Seven Oaks nurses sound alarm over staffing levels, patient safety in letter to health minister

Ahead of the planned closure of the emergency room at Seven Oaks, 15nurses at the Winnipeg hospital are sounding the alarm over what they say are unsafe conditionsin newly created units that are dealing with patients with higher needs than ever before.

The nurses signed a strongly worded letter to Health Minister Cameron Friesen dated May 22, 2019, highlighting their concerns about patient safety in light of changes made tounits at the hospital lastfall.

Those included the closure, and then conversion, of two geriatric psychiatric units and a surgical unit to three "subacute" units forpatients with a variety of medical needs, and extra "over-capacity" beds on a new medical unit.

"If they label [the unit] as subacute, then it has less staff,"said Darlene Jackson, president of the Manitoba Nurses Union.

"But when I talk to those nurses, the patients are not any less sick than what they would be on an acute medical [unit]. And that is very worrying for those nurses, to be expected to provide safe quality patient care with those nurse-to-patient ratios."

The changes come ahead of the planned conversion of the emergency department at Seven Oaks into an urgent care centre, planned for this fall as part of the Progressive Conservative government's overhaul of health care in Manitoba.

"Being the first subacute units at Seven Oaks Hospital, we are the model for this new system," says the letter,signed by a combination of licensed practical nurses and registered nurses at Seven Oaks.

"We are receiving unsafe transfers from other hospitals and direct admissions from Seven Oaks emergency department. The patients we are admitting are acute and not appropriate admissions to these specific departments," they say.

The nurses argue they are not equipped to handle patients with acute needs"due to high patient-to-nurse ratios, less staff and other patients with complex issues (behavioural and violent)."

And even when patients do need acute care, "we are forced to provide care in the subacute setting due to the lack of medicine beds and busy emergency and ICU departments that cannot take an influx of extra patients," the letter says.

While the newer units at Seven Oaks are designated"subacute," the nurses saythe patients they're treatingoften require acute care, with diagnoses like congestive heart failure, sepsis and unstable angina.

"When you see the words 'unstable angina,' the word 'unstable' should give you a really good idea that they're not fit for a subacute bed. That's an acute patient," saidJackson.

The Winnipeg Regional Health Authoritystill needs to delineate what the term "subacute" means, she said.

"Sepsis means that the patient has a fairly large infection going on that needs aggressive treatment. These are medical problems that I would think need to go to an acute medical bed. But there are no beds," she said.

"Every facility in this city is bursting at the seams. That's how we ended up in the mess at Seven Oaks."

Jackson said for at least one of the units referred in the letter, one nurse and one health care aide oversee the care of 10 patients. The letter says Seven Oaks opened extra beds on a medicine unit "without the support of regular hospital staff."

"These situations are very dangerous for patients and raise several safety issues,"the nurses' letter says.

They've been raising patient safety concerns withmanagement for months, since the units were opened to reduce pressure on the Health Sciences Centre, Grace and St. Boniface hospitals as they convert to tertiary care, said Jackson.

Meeting with nurses

"We're interested in what the nurses have to say who have raised these concerns at Seven Oaks Hospital," Friesensaid following question period in the Manitoba Legislature Tuesday.

The health minister said upon hearing the concerns from nurses, he immediately instructedthe Winnipeg Regional Health Authority'schief operating officer and the chief nursing officer of Seven Oaks Hospitalto meet with the letter's authors about their concerns.

That meeting was held Tuesday.

"I would want to make clear, though, that there has been no formal transition to a subacute and acute structure of beds. We definitely are moving in the direction of trying to delineate the level of acuity of beds that we would be having in hospital," Friesen said.

"It makes sense from an efficiencies point of view. It makes sense from a human resources point of view."

But he acknowledged that work is underway to define the term "subacute," and what it will mean for the units that admit patients with that designation.

Jackson said that should have happened before the new units opened.

A spokesperson for the health authority said the "low-acuity" units, which are synonymous with "subacute,"are intended to provide care to patients with stable vitals and low or stable oxygen requirements.

"We continue to meet with staff to hear their concerns and to ensure all personnel have a shared understanding of established protocols for low-acuity patients,"the spokesperson wrote, addingprotocols to admit these patients at Seven Oaks are the same as those Victoria General Hospital has used since 2017.

Jackson applauds the nurses who brought their concerns to the health minister in the name of patient safety.

"There is a price to be paid for standing up for their patients, there is a risk there. They're very brave for standing up because it is scary when you actually come out and say, 'This is not right.'"