Southlake Regional Health Centre's plan to fill 13 positions in the intensive care unit (ICU) with inadequately trained nurses and to implement a team-based nursing model is dangerous and will put patients at risk, according to the Newmarket hospital's critical care registered nurses and respiratory therapists.
In a letter sent to the board of directors on July 12, registered nurses (RNs) of the intensive care unit, cardiac intensive care unit, cardiovascular intensive care unit and registered respiratory therapists (RRTs) urged the board to take action to stop the plan.
A source told NewmarketToday that the letter was signed by 96 per cent of the critical care RNs and RRTs at the Newmarket hospital.
"RNs who do not have training in critical care will not recognize and be able to respond immediately due to their lack of knowledge and experience, which could result in serious complications and may be potentially fatal for patients," stated the letter from Jill Moore, Southlake bargaining unit president for the Ontario Nurses Association (ONA).
In response, the Southlake board acknowledged the current human resources challenges faced by the hospital's critical care unit and of the "broader system-wide staffing shortages" that the Newmarket hospital and others across the province are struggling with as a result of the pandemic, according to a copy of the letter from board chair Patrick Horgan obtained by NewmarketToday.
"With quality and safety in mind, like other hospitals across the province, Southlake is implementing a model of care to help address these pressures while it works to build back the critical care work force," Horgan stated in the letter.
A Southlake RN, who wishes to remain anonymous to protect her job, told NewmarketToday that several nurses have already left their positions in the ICU since the team model was announced and many more are actively looking for employment elsewhere due to the hospital's plan.
"If staff are willing to give up their seniority, their vacation, their sick time to get out, that is very, very telling," the RN said.
According to ONA president Vicki McKenna, the move is due to severe under-staffing at the hospital and a lack of nursing applicants who meet the criteria.
As a result, the hospital plans to hire applicants and provide them with a five-day training course rather than the 13-week critical care nursing program.
"It's grossly inadequate. I live in Newmarket. This is my hospital. If I'm in an accident or become ill or if my family is in an accident or becomes ill, we're going to Southlake, and as a critical care nurse and as a member of the community, I am shocked and terrified that this is Southlake's response to a staffing shortage," the RN said.
As part of a team-based nursing model, these nurses will be immediately eligible to care for less critically ill patients and to work with RNs who have been trained properly to care for acutely ill patients, she said.
"That just doesn't follow logic....it just seems like a stop-gap, a Band Aid. The most important part of it is that (the nurses) believe that there will be real patient risk," McKenna said.
A Southlake RT, who wished to remain anonymous to protect her job, said that nurses with inadequate training may not be able to recognize subtle changes in a patient's status and respond appropriately, and that the lack of proper training and experience affects all members of the critical care team.
"When you have RNs who aren't trained, you're lacking in the resources you need to provide that care for those patients. As part of the critical care tram as an RT, we have a responsibility to speak out on behalf of patient safety and patient care and this pre-sponsorship and team-based model of care is not safe," the RT said.
Patients in ICU normally have a single nurse assigned to care for them. This one-to-one ratio means that ICU nurses have extensive knowledge about their patient.
With a team-based system of care, ICU nurses may be required to look after several patients at once. Less qualified nurses would have some responsibilities and the qualified nurse would be responsible for the balance of the care, the ONA said.
Due to the unstable medical status of ICU patients, this model can sometimes result in a fragmented and depersonalized patient care that McKenna described as "pieces of care rather than the total care of the patient."
ONA was informed that Southlake was implementing a temporary team-based nursing approach during the pandemic surge, but they said they were assured in writing that it was strictly temporary and would not continue post-pandemic. The RN said that the current job postings are for permanent positions.
The hospital does offer sponsorship programs that pay the tuition for nurses who would like to take the 13-week program to qualify to work in the ICU.
According to the RN, requests were made for the hospital to run the program more often or two at a time so that nurses who meet interview requirements and who have enough experience can train to become ICU nurses but their requests were denied.
"They want to do this program instead," the RN said. "Can you imagine being critically ill or injured and having a brand new nurse with five days of training being your nurse in the ICU?"
The RN said that as advocates for their patients, and due to concerns for the quality of patient care and their community, the hospital left them no choice but to act after their requests to meet with hospital CEO Arden Krystal were denied.
In a response to a request for comment, Bill Campbell, media relations for the Ontario Ministry of Health, said in an email that staffing decisions are the responsibility of health-care organizations and that "the ministry encourages all health-care organizations to make decisions that promote quality of care and the safety of patients and providers."
The ONA letter provided a deadline of July 25 for the Southlake board to reply to the nurses' request for a meeting.
A response was received by ONA today, Friday, July 23, shortly before 5 p.m.
While refusing the request for a meeting, the letter stated that the Southlake board is appreciative of the "hard work and dedication" of the hospital's nurses.
Horgan advised further questions should be directed to the leadership team implementing the staffing plan.
"This decision will harm the reputation of the hospital as a regional centre of acute care excellence," McKenna said.