Fredericton ER doctor recounts weekend shift with only 2 nurses on staff

On Saturday night, an emergency room doctor in Fredericton told people waiting that most of them would likely have to wait until morning to be seen.

"The reality is if you're not critically ill, you're probably not going to get seen tonight," Dr. Yogi Sehgal recalled telling the patients at the Dr. Everett Chalmers Regional Hospital in Fredericton.

"Even though you have an emergency, you're probably going to be served better by driving an hour away to a different facility if they can see you tonight."

On Saturday, Horizon Health Network sent out a news release saying the Chalmers hospital would be operating at reduced capacity from 7:30 p.m. Saturday until 7:30 a.m. Sunday, due to an "unexpected shortage of available staff."

The health network said the emergency room would remain open for people with "medical emergencies."

Sehgal said while there are supposed to be at least five nurses on duty, there were just two on Saturday night.

He said the emergency room is short-staffed "all the time," and this is not a new problem.

"We literally had, I think, one person scheduled for the night at one point in time, plus a new grad," he said.

He said it was difficult to have to tell the people in the waiting room they probably wouldn't be seen for a long time.

"There were people who had belly pain that could have been appendicitis. There were people with, you know, potentially broken bones,"  Sehgal said.

Horizon says medical emergencies that warrant an ER visit include discomfort or tightness in the chest, unusual shortness of breath, abdominal pain, prolonged and persistent headache or dizziness, an injury that may require stitches or involve a broken bone, a child with prolonged diarrhea or vomiting and a baby under six months of age with a fever of 38 C or higher.

Sehgal said no one was turned away from the emergency room as far as he knows.

'Moral injury' when a patient doesn't get timely help

It's not the lack of staffing, or the increased chance of making a fatal mistake, or being underpaid and overworked that's the biggest challenge for health-care workers right now, he said.

It's the fact that because of these factors, nurses, clerks and doctors have to turn people away, or watch them wait in pain, when they know those patients deserve to be seen.

It's against the nature of health-care workers, and it's culminating in a mass nurse exodus and an outbreak of burnout, Sehgal said.

"It's that moral injury of knowing that, man, I could help you if I had the resources to do so, but I don't," he said.

"We just do the job that's in front of us."

And the nurses who do step up to work those difficult shifts take on more risk, not just in their personal health, Sehgal said, but in their professional life as well.

"If you are the one of those two nurses that are left looking after all these patients, who's going to get in trouble if something happens? It's going to be one of them … even though they're in a situation that's impossible," he said.

"I think more and more nurses are feeling that stress and that pressure."

He says that stress will likely take a toll on the quality of service for all health-care workers, not just nurses.

"I guarantee you, we've all made mistakes in the last year or two because of this, there's no question," Sehgal said. "When you're under-resourced, and you're trying to do everything at once, you're going to make a mistake. We're human beings."

Compensation does not match sacrifices

The province has been working on implementing its health plan titled Stabilizing Health Care: An Urgent Call to Action. In the past month it's made multiple announcements about agreements with universities to increase the number of nursing seats.

The plan says the current shortage of nurses existed before the pandemic, but was made worse by COVID-19. It says more than 32 per cent of registered nurses are over the age of 55, and with seven per cent over the age of 65.

The plan has few details on how else the province plans address a growing shortage of doctors, nurses and other health-care professionals.

Sehgal said more difficult and more stressful work is not worth it when it doesn't come with adequate compensation.

Nurses leave because they're underpaid and overworked, staffing shortages create more stress, which causes more nurses to leave. Sehgal said this cycle is getting more vicious, and there are things that can be done right now to address it.

For example, just pay nurses more, and pay them more for the experience they have, he said. 

He said he had no idea that nurses with emergency room training who have to work in this hectic environment get paid the same as others. So there's no incentive to work in emergency rooms, and in fact, there's a disincentive because of how stressful and unmanageable it can be.

"That just seems completely counterintuitive, but that that's the way the system is right now," he said.

In January of this year, the province offered signing bonuses, extra wages and expenses to nurses who sign up for a program where they're required to travel to any health-care facility in the province to work in an intensive care unit, critical care unit or emergency department.

Sehgal said it's common for people to get called in on their days off, or when they're not scheduled, and the only reason Saturday's staffing shortage doesn't happen more often is because people say yes.

"It's a continuous battle," he said. "[The last] two years particularly have gotten much worse for physicians. But from the nursing point of view, it has gotten, you know, they use the word 'untenable.'"