I saw first-hand how the nursing shortage is squeezing smaller centres

As Ontario’s nursing shortage worsens and hospitals deal with temporary ward closures across the province, the impact on hospitals in smaller centres must be made a priority consideration.

Earlier this year, I completed a rotation in emergency medicine in Kincardine, a rural town in Bruce County, southwestern Ontario, as a medical student. The only hospital in town, South Bruce Health Centre, does not have a CT scanner. Most specialist services are not available within the hospital; family medicine-trained physicians staff the in-patient unit and emergency department.

During one overnight shift, the staff consisted of three nurse practitioners (NP), the staff physician and me. Each time a patient needed to be transported to another hospital for an investigation or specialist consult, one of our nursing staff would need to accompany the patient. After transferring an acutely unwell child to another hospital for admission and sending an older gentleman for a CT scan, we were down to our last nurse. That’s when a patient with a case of suspected acute cholecystitis came in, needing a transfer to a facility with a CT scanner. I remember watching the physician I was working with struggle to problem-solve in the face of this resource scarcity. With no nurse to accompany the patient, we were forced to wait for one to return – however long that might take.

All patients have the right to health and to receive the same standard of care as others across the country. The patient in our emergency department had a right to an urgent CT within hours of presenting, as in a larger city centre. Instead, the lack of nursing staff meant the patient had to wait longer than appropriate for care. The impact of this shortage is borne by all patients in the Canadian health-care system but rurally, there often is much lower reserve to handle the shortage.

“There is often one nurse practitioner per ER in a rural centre. Sometimes there’s just one registered nurse.”

Cathryn Hoy, the head of the Ontario Nursing Association (ONA), notes that “there is often one NP per ER in a rural centre, sometimes there’s just one RN (registered nurse).” The impact on rural hospitals can be acute. A few weeks ago, a remote First Nation community announced that it would not be providing routine care such as prenatal care and walk-in appointments as it was down to two primary-care nurses rather than its usual nine.

Hoy says that at the heart of the nursing shortage are concerns regarding remuneration, specifically relating to Bill 124, which she describes as a wage-suppression