Union calls Halifax hospital emergency department "revolving door" of staff

HALIFAX — As pressure continues to mount on hospital emergency rooms in Nova Scotia, staffing levels at a major Halifax emergency department are being described as a “revolving door” of junior and inexperienced employees by their union.

The characterization is contained in a letter sent last week by Nova Scotia Government and General Employees Union president Sandra Mullen to the CEO of Nova Scotia’s health authority Karen Oldfield.

Mullen said in the Jan. 9 letter that staff initially drawn to the department at the Halifax Infirmary by a $5,000 recruitment bonus quickly leave when they realize they could be risking their license because patient loads don’t allow them to meet their standards of practice.

“What they (staff) described to me is quite simply the complete unravelling of the major trauma centre for the Atlantic provinces,” wrote Mullen. “What used to be a highly sought-after and respected area to work is now a revolving door of junior, inexperienced staff.”

She said staff are “desperate” for changes within the department and she forwarded a list of 59 suggestions to address areas including ER staffing levels, recruitment and retention, security and morale.

But Mullen stressed the most pressing issue is the retention of experienced workers.

She said failure to offer further financial incentives will see the continued loss of emergency department staff to other areas of the health system, including to so-called travel nursing where the pay is higher for contract nurses who shore up areas of the system experiencing staff shortages.

Mullen suggested the offering of a “stepped up” retention bonus as well as a “work short” hourly premium to experienced workers could entice some to come back to the emergency department.

“While money alone will not solve this problem altogether … Financial incentives may very well stop the hemorrhaging and allow the emergency department to get through this period of crisis so that other, longer-term solutions can be implemented,” she wrote.

In an interview Saturday, union vice-president Hugh Gillis described the working conditions at the emergency department as “very poor.”

“The health minister has indicated that they could hire 1,500 more nurses tomorrow,” said Gillis. “That tells you all you need to know. You can’t run hospitals or emergency departments without nurses.”

He said the union has been told the recent staff vacancy rate at the Halifax Infirmary emergency department has been about 30 per cent “on any given day.”

Among some of the union suggestions aimed at reversing that trend are the offering of incentives and signing bonuses to recruit new staff and retention bonuses for senior staff. The union also says there should be more opportunities for education and training, adding nurses are leaving because they are not being given the opportunity to move and work in the department's triage or trauma areas.

The union suggests three nurses should work in triage at all times along with a nurse practitioner in order to expedite patient flow through the ER. It points out that the nurse practitioner position has not been filled for the past two years.

The union also asks that managers with nursing backgrounds be used to help fill in during “periods of crisis” and that a public campaign be launched to inform the public on what types of illnesses or injuries are appropriate for emergency department care.

It added that a “culture of no breaks” also has to be changed in order to reduce errors and retain staff.

Gillis said the health authority had acknowledged the letter, but said it needed more time to respond to the union’s recommendations. The health authority did not immediately provide a response to The Canadian Press's request for comment on Saturday.

The union’s concerns come at a time when the head of emergency medicine for Halifax and the surrounding area says ERs are under the most extreme pressure he's seen in his 23-year career.

Dr. Kirk Magee said in an interview Friday that pressure on ER staff has resulted in stress and long-term exhaustion that have driven many to reduce their working hours or leave the profession. Magee called it a complex problem without any one solution that would make things better.

The situation at provincial ERs has attracted heavy public scrutiny since the recent deaths of 37-year-old Allison Holthoff following a seven-hour wait at the Cumberland Regional Health Centre emergency department on Dec. 31, and of 67-year-old Charlene Snow, who left the Cape Breton Regional Hospital on Dec. 30 after giving up on seeing a doctor about flu-like symptoms and jaw pain.

This report by The Canadian Press was first published Jan. 14, 2023.

Keith Doucette, The Canadian Press

Note to readers: This is a corrected story. A previous version had the wrong first name for the woman who died after leaving Cape Breton Regional Hospital.