The Ontario NDP is calling on the Ford government to invest in nurse training, recruitment and retention after learning of Southlake Regional Health Centre's solution to deal with the severe staffing shortages that are impacting hospitals across the province during the COVID-19 pandemic.
"While Ford avoids investing in nursing, Southlake hospital in Newmarket is adopting so-called 'team-based' nursing for its ICU — filling critical care nursing jobs with people not certified in critical care nursing, and asking qualified nurses to pair with them," NDP health critic France Gélinas said last week.
The statement was issued after Southlake's board of directors refused to meet with critical care RNs and RRTs who sent a letter asking it to take action against the hospital's plan to fill 13 positions with under-qualified nurses for its ICU and to use team-based nursing to deal with shortages.
“When your loved one’s heart stops beating, or they stop breathing, you want a fully certified and fully staffed-up critical care squad rushing to their bedside,” said Gélinas.
"People deserve better — they deserve a plan that gets more nurses with the right qualifications providing care in every ward, on every shift," she said.
The NDP said the former Liberal government cut about 1,600 nurses during years of hospital budget freezes and that the Ford government has not restored the positions. Without a plan to deal with staffing shortages, Ontario hospitals are spiralling out of control and burnout and stress is causing more nurses to leave their positions.
Doris Grinspun, chief executive officer of the Registered Nurses' Association of Ontario (RNAO), takes exception to the NDP's use of the word "nurses" because it's registered nurses specifically who have been cut.
She also said that Health Minister Christine Elliott's announcement last week that hospitals will operate at 115 per cent capacity to address surgery backlogs is pointless if there are not enough qualified RNs to assist with complex surgeries.
"If you don't have the RNs who have the knowledge, expertise and competencies and clinical judgment to care for complex patients, you cannot do more than what's done now — in terms of complex patients — because we don't have them," she said.
The team-based nursing model like the one Southlake plans to implement was "ditched" in the 1970s "because it was producing poor patient outcomes" and is not a solution for staffing shortages, Grinspun added.
Patients today spend significantly less time in hospital and many procedures are outpatient, so those in ICU are much more complex and require the expertise of qualified RNs, she said.
"Models used in the '70s with patients that were way more stable than now will not work."
Elliott did not respond to a direct request for comment.
Southlake Regional Health Centre declined to respond to requests for comment.
Ontario Nurses' Association (ONA) president Vickie McKenna said hospitals used a team approach during the pandemic "when ICU numbers were off the charts" and nurses were brought in to help ease the crisis.
"Boots on the ground, everybody's in and hands wherever we could get them and working in a different way," she said, as nurses with military backgrounds compared it to a MASH unit.
"But this shouldn't be our norm. We didn't have any options. Southlake has options now. This is not best practice."
Grinspun said she doesn't think the model should have been implemented, even during the pandemic.
"To bring people from other units may sound very good to use the term teamwork," she said, "but to care for that very ill patient, it becomes harder, not easier. They (RNs) are leaving; many are exhausted."
According to the ONA, the trade union that represents 60,000 registered nurses, at least 21 ICU nurses have left their positions at Southlake in the last year-and-a-half and four more plan to leave by September.
"If you want to retain nurses in your organization, you have to support them and require proper education so that they can practise and feel good about what they're doing. They're not going to stay if you don't," McKenna said.
She said that while all registered nurses have the basic skills, a critical care nurse has been taught to recognize the subtleties that can occur in a critical care setting, which is why that extra education is so important.
To receive a critical care nursing certificate, RNs are required to complete a 12 to 18-week program that includes neuroscience, cardiovascular care, respiratory care and more. It also includes a practicum requiring a RN to spend a certain amount of hours bedside in a critical care unit.
ONA said it is not aware of what Southlake's short-term critical care training will entail.
McKenna said part of the concern for the current ICU nurses is "that they want their colleagues to have the same level of education as they do and want their unit fully staffed."
She called Southlake's actions "bizarre" and went on to say that because of the provincewide shortages, this is not the time to lose even a single RN and an ICU RN in particular.
"This is one of the bigger problems — not just at Southlake but provincially — is we have a shortage in registered nurses and part of the issue with current nurses, to keep them, we have to make sure we support them. It's beyond me why they (Southlake) would do this."
Both Grinspun and McKenna said that heavy recruitment from the United States is a concern.
"They really want our nurses," McKenna said.
The average age of nurses in Ontario is 48.9, with thousands now eligible to retire, she added.
A survey conducted by the RNAO before the pandemic — when there was already a nursing shortage — found that mid-career nurses would go into a new profession or would consider working in the States if the situation didn't improve, and those near retirement said they would consider staying on for a few more years even though shortages have made things difficult.
Now, at the end of the third wave of the pandemic, retirement-age nurses have said they cannot continue, while the mid-career nurses feel "disrespected" by a government that is doing nothing to support them or retain new nurses, McKenna said.
"It's made me very, very worried for the future," she said. "This is not only an Ontario issue (shortages), it's national and international but that doesn't make it OK."
Grinspun said one of the solutions is for the government to "retain, retain and retain nurses."
"This is a solution that is viable and doable."
Another solution is to get rid of Bill 124, the legislation that puts a cap on nurse wage increases, she said.
"What will bankrupt the system is if we lose all our RNs because we will bankrupt the future of Ontario health. Ontarians' health will suffer the consequences of destabilization with these models and of the unsafe care they will receive. "
She said the backlog of procedures and surgeries need to be done not only according to how many CT scans and MRIs and surgeons are available, but also how many nurses with the proper competencies, training and education are there.
If the type of surgeries being performed are complex and require critical care or ICUs, she added, then hospitals need to have the right number of RNs because if not, the patients will suffer the consequences.
"The more you use this Band-Aid solution like what Southlake is doing, the more RNs will leave," Grinspun said.
"They (Southlake) are heading in the wrong path I think patients will pay with their own safety and health outcomes and I think Arden Krystal (president and CEO of Southlake), whom I respect immensely, should backtrack — the sooner the better."
The hospital, in Health Minister Elliott's Newmarket–Aurora riding, plans to provide applicants previously considered ineligible to work in the ICU with a short training course instead of hiring nurses who have completed a 12 to 18-week critical care nursing program.
The plan has also attracted some criticism from the community.
One NewmarketToday reader called the hospital's plans "worrisome" and another said, "Shame on the HR department."
"Southlake is a disaster and gone further and further downhill over the last 10 years.... And now to cut corners in the ICU of all places? I’m dumbfounded," said a comment on NewmarketToday's Facebook page.
"No one should go to Southlake then. Wow, why are we paying taxes if we can’t begin proper health care," said another.
