Source: Adam Bowie, THE DAILY GLEANER
March 7, 2017
Paula Doucet, president of the New Brunswick Nurses Union, said she was startled to see the figures collected through an investigation by The Daily Gleaner last week that revealed many provincial hospitals routinely operate above capacity.
That means there are more patients admitted to hospitals than they were designed to hold, or are typically staffed to manage.
According to figures provided by the province’s regional health authorities, some hospitals operated for more than a month above 100 per cent occupancy levels. A small, six-bed hospital in the northwestern corner of the province actually operated at 200 per cent capacity for one day.
Doucet said that creates significant problems – and risks – for patients and staff.
“When you have higher numbers than what should normally be in a hospital, your risk for inadequate care is increased, along with potential hazards for patients to contract new infections due to closer proximity to others,” she said.
“[Patients are] put in hallways.
They’re exposed to germs, to other infections, that could possibly lead to more complications during their hospital stay.
“We have concerns about safety and security. There are hazards there. There could be IV pumps plugged in [with cords on the floor] across hallways. There’s privacy issues. There’s no curtains out in hallways to give that patient the privacy they need, the privacy they deserve,”Doucet said.
The practice may also put front-line medical staff in danger, she said.
“Overcrowding increases the number of tense situations. It’s a bad experience for patients and their families. Emotions are high. I believe that the risk for violence and frustration is increased with the overcapacity,”she said.
And working in these conditions also leads to high levels of burnout, said Doucet.
“Already the nursing workload is high. By adding one, two, three, four, or five patients to a nurse’s careload for a shift, you know the level of exhaustion is going up,”she said.
To complicate matters further, Doucet said about one-third of the union’s members are eligible to retire in the next five years.
“Employers need to be aware that there could be a mass exodus of registered nurses from the system. They need to have plans in place to kind of backfill all those possible vacancies due to retirement,”she said.
She’s calling on the provincial government to take action now.
“Between the government,the [regional health authorities], the unions, we need to sit down and look at a collaborative approach, one that will have viable solutions right now,”she said.
“The overcapacity you’ve show is escalating. It’s getting worse. Something needs to be put in place now to address it.”
Health Minister Victor Boudreau recently told The Daily Gleaner he realizes it’s a serious problem, but it’s one that his department is working to address.
“We’ve been working so hard at trying to develop more capacity at the primary care level, the home-care level,” he said, citing collaborative work with the New Brunswick Medical Society and with the New Brunswick Association of Nursing Homes on some forthcoming projects and programs.
Dr. Lynn Murphy-Kaulbeck, president of the New Brunswick Medical Society, said chronic congestion in provincial hospitals creates a number of problems – from the cancellation of non-urgent surgeries to the earlier-than-usual discharge of many patients.
“When it’s that crowded, it affects every part of the hospital,”she said.“Any time you’re overcapacity, your staff is working extra hard. And when there’s fatigue, when you’re trying to care for more patients than what you’re routinely supposed to, yes, it probably does translate into issues of patient safety,” Murphy-Kaulbeck said.
“If you’re overcapacity and dealing with more patients than you’re supposed to, you’re not able to give that care you would normally want to give – holding someone’s hand, talking with them. You just don’t have as much opportunity.”
Back in 2013, she said, the New Brunswick Medical Society released a document it called Care First. Essentially, it was a prescription for the province on how to address serious problems within the health-care system.
“We need to fix primary care, by using electronic medical records and ending billing numbers that prevent doctors from working where patients need them. We need to fix wait times, by paying hospitals differently and providing seniors with better options for care,” reads the text.
“We need to listen to front-line professionals by involving them in decision-making throughout the system, rather than keeping them out. And most importantly, we need to focus on the health of New Brunswickers, to move from a sick care system to a health system.”
At the time, the society said making these changes could lead to $100 million in savings, based on its own research. Yet many of these suggestions are still works in progress, or have yet to be addressed at all.
Murphy-Kaulbeck said new nursing home beds are also needed – one in four hospital beds in the province are taken up by those waiting for space at long-term care homes – and the province must expand the Extra-Mural program, which can allow people to remain in their homes longer.
“These are things that need to be addressed,”she said.
“It’s a multi-pronged problem. Yes, we need movement from the government. I think there needs to be a concrete strategy moving forward.”
The problem is being blamed largely on the vast number of long-term care patients waiting for beds to open. About one in every four acute-care beds in New Brunswick is currently occupied by seniors who’d be better served by a nursing home.
Lisa Harris, the minister responsible for seniors and long-term care, has said her government is working hard to address that end of the problem.
She said the government has formed regional committees with staff from the two health authorities and the departments of health and social development to do“an intensive review.”
– With files from John Chilibeck