Our team at the hospital hears and understands your frustrations with the ongoing emergency department closures. We know it’s frustrating. We know that’s scary. We know that is not an acceptable way to continue.
What you may not know are the realities of why this is happening and everything we are doing to try to fix this issue. Some background information.
Our hospital is made up of three types of people in direct patient care:
– Registered nurses (RN). They are what most people think of when they think “nurse”. These are the people who have the training and skills to assess and triage patients, administer medications, and perform certain critical care skills. There are certain treatments and medications they are allowed to give before receiving doctor’s orders within their scope of practice. These are the nurses who work in our emergency room, but not all RNs are trained/certified to work in the emergency room. According to College regulations and for safety reasons, RNs who do not have the training cannot occupy the emergency room.
– Licensed Practical Nurses (LPNs). These nurses are an often under-recognized part of health care. They are nurses whose scope is not as wide as a registered nurse, but they provide most of the day-to-day care of inpatients in our hospital. They do not have certification to provide IV medications and initiate critical care interventions. They often help in our ER, but are not trained or licensed (by College regulations) to be the only nurse in the ER.
– Doctors (doctors). They are people trained in the diagnosis and treatment of multiple medical problems. The physicians in our emergency room are family physicians who have undergone additional education and training to be able to provide emergency care outside of a tertiary care facility (eg Royal Inland Hospital ). Some of our attending physicians have also undergone extensive training to work at any level of emergencies. They work closely with RNs and LPNs to provide patient care.
During a day with all the necessary staff, our hospital is served by: one LPN per shift, one day shift, one night shift; three RNs, one day shift, one night shift and one on the emergency shift from 9 a.m. to 9 p.m.; a doctor, on call 24 hours a day from 8 to 8 a.m. and 48 hours from Saturday 8 a.m. to Monday 8 a.m. on weekends; and our locum physicians, who come to cover emergency work from Friday 6:00 p.m. to Monday 8:00 a.m.
If you look at these shifts, that means that in any given week there are 14 LPN shifts, 21 RN shifts, and six physician shifts. RNs and LPNs typically work four days in a row per shift (four 12-hour shifts = 48 hours per week). Our doctors work in the clinic when they are not working in the hospital.
This means that, at a minimum, you need six RNs and four LPNs to staff the hospital for a week. Our hospital is designated for eight RNs and four LPNs. Currently we have four RNs and four RPNs.
We have positions for up to seven additional RNs (full-time, part-time, or casual) and two LPNs.
Please be clear on this point above: we have four AIs. We’re supposed to have eight. We are operating at half capacity for AI. The emergency cannot be opened without a nurse trained in emergency medicine care.
Our registered nurses also have duties in the acute care department. A nurse trained in emergencies cannot be replaced by any other health professional. Physicians, LPNs, orderlies, paramedics, and RNs not trained in emergencies lack the skills and knowledge to safely care for patients. You could put as many of these other practitioners in the ER, but that’s not enough.
So why the nursing shortages? It’s a complex answer. To be clear first: Dr. Helmcken Hospital has not lost any nurses – RNs or RPNs – due to the vaccination mandate. The pandemic has played a certain role. It was tiring and exhausting. We had to learn about a whole new disease entity, its presentation, its treatments and how to protect ourselves and you as much as possible.
Medical professionals would be sleeping in their trailers and guest rooms rather than exposing their families to possible COVID infection. Patients were often frightened or angry and it was the job of our nurses to care for you, reassure you and educate you, while providing you with the medical care you needed.
Our hospital is busier than ever. Before the pandemic, a busy weekday in the emergency room would see between two and eight patients. Now we regularly see 12 to 18 patients a day. Some of these visits are straightforward, but many of them involve complex medical issues and very ill patients.
Many people have less patience and compassion for our staff when they are in the emergency room – they waited longer in the emergency room, they couldn’t get a timely visit to the health center because we didn’t than half of our physician workforce, they are injured, tired and sick. The nurse then becomes the person who experiences these frustrations the most because they are the ones who are there when people feel the worst.
None of this takes into account the personal life factors that influence a person’s decision to stay in nursing.
So what is our local health care team doing to address this issue, to try to prevent hospital and ER closures? Again, we posted several positions: RNs, LPNs and physicians. There are hiring bonuses to try to encourage people to come to Clearwater. Unfortunately, these shortages extend far beyond Clearwater and we are not the only community struggling to recruit available healthcare workers.
We have not given up on that. We continue to work hard to fill vacancies. We are expanding the training and skills of our LPNs where possible to help fill other gaps in care. They will not be able to be the nurse who covers emergencies, but they can offload other duties.
We are withdrawing nurses from other regions, temporarily sacrificing other services to keep the emergency room open. We have locum agency nurses who come in to help when they are available. We have pulled nurses from other Interior Health facilities to keep our emergency room open. In the meantime, our local RNs and LPNs are going above and beyond to keep our hospital open. We are lucky that all of our current RNs are trained in emergencies and can cover emergencies while on duty.
RNs and LPNs extend their shift hours until the next shift can make it happen. Our nursing managers are taken off duty to work on the floor or in the emergency room. Nurses are working overtime, knowing that if they don’t, the emergency room will be closed.
They return from a vacation they booked a year in advance to cover shifts. They lack time with their families to ensure that our community receives continued health care. Each time we close the ER, we have gone through every possible step, tried to adjust the current schedule, and called each of our nurses to see if they could come and help us.
Unfortunately, until we have gone through all possible steps and contingencies, we are not authorized to officially close ERs and therefore are not authorized to provide notice of closure. It also frustrates us and we know it frustrates our community.
So please remember this when we have no choice but to close the ER. We have done everything to avoid this. We are operating at half our RN staff. Without an ER-trained nurse, we cannot safely open the ER. A doctor does not have the training and skills of an emergency-trained nurse. An LPN lacks the training and skills that an ER trained RN has. Without a trained emergency nurse, it would be negligent and dangerous to pretend that we can give you the care you need.
We are actively recruiting to fill our vacancies. We are human too and the state of health care breaks our hearts.
Dr. Perdue and
the Dr Helmcken Hospital team
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news@starjournal.net
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