Special to Northern Beat
[Code Grey is the standardized hospital code used to notify staff of a system failure.]
It’s no secret that Northern Health — along with other health authorities across the province — are struggling with recruitment and retention of health care staff.
While urban areas are just beginning to see the cracks in the system, those in northern and rural communities are quite familiar with the inequities and gaps in care – they’ve been trying to raise their concerns for years.
In Fort St. John, the ICU has been closed since June 2020 and Chetwynd General Hospital has been forced to close or divert its emergency room over 50 times in the past two years, according to data compiled from Northern Health. Fort St. John has had long-term doctor shortages dating back to 1974.
Not a new problem
A 2018 Auditor General report on rural and remote nursing in northern B.C. found Northern Health did not do enough to recruit and retain nurses effectively. The audit noted as of April 2017, a regional shortage of 121 full-time-equivalent registered nurses, approximately 15 per cent of its rural and remote registered nursing workforce, and almost six full-time-equivalent nurse practitioners.
“Not having enough RNs and NPs means patient needs may go unmet, and [patients] may have to wait longer for care,” wrote then auditor general Carol Bellringer.
Even worse, the shortage of nurses could have disastrous effects on patients and health care staff, the report stated. “Working long hours to cover vacant shifts increases the risk of medical error and can lead to burnout, illness and injury, and backfilling shifts at overtime rates or with agency nurses is more expensive.”
Five years later, the Peace region continues to struggle with staffing shortages.
“We’re doing something wrong”
“To have a hospital that is ten years old now that is struggling to keep essential services open tells you that we’re doing something wrong,” Fort St. John mayor Lori Ackerman said.
As one of the largest cities north of Kamloops, Fort St. John should not be struggling to keep necessary services accessible to residents, she said, adding that the pandemic is not the primary driver behind Northern Health’s current crisis.
“We need to acknowledge that our health care system was pretty much in shambles before COVID hit,” said Ackerman.
Ackerman and several other Northeast mayors and business leaders in the Resource Municipalities Coalition want to find out why.
Be brave, ask questions
“If you’re brave and courageous enough to ask uncomfortable questions, people will tell you what the issues are,” Ackerman said.
The coalition includes municipal and business leadership from Fort St. John, Fort Nelson, Mackenzie, Chetwynd, the districts of Taylor and Tumbler Ridge, and more. It was formed to enable municipalities to pool their energy and resources and advance their common interests.The coalition has asked the Ministry of Health for a full audit of Northern Health operations.
Despite several requests for comment, the Ministry of Health did not respond by the time of publication.
“Doing an audit on Northern Health would be specific to the North. But this issue is right across the province and across Canada,” Ackerman said.
“We want to understand the service levels across the entire region to see whether or not there are gaps and inequities, where we’re doing things really well, and see if there’s an opportunity to learn from that,” said Taylor mayor Rob Fraser.
“The crux of the problem is we don’t fully understand [Northern Health] processes,” said Mackenzie mayor Joan Atkinson. “Once we have this audit done, then we would know what we’re dealing with.
“Right now, we’re making stabs in the dark,” Atkinson said.
“One of the biggest challenges with health care is the number of people in the health care industry,” said Fort Nelson mayor Gary Foster. “We’re short of nurses, doctors, lab techs, and not just in the Northern Rockies or in British Columbia, but in fact, all across Canada.”
Staff shortages have more profound impacts in smaller communities such as Fort Nelson, said Foster.
His comments were echoed in Northern Health’s 2020/21 – 2022/23 service plan.
Because the health authority serves primarily smaller, spread-out rural communities, small facilities and services are more common. However, these facilities and services can be difficult to sustain.
“The departure of a single practitioner, for instance, can have a significant impact on many northern communities,” the health authority plan states.
Northern Health now has a “robust workforce sustainability strategy,” said Angela De Smit, chief operating officer for the northeast division.
Recruiting new grads
“We’ve contacted over 144 internationally educated health care professionals that live here in the Northeast,” De Smit said.
Many of those professionals have taken or are enrolled in the Northern Lights College Health Services Management Administration program and the health authority hires about 100 new graduates each year, she said.
“Some of the successes are that we’ve built back and will have almost filled all of our emergency room department positions [in Fort St. John] by the end of October. I believe there’s a part-time position that will remain unfilled. We’re now 50 per cent filled back up with our ICU,” De Smit said.
While Northern Health has recruited more nurses in recent years, the Peace region continues to face severe staffing shortages.
Not enough nurses
During a recent visit to the Energetic City, Adriane Gear, vice president of the BC Nurses Union, said members in Fort St. John are reporting increased negative patient outcomes because there aren’t enough nurses to provide care to those in the community.
“In the emergency room, for example, their baseline ratios are two nurses to 16 patients, or one to eight. In any other part of the province, you’re going to see a ratio of one to three, or one to four,” Gear explained.
De Smit said the health authority doesn’t measure in ratios in the Northeast.
