled from their duties to work on the floor or ER. Nurses are picking up overtime shifts, knowing that if they don’t the ER will be closed.
They are coming in from holidays that they booked a year in advance to cover shifts. They are missing time with their families to ensure that our community has ongoing health care. Every time we close the ER, we have gone through every possible step, tried to adjust the current schedule and called each one of our nurses to see if they can come to help.
Unfortunately, until we have gone through every possible step and contingency, we are not allowed to officially close the ER and therefore, are not allowed to provide advance notice of closures. This frustrates us too and we know it frustrates our community.
So please remember this when we have no choice but to close the ER. We have done everything we can to avoid this. We are operating at half of our RN staff. Without an ER-trained RN, we cannot safely have the ER open. A doctor does not have the training and skills that an ER-trained RN has. An LPN does not have the training and skills that an ER trained RN has. Without an ER-trained RN, it would be negligent and dangerous to pretend we could give you the care you need.
We are actively recruiting to fill our vacant positions. We are human too and the state of health care breaks our hearts.
Dr. Perdue and the Dr. Helmcken Hospital Team