24-hour shifts, staffing issues plague pediatric ICU at Janeway Hospital

There have been six 24-hour shifts at Newfoundland and Labrador's pediatric intensive-care unit in the past month, the same unit that has been under diversion to Halifax since last weekend, according to Eastern Health.

The diversion protocol is the latest in a string of issues that have been going on for years in the PICU, says Yvette Coffey, president of the Registered Nurses' Union of Newfoundland and Labrador.

In an interview with CBC News, Coffey said the 24-hour shifts should never have happened.

"When you are working a 24-hour shift, your head is not in the game as it would be if you were working your regular shifts of eight hours or 12 hours," she said.

"When our members are tired, when they're mentally exhausted, that equates to risks for the patients and risks for our members."

In a statementThursday, an Eastern Health spokesperson said the diversion protocol was still in place. The spokesperson said the PICU has four beds occupiedand a core staff of 16.6 full-time positions.

According to Eastern Health, the unit can accommodate two extra patients if required, but Coffey said it's a challenge to care for more than two patients at a time given current staffing levels.

"Our members are being mandated to stay extra long at their workplaces and being mandated to do overtime and extra shifts here, irregardless of their own home life situation," Coffey said

Speaking with reporters Thursday, Health Minister John Haggie said the diversion protocol is reviewed at least once a day, and no patients have been diverted to Halifax yet.

"As soon as the occupancy drops to what the clinicians decide is at an appropriate level to match the resources than the capacity they've got, then they'll lift it," he said.

Haggie said the department would like to avoid 24-hourshifts if possible, but he's grateful to those who have worked them. He said Eastern Health is training new staff for the PICU, although he doesn't know when the staff will be ready.

Staffing the PICU can be more difficult because it requires staff with specialized skill sets in critical and pediatric care.

Coffey said a committee was established in 2019 to look at staffing levels in the unit and possibly establish a "float team" of specialized nursing staff, but the team didn't come to fruition.

"We are still experiencing the same challenges here in 2021 that we were experiencing back in 2019 when we had the last diversion," she said.

Beyondthe PICU

Coffey said staffing in the Janeway emergency department is in a similarly dire situation.

She said staff members have worked 36 16-hour shifts since August. Additionally, she said some staff members have worked six 12-hour days in a row, mandated over time, and multiple 24-hour shifts.

She said more than 80 shifts remain uncovered in the current six-week schedule, meaning staff will have to pick them up in overtime in order to provide coverage.

CBC has asked Eastern Health for comment on staffing in the Janeway emergency room.

Coffey said the staffing situations at the Janeway emergency room and pediatric intensive-care units are emblematic of nursing shortages across the province.

"There's not enough staff. There's endless overtime, mandated overtime, missing time with their loved ones and families," she said.

Coffey said the union was pleased to hear about new initiatives announced by the Health Department last week, including a new office for health-care worker recruitment and retention, and a new provincial health-care human resources strategy.

However, she said, members of the union need to see a tangible difference in their workplaces. She said the physical and mental well-being of staffalso impacts patient outcomes.

"If we don't fix that, that equates to issues for patients in our province," she said. "We need our people to be rested to be mentally prepared when they're going into work."

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