“What we look at is our statistics – in terms of, what is the acuity of patients that are coming into the facility and what is the reasonable amount [of staff] – because there’s always peaks and valleys,” she explained.
“That’s why at times, we do pull staff because, for the last three days, we were fine. We had staffing that was appropriate to care for the number of patients in there. And then maternity might drop down to two mums and babes, and the emergency department spikes. So we say, ‘OK, how do we support the emergency department? Because right now, they have an increase of patients,” De Smit said.
In September of 2022, the BCNU held a town hall meeting with nurses in Fort St. John who highlighted issues they face in their workplace, such as staffing shortages and a perceived lack of respect from the health authority.
Nurses feel disrespected, unsupported
“They certainly acknowledge that some of their immediate managers are good people trying the best that they can do. But, generally speaking, they do not feel supported or listened to by the health authority,” Gear said.
Some nurses feel unable to bring up genuine health and safety concerns and practice standard issues because of a fear of retaliation, Gear said. Nurses are not covered by whistleblower protection, and risk being penalized or losing their jobs if they complain about the health care system publicly.
“If someone brings a patient safety concern forward, they’re considered to be stirring the pot or a troublemaker,” said Gear. “So what’s happened is that nurses who historically have brought forward patient care issues are now saying, why would I bother? Nothing happens.”
This leads to more nurses vacating their positions because they don’t feel confident in the level of care they’re providing, Gear said.
“They don’t feel good about what they’re doing as a nurse. They cannot provide the care that patients deserve or require.”
Disconnect between the ranks
Taylor mayor Fraser said he saw a disconnect between staff and management emerge during consultations with health care workers when the municipalities coalition was putting together the Health Care Advocacy report.
“We have two types of people in the health care system who live in our communities — the people who use the system and the people who work the system,” Fraser said. “The people who work the system are telling us something completely different with respect to what it’s like to work in Northern Health than what the administrators of Northern Health are telling us.”
Many health care workers in Atkinson’s community of Mackenzie aren’t feeling supported, the mayor said.
“They’re not having good conversations with administration,” Atkinson said.
“I don’t know if they don’t fully recognize the crisis that the clinicians feel that they’re in,” said Atkinson, “but there have to be some more open conversations so that we can get to the root of what’s working and what isn’t working and why we’re having such a hard time retaining staff, especially nurses, in our community.”
Fraser says there appears to be a cultural gap within the health authority, with some employees mentioning a difficult work environment.
“The nurses can tell you about the toxic environment, the general administrative workers, cleaning staff, the workers in the food department, they’re the ones that you know can really identify the specific causes of the toxic environment,” Fraser said.
He said nurses also raised concerns around basic training, staffing levels, and inadequate cross-department training.
Inadequate cross-department training
“So making sure that if nurses ever have to go work in emergency, that they’re trained in the emergency department,” said Fraser. “If she’s not trained, she’s going there because they don’t have enough people. If there are not enough people there, she’s got to try to make decisions on her own without being adequately trained.
“You can see how that must put enormous stress on people,” Fraser said.
According to the BCNU, Northern Health has allegedly changed the model of care, requiring all primary care nurses to be generalists, meaning they must learn and be competent in all complexities of the different areas of nursing.
“The primary care has changed here. So where they would have a specialty in seniors care, diabetes care, mental health, or pediatrics, now they’re being asked to be a generalist in everything,” BCNU president Aman Grewal explained.
Grewal said this takes them away from the work they’re passionate about and can be a massive strain on nurses’ mental health.
“You don’t become an ICU nurse because somebody told you that’s what you have to do. You do it because you have that in you and that adrenaline. There’s that draw to certain things,” Grewal said.
“I was drawn to pediatrics and I was drawn then to pediatric emergency, so those were my specialties. Then it evolved, and it was diabetes care as well,” Grewal said.
“Nurses have passions for certain things, and now they’ve had that taken away,” she said.
Some nurses feel disrespected by Northern Health because of this change, Gear said.
“Nurses need to be respected and acknowledged for the unique skill set they bring, for the specialized training and experience they acquire,” she said. “There should not be this position of a nurse is a nurse is a nurse.”
Northern Health’s De Smit said the policy is not new and it’s largely driven by geography. Because the North is comprised primarily of rural and remote communities, most health facilities don’t always have enough staff to practice in specialty areas.
“Nurses come out as generalists. They have med-surg training, maternity training, pediatric training, and that’s what the North really likes is the fact that they are generalists and they’re well-rounded,” De Smit said.
“This is always the case where staff float back-and-forth to different units, depending on their comfort level and what our needs are, to minimize service disruptions.”
But Grewal said if steps aren’t taken by the health authority to address these issues, the nursing shortage will continue to escalate, causing the health care system to “crumble.”
“What [Northern Health] needs to do is talk to the members,” Grewal said. “Talk to me and talk to my team. We’ve got labour relations officers servicing all sorts of different people that they could be talking to.
“But, the most important thing is to listen to the members and see what it is that they want because they are your workforce.”
Read the full story at Energeticcity.ca.