The guest column is written by an anonymous nurse.
THIS IS IN RESPONSE to the campaign of misinformation propagated by the administration of the Interior Health Authority. But first, we must start by quoting our code of conduct, for by taking off the gag, we risk our careers.
AU0100 — STANDARDS OF CONDUCT FOR INTERIOR HEALTH EMPLOYEES
2.1 Compliance with Standards
The requirement to comply with these standards of conduct is a condition of employment. Employees who fail to comply with these standards may be subject to disciplinary action up to and including dismissal.
– IH employees have a duty of loyalty to IH as their employer. The duty of loyalty requires employees to serve IH honestly, faithfully and to the best of their ability.
– The conduct of IH employees should instill confidence and trust and not bring IH into disrepute.”
Our hospital is on fire. The staffing shortage, downplayed by administration, is in full crisis. To throw some numbers at their statistics: between ER and ICU there are approximately 60 vacant full time lines. That’s 60 specialty care RNs.
The casual pools that typically assist in replacing the vacant shifts are also nearing depletion. In the ICU alone, there was an advanced call-out for 406 vacant shifts between May 26 to June 25. Only 10 have been taken.
Notice, we didn’t mention the third critical care unit in the hospital: CCU. A little known fact outside the hospital, the CCU has been closed for several months due to a lack of staff. It was previously only operational at half capacity by the utilization of ICU staff and has now been amalgamated back into the ICU’s 17 beds, which puts RIH down four critical care beds.
The wards are now running routinely with nurse-to-patient ratios of 1:7-8, where 1:4 is the ideal. Unfortunately, those ratios often become 1:10+. At times, there are no staff assigned to a unit, necessitating the redeployment of staff from other already short units just to keep the doors open.
The ER has occasionally run with only three trained staff, the rest being pulled from the wards or ICU, which itself typically runs at 60 per cent staffing. That’s nine out of 15 nurses with ratios of 1:2 and, at times, 1:3 for the most critically ill patients. If that’s not a critical shortage, what is?
That’s where we’re at, but how did we get here? The general statement from the IH brass is that we have experienced staffing challenges due to an unprecedented combination of a pandemic, wildfires and floods. Now, they’ve started to openly blame the nurses who call in sick for the need to close down a unit over a weekend.
However, the first waves of staff losses started 4-to-5 years ago, well preceding their stated reasons. Instead, the staff of RIH have consistently been subjected to continued harassment, poorly designed PR projects (CCU, ACE, tower build), and mandatory line changes.
For several years now there have been complaints of bullying and harassment by the higher administration of the hospital. This has led to an incredibly toxic workplace and a steady stream of staff exiting the hospital. This ultimately culminated in a meeting last year between the vice president of IHA and the charge nurses and shift coordinators of RIH. He urged those present to be candid and name names with the stories of harassment experienced by those present. They did.
Yet, no real change occurred. Instead, we had brief hope followed by a great letdown and understanding that the directors hold all the power in this organization. Even now, all of our concerns are publicly downplayed and waved aside by administration.
As for the personal stories of harassment and toxic reproach, we hope those who have their personal experiences will be afforded the opportunity to speak up without fear of retribution.
As mentioned, the CCU department failed. It failed right from its inception and design. No care was taken to consult those who would participate in it, the staff who would ultimately be stuck in a work environment unsafe for both patient and staff alike. An environment that burned through seasoned critical care staff and ultimately led to an exodus of CCU RNs. The money raised was wasted on a hastily-designed and implemented program.
Advancing Care Electronically, that’s ACE for short. Our multi-million dollar upgrade to enter a digital world. Just as it was about to be rolled out, we were told by a few of those implementing the system that we could expect acceptable losses of up to 10 per cent of our staff.
Acceptable. In the middle of a pandemic. In the middle of burnout. In the middle of a staffing crisis. The directors even acknowledged all of our concerns in a site-wide email and acknowledged that we’re doing it anyway because it would cost too much to delay.
Thankfully, we didn’t end up losing 10 per cent, but we did lose many. It hit our casual pools hard. And how successful was the program? A complete failure in every regard of patient safety, information accessibility and usability.
It has been an absolute nightmare for the end users. Charting is no longer meeting standards of best practice with frequently missed documentation and assessments. Errors in medication orders and administration are frequent. Patient care and interventions are delayed.
Nurses spend more and more time at a computer and away from the patient’s bedside. All of our concerns are downplayed and chided with — “You’ll just have to get used to it.” Nearly a year in, and we’re still not used to providing substandard care.
Line changes. The mandatory push throughout the hospital has been to increase the number of full-time lines and shift away from part-time positions. Makes sense on paper; force the remaining staff you have into working more hours to cover more shifts. The result? More staff leave.
The reason many nurses work part-time is that they are parents and need the flexibility to care for their children. There is no daycare for 12-hour shift workers. So the solution if you’re forced out of part-time into choosing a full-time line? Choose a casual position, taking fewer hours and having a better balance in life and work.
These top down decisions are just a few of the many reasons we’ve lost so many staff. More than due to any pandemic, wildfire or flood. And the belief that a new tower will solve our problems? “Build it and they will come,” seems to be the hope because we don’t have the staff to operate it currently. Or maybe it will be all the new grads coming out of TRU? The ones that have gone through our hospital in clinical and seen how toxic it is and are now being told that they must only accept full time lines in RIH so they can “consolidate their skills” while being used as cannon fodder.
Or maybe it is the hope of increased class intake sizes, though the first of these would graduate in four years, after further staff attrition and losses.
Maybe it’s the Facebook and LinkedIn ads? Except every hospital in BC, and their nurses, knows RIH is burning, so who are they trying to recruit? Travel nurses? They have filled some of those 60+ empty critical care lines, but for only a few months at a time. Many have also said they would never return knowing the conditions they faced. So how long until we exhaust that pool of resources?
Where instead is the accountability of the administration? Where instead is the focus on staff retention? We’re told, publicly, that these discussions are being had with the staff, but why are we not aware of this? What conversations have been had? And with whom? It hasn’t been with front-line staff.
Your “healthcare heroes” are burning out. We’re, literally, crying every shift for help. Help for us. Help for our community that we love and care for. It seems that the health authority is not interested though, focusing instead on ivory towers and Band-aids for hemorrhages… so who are we to look to for support now?
This guest column was originally published in CFJC Today.