As emergency department staffing shortages and overcapacity issues continue to burden Nova Scotia hospitals, the province’s deputy minister of health said change is needed and addressing it is a priority.
“The reality we face in Nova Scotia and across our country is that our emergency departments are facing more demand than ever before. It’s not as simple as adding more staff to existing emergency departments,” Jeannine Lagassé told the legislature’s public accounts committee on Wednesday.
“Our health care system is complex and interconnected. Easing the pressures that emergency departments across the province requires changes in several areas.”
The committee’s agenda focused on the impact of government expenses on emergency department understaffing.
Lagassé told committee members she’s “very aware” that “much more” needs to be done to create a health care system Nova Scotians “need and deserve.”
‘Time for change is now’
“We are learning from our challenges to create opportunities, to do things differently, to offer better care,” Lagassé said. “The way we have always done things is not working. The time for change is now.”
Noting that emergency departments “need to be there” for people during emergencies, Lagassé outlined a number of initiatives and changes she said will ease the pressures currently facing the system.
Those include mobile primary health care units, a temporary after-hours post-triage unit for patients who show up at an emergency department needing non-emergency care, and a program that allows paramedics to treat low acuity patients on scene without a hospital transport.
“And most of all, it means training, recruiting, and retaining health care staff,” she said. “These are simple things to say but they require a huge lift from the entire health care system.”
‘Budgets have not been a limiting factor’
Eileen MacGibbon, vice president of operations for Nova Scotia Health’s (NSH) Central Zone, also addressed the committee. She said staffing and ensuring physician coverage for emergency departments is a priority.
“I want to assure you that budgets have not been a limiting factor. We have the funds available to fill vacancies and ensure shifts are fully staffed. It’s the actual human resources that have been scarce,” MacGibbon said.
“At times, it’s necessary to use nurses and other staff from external staffing agencies either to fill gaps or to ensure our own staff are able to take a much needed vacation. This comes at a cost, but we believe it is the right thing to do to be able to offer care when other alternatives have been exhausted.”
MacGibbon said overcrowding in emergency departments often boils down to an inability to admit patients to beds in the hospital. She said the issue is being addressed at local and system levels.
“Our system is in a period of transition. And like other parts of Canada, there are strains that are affecting our staff, doctors, and patients,” MacGibbon said.
“However, we believe the actions we have in motion are creating the foundation for a reliable and sustainable emergency care system in Nova Scotia.”
Work-life balance
The issue of spending $18.4 million to hire travel nurses (also called agency nurses) to fill long-term care vacancies was brought up by NDP MLA Susan Leblanc.
Leblanc pointed to a CBC story about the practice published last week. She asked if the province was also hiring travel nurses for hospitals, and in particular to fill emergency medicine vacancies.
Bethany McCormick, vice-president of operations for the Northern Zone, said they do hire travel nurses or agency staff when all available internal options have been exhausted.
“It does come at a cost, of course. We do use them in the emergency department as well as in other areas of our hospitals and services as needed,” McCormick said.
“We did spend in 2022-23, year to date, $11.4 million on travel nursing.”
Leblanc pressed McCormick about agencies from other provinces actively advertising and recruiting emergency department nurses from Nova Scotia.
“These nurses would be able to make nearly triple their wages by switching to agency work with the added benefits of greater flexibility and autonomy,” Leblanc said.
She also asked how NSH was remaining competitive to keep nurses in the province.
“We are looking at a number of factors within Nova Scotia Health, such as scheduling, flexibility, flexibility around FTE. So, whether somebody perhaps wants to work 80% of the time instead of 100% of the time to increase their work life balance,” McCormick said.
“We’re also working very hard to ensure that we can allow people to have their scheduled and planned breaks and vacations as requested. Those are some of the factors that we know really impact a nurse or health care provider’s ability to have that work-life balance.”
Lagassé also weighed in on the issue of nurse retention. She said her department is open to “new ways of doing things,” stressing that wages were just one aspect.
“We think that there are a number of other things outside of collective bargaining that we may be able to do as well,” Lagassé said.
‘We’re all concerned’
Both NDP and Liberal committee members expressed disappointment that answers weren’t immediately available for several questions they asked of those who appeared before the committee.
Liberal MLA Brendan Maguire said while he wasn’t blaming anyone in the room, he found it “troubling” that he couldn’t get answers to the first six questions he asked.
“These are very simple questions that I would argue that individuals in senior management positions within the Department of Health and the Nova Scotia Health Authority should be able to answer,” Maguire said.
“I think there’s an issue when we can’t get a definitive answer in this committee on things like emergency room closures, access to emergency rooms, IWK, things like that.”
Leblanc agreed, echoing Maguire’s disappointment about not being able to get the “short snapper” answers.
During a media conference last week, the IWK Health Centre’s chief and chair of pediatrics, Dr. Andrew Lynk, and Chief Medical Officer of Health Dr. Robert Strang addressed the crushing impact an early flu season and increase in cases of respiratory syncytial virus (RSV) was having on hospitals.
Maguire asked those who appeared before the committee about their level of confidence in the system’s ability to accommodate greater numbers of emergency department patients as the province enters peak flu season.
“We’re all concerned. I think across the system we’re concerned, because we’re seeing unprecedented levels…with respect to demands on the system,” McGibbon replied.
“I will say that the IWK…and Nova Scotia Health have been extremely successful with recent clinics we’ve done to be responsive.”
Apparently “budgets have not been a limiting factor,” and yet “it’s the actual human resources that have been scarce.” Have they tried offering higher pay to doctors and nurses? To compete with agencies and other jurisdictions, and make the job more appealing in a province with massive rent increases? No mention of that – instead, the carrot is apparently the chance to work fewer hours, likely with an accompanying cut in pay. The government seems willing to do anything to improve healthcare except restore the funding cut after austerity budgets – a quick and simple fix. And yes, things are interconnected, but fund LTC care properly, and more beds will become available. Fund new doctors appropriately (and give them a place to live that offers amenities for residents and not just tourists) and fewer people will go to emergency. The typical Conservative response of “we can’t just throw money at a problem” demands the questions “why not?” and “have you tried that?”
How is it possible to mention a backed up ED due to lack of beds without mentioning the 20 – 30% of beds occupied by people waiting for LTC placement?