A nurse at Surrey Memorial Hospital is sounding the alarm over staffing issues they say make work unsafe.
The individual, who requested anonymity for fear of retribution from their employer, told the Now-Leader about the immense pressure they are under as ICU nurses are being assigned 鈥� otherwise known as redeployed 鈥� to the emergency room to cover as the ER is short-staffed.
Emergency room nurses have been leaving Surrey for a while, but the breaking point came in early June.
"The major trigger point was when the nurse got beaten up by a patient in emerg (ER), ended up with a brain bleed and had to go for neurosurgery," the nurse said.
BC Nurses' Union (BCNU) president Adriane Gear said she was made aware of a "very serious assault" on a nurse who required a neuro assessment. She could not confirm if it was the same incident.
"There's so many serious situations that happen, like, it gets normalized," Gear said. "If it's the situation that I was apprised of, I understand that that nurse, I don't know that they fully recovered, but they were anticipated to fully recover."
Nurses do not feel safe working at Surrey Memorial
The nurse who spoke anonymously with the Now-Leader said more than 15 emergency room nurses had left Surrey Memorial Hospital for jobs at other hospitals in the region.
Since June, to compensate for the ER's short staff, the clinical operations directors/assistant directors of nursing have often redeployed two ICU nurses down to the ER. As a result, the nurse said, ICU nurses are calling in sick because they are worried about being redeployed down to the ER. Before this happened there would usually be one or two sick calls a shift; now there can be as many as five to 11 sick calls.
"If they know they're being floated (redeployed), they're calling in sick," they said. "Which then in turn has a knock-on effect, because now we're short in ICU."
This redeployment is impacting not only the nurses but also the patients, they said.
ICU and ER nurses have two different scopes of practice, the nurse said. An ER nurse's job is to stabilize the patient and "get them where they need to go," like to another unit or discharge them. The nurse described the ER as fast-paced, where the ICU is meticulous.
"Whereas ICU takes them over and gets them through their treatment course, to hopefully get them to leave the hospital," they said.
To be an ICU nurse, you must complete a specialized course; the same goes for the ER, where they have to complete an emergency medicine course.
"There are nurse-initiated activities that an ER nurse would be expected to do, an ICU nurse would not know how to do them because they would not know they exist, so their care gets delayed," the nurse explained. "There are skills that an ER nurse can do with their eyes closed, whereas an ICU nurse probably hasn't done it in 10 years."
The charge nurse in the ICU often tells the clinical operations directors that it is not safe for them to give two nurses to the emergency.
"And they (the directors) say, 'do as I say, otherwise, you're going to be disciplined,'" they said. The discipline could include getting fired.
They're also concerned that staffing decisions are being made by directors who may not be present in person 鈥� even as nurses on site are saying "we are not safe, you can't do that," they said.
Contract allows redeployment in 'short-term circumstances'
The BC Nurses' Union contract wording allows this type of redeploying nurses in "extraordinary short-term circumstances." But the nurse wants to know: what is considered short-term?
Gear told the Now-Leader that redeployment should be a last resort.
"Nurses all have fundamental basic assessment skills, and is any nurse better than no nurse? For sure, but redeployment should be used as a last resort and, unfortunately, what's happened is this has become the health authority staffing strategy," Gear said.
There is wording in the collective agreement on the requirements that the employer has to take to find staff, she noted.
"They're required to call in regular staff. They're required to call in casual staff. They're required to call in part-time regular staff. They're required to provide call-in staff at overtime and then assign where appropriate and then shift assign where appropriate," Gear said.
Both ICU and ER nurses have advanced skills to care for critically ill patients.
"But the emerg (ER) patient looks very different than it than an ICU patient, and the resources are different," Gear said.
This is also being done at Royal Inland Hospital in Kamloops, she said.
"In terms of redeployment, what we say is it should be on a voluntary basis. You should canvas people and ask people if they're willing to go elsewhere," Gear said.
She said some people are willing to be redeployed but added the hospital has "overused" that and "burnt out the goodwill" of nurses.
High vacancy levels for nurse staffing: BCNU
Gear said the emergency room has 51 vacancies for full- and part-time nurses.
"From what I understand, that on any given day, they work 10 to 17 short out of 39," Gear said.
"I can be very critical that this is what they're doing, you know, but I don't know that I have a better solution, other than I think that they need to look at the problem critically and try to understand, why do they have so many vacancies?" Gear said.
She said the health authorities should ask nurses for ideas for solutions.
"Nurses have tons of solutions, and what I hear from nurses each and every day is 'they won't listen to us,'" Gear said. "Nurses understand we can't grow more nurses on trees, but there is other things that can be done."
Gear said she suspects some nurses being deployed to the ER from other areas of the hospital may lack critical care skills.
"They are addressing the vacancies the best they can, but they are substituting staff that likely do not have the minimal qualifications to be there," she said. "They are still nurses and are going to provide the very best care they can."
In these situations, Gear said pressure is often put on the emergency room nurses who do have the proper training.
"This is a safety-sensitive industry, and I think that health authorities are likely doing the best they can with the resources they have, but what they're failing to recognize is that this is no longer a one-off. This is habitual, this is chronic, and nurses cannot burden that," Gear said.
'We can't care for our patients': Nurse
The Surrey nurse said the whole situation poses a huge burden for nurses.
"We can't care for our patients, and the worst part was we worked hard through a pandemic. It was extraordinary times where we were asked to do extraordinary things, which we did," they said.
The nurse added that people are leaving the profession without safe patient ratios and adequate staffing levels.
Gear said they are working with the government to implement these minimum nurse-patient ratios.
"In the meantime, the employer really needs to get it together. They need to take all reasonable steps to keep nurses safe, like, particularly the ER, (where they are) subjected to so much violence," Gear said.
She said the employers need to meet with their members to see what can be done and address the abuse they are facing.
The Surrey nurse said the situation, as it stands, puts patients at risk.
"On any given day, there are 70 patients admitted in the emergency department, and there is nowhere for these patients to go, and the problem is these patients are probably not being rounded on daily by the doctors," they said. "So you're hoping that somebody doesn't deteriorate and something gets missed and somebody dies because you've got patients that are admitted in the hallways."
The Now-Leader reached out to Fraser Health but was unable to secure an interview by deadline. A promised statement from Fraser Health has not yet been received.
