An independent assessment committee has made 101 recommendations following a three-day hearing in March into concerns raised by nurses working in the emergency department at Brantford General Hospital.
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The panel of three independent registered nurse experts assessed the professional responsibility and workload issues raised by ED nurses. The panel’s recommendations deal with staffing, skill mix/novice staffing and education, processes, environment, leadership, and a healthy work environment.
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“Nurses are alarmed for the safety of their acutely ill and unstable patients. Access to safe and timely care is being delayed due to ongoing and unsafe RN staffing levels,” Ontario Nurses’ Association president Erin Ariss said in March about the Brantford situation.
Nurses have filed 321 Professional Responsibility Workload Report Forms concerning workload or patient care since 2020, said the IAC report. The concerns include gaps in continuity of care, balance of staff mix, access to contingency staff, and an appropriate number of nursing staff.
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In a press release Tuesday, BCHS stated a process began a few years ago to implement strategies to resolve many of the nurses’ concerns, resulting in 32 of 33 recommendations being resolved.
The BCHS statement said 62 of the 101 recommendations made by the IAC in this week’s report are already in progress, while those remaining will be reviewed and discussed in detail.
“I’m still a bit shocked about their number of recommendations already in progress,” ONA vice-president Angela Preocanin said on Thursday. “I would hope that they would actually be able to put pen to paper and action to their words and be committed to the recommendations of increasing staffing and understanding the skill mix and delegation of work.”
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When a workload report form is submitted, the matter can be discussed with a manager, or can be brought to a monthly hospital association committee (HAC) meeting where both the employer and the union try to resolve issues.
“When that can’t happen because there is a reluctance to proceed with some improvements, that’s when the IAC comes into play and really is a last-ditch effort,” Preocanin explained. “It tells us that at the HAC our requests, demands, and voices aren’t being heard about our patient care and conditions.”
The hospital said one of four position recommendations is already in place, while $32.5 million in renovations to the emergency department will address environmental concerns.
Additionally, 24/7 security coverage in the ED has been implemented and a variety of interprofessional positions have been added over the past four years at an annual cost of $3.1 million.
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The BCHS release said there were 38 position vacancies in the emergency department in October 2022, but that number now stands at 18.
Acknowledging a province-wide shortage of nurses, the ONA vice-president said retention is something employers are not recognizing.
“You can’t retain nurses if you don’t give them working conditions that are safe for their patients where they can give quality care,” she said. “In this department they do have a number of junior nurses with less than five years’ experience.
“When you can’t keep your seasoned staff and you load up on brand new staff – which is a great opportunity — it takes time to become and develop the skills to be an ED nurse.”
Preocanin said senior ED nurses having to support their novice counterparts in an unpredictable workplace is emotionally draining for all involved and questioned the hospital’s stated decrease in vacancies.
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“To suggest that’s a good thing is also concerning,” she noted. “We had the opportunity to speak to the nurses after the hearing telling their stories, and truthfully their stories are telling about the conditions in which they are working and the kind of care they are not able to provide.”
The IAC’s findings are not binding but are intended to provide an independent external perspective to assist the RN’s, ONA and BCHS to achieve mutually satisfactory resolutions.
“We know that staff who work in our emergency department face incredible pressures, are required to make timely and critical decisions, and deal with traumatic situations on a daily basis,” said Interim Chief Nursing Officer Beth Morris. “The ED relies on an interprofessional team and our community partners to deliver care and work effectively. The environment is busy, complex, challenging and pressure packed.”
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