'You can't always count on us,' ER nurses say: Short-staffing having a 'trickle effect' on other hospital wards
Cowichan Valley Citizen  March 22, 2006 
If you're in Cowichan District Hospital's Emergency Department, Registered Nurses in the ER say you may not get your pain medicine delivered when you should. And if there's a bus accident, don't have a heart attack because chances are there won't be anyone to treat you.

"We want VIHA to staff us starting today," said RN spokesperson Tere Christoffersen. "We want five nurses in our emergency room and the Cowichan residents deserve that. They have the right to come here and get safe care and at this point we can't guarantee that it is safe."

Registered nurses from CDH Emergency launched a campaign Monday morning to get the word out to residents in the Cowichan Valley that they are chronically understaffed and patient care is being compromised.

"The Emergency room nurses feel very strongly that the public needs to know," said Christoffersen. "They need to know that you can't always count on us for emergencies because, although we try our best, at any given moment we may get another (emergency) incident."

For the past 20 months the nurses have been documenting incidents of compromised patient care, and last week released information that there have been 30 instances since January.

"We continue to document daily," said Christoffersen.

Nurses said they've been through the proper channels at the Vancouver Island Health Authority, which makes decisions on funding and staffing, but they haven't gotten a satisfactory resolution to their problems.

They said measures VIHA has agreed to are all for some indeterminate date in the future, which doesn't address the situation they're in now.

CDH Emergency is currently run with four nurses on duty at all times and a triage nurse on duty from 11 a.m. to 11 p.m.

However, it's not unusual for the ER to be running with just three nurses present, as they are sometimes called to cover other parts of the hospital where they're struggling with staff shortages, or travelling with patients being transferred to hospital in Victoria.

While VIHA recently increased the number of clerk hours the ER has and has offered a relief position that would cover sick days and vacations, co-spokesperson Karen Hill says it's not enough.

"Even though we're grateful for those initiatives that have been put in place, we still haven't had the problem addressed which is really nursing at the bedside and direct patient care, which is still compromised despite these initiatives," said Hill.

The ER is not the only part of the hospital feeling the effects of the ER nursing shortage, said Hill.

The lack of adequate personnel, she said, is having a "trickle effect" on other wards as well, as they feel the pressure to take patients from the ER.

"They're overtaxed just like we are," said Hill.

For the some 30,000 patients they see per year, Hill said they need at least one more nurse on 24 hours a day, seven days a week. That works out to about four-and-a-half more nursing positions.

She said it would also be a good move to increase support staff, such as having a triage nurse and respiratory therapist available 24/7.

Christoffersen said emergency departments are supposed to be staffed to a level where 40 per cent of those working are available to handle an emergency.

At CDH, they're working at capacity all the time, she said. "There is no way we can handle a disaster at this point."

She uses an example from late last year when four burn victims were taken to CDH after a fire destroyed an old warehouse in town.

"It taxed all our resources on those four people and there was no one left for the people coming in. So, if you would have had a heart attack, we would not have been able to help you," she said.

"You can't function as part of a disaster plan when you have an overflowing department," agreed Hill.

Hill said among the incidents of compromised care they've catalogued are such things as medications not being given in a timely manner, or missed altogether, and having patients remain on stretchers in the hallway, for several days in some cases, where they have no access to suctioning or a nurse call button.

"I don't think any cancer patient should be left alone waiting for their pain medication, which they so desperately need," said Christoffersen.