Grace Hospital nurse fears for patient safety amid changes

A Winnipeg nurse says she is afraid for her patients' safety at Grace Hospital as a result of major health-care changes that have affected her unit and the patients she cares for.  

The nurse, whom the CBC News has agreed to not identify, works on one of two clinical teaching medical units at the Winnipeg hospital. She says the unit, which has always had a baseline of 30 patients, consistently operates over capacity by up to seven patients each day.

The morale is really low. People are stressed out. You don't want to go into work.- Grace Hospital nurse

"It's scary. It's scary to go to work," she said.  

"You dread it. And it's fear. Fear of how unsafe you're going to be as a nurse, like for your licence — like, if something's going to happen with the patients, are you going to miss something, is somebody going to be discharged too early — that kind of fear." 

Complex cases transferred to Grace 

Sandi Mowat, president of the Manitoba Nurses Union, told CBC News on Oct. 20 the unit had been converted from chronic care, with mainly elderly, moderate-care needs patients, to an acute-care teaching unit with complex patients. This was partially a result of medical patients being transferred from a unit that had been closed at Victoria General Hospital.

That, plus the influx of patients who would have been treated at the recently closed Victoria General Hospital emergency department has put pressure on the nurses, the nurse says. 

"The morale is really low. People are stressed out. You don't want to go into work because you know it's just going to be a stressful day of no breaks or very little breaks," the nurse said.

According to the nurse the patients require tube feeds, have had tracheotomies, require heart monitoring, oxygen, IV medications, total care, or are palliative.

"It's just so chaotic, you know?" the nurse added. 

Grace CEO defends changes

According to the hospital's chief operating officer, the changes have gone as planned.

"We've certainly been busier, as we expected we would be, in this time of transition, and we believe we're managing very well from all indicators," said Kellie O'Rourke.

Before Oct. 3, she says, the average volume of patients in the emergency department each day was often in the high 80s. Now that the Grace Hospital is recognized as one of the three primary emergency departments in Winnipeg, she says, patient numbers in the emergency department have increased to 110 each day.  

The majority of those admissions go to the medical units, O'Rourke says, but baseline numbers on the units are being constantly monitored.

She concedes that the acuity (the level of severity of an illness) of the patients on the units is higher, but adds staffing rotations have been adjusted to account for the changes and are in line with rotations on similar units at St. Boniface Hospital and the Health Sciences Centre.

It angers me … it's not how they say it is.- Grace Hospital nurse

"There have definitely been a few days when we've had to go over our normal [number of patients], and when we've had to do that, we've been able to arrange for additional staffing to provide safe patient care until patients are discharged," O'Rourke said.

However, the nurse says, the unit still operates short-staffed, and it's only a matter of time before one of the vulnerable patients in her care suffers a critical incident, such as a medication error or worse.

"We've just been thrown into the situation and we're trying to stay afloat. It's survival mode every day," she said.

"You're a nurse because you care about patients. You want to provide safe care, you want to advocate for them, you want to comfort them, you want to hold their hand."

With the changes, she says, there's no time for that.

"It feels like we're drowning and it feels like we're not trying to stay afloat. … It's just a matter of time before something really bad happens, like an accident, and that's kind of when maybe change is going to take place,"

'It's not how they say it is'

Last week, the WRHA announced preliminary results after the closure of the Misericordia Urgent Care Centre and the Victoria emergency department's conversion to urgent care. That is what prompted the nurse to reach out to the CBC.

"It angers me, and it's because they're so misleading. It's not how they say it is," she said.

"They're putting patients more at risk with the changes. They're putting their staff at risk for mistakes. … it's a lie, as far as I'm concerned."

She says she would like to see a consistent increase to staffing ratios, especially during this time of transition, and greater support for staff who are dealing with stress. 

O'Rourke says it's a "time of change and it is in many cases people getting used to the change and to the feeling of greater acuity."

If nurses are feeling unsafe or are concerned for their patients, she encourages them to speak up to their manager or their manager's manager, or even herself "immediately."

Union rep to meet with nurses Thursday

Mowat says she's aware of the staffing concerns at the clinical teaching medical unit, and a local president who is meeting with nurses there on Thursday will bring the concerns to hospital administration. 

Mowat says one of the primary things that needs to happen is proactively adjusting staffing levels before the unit gets crowded. 

"The staffing needs to be adjusted consistently and not just when the nurses say, 'We still have 34 patients but we're busier today so send us extra help.' At this point in time, they should be staffing appropriately for 34 patients," she said.

O'Rourke says she's proud of how the Grace staff has handled the changes so far, and will personally speak with any staff member who has concerns about patient safety, something Mowat encourages.

"Please listen to the nurses," Mowat said. "If they're telling you that they have concerns, then we want to make sure that we're being listened to and our actual concerns are being listened to in a meaningful way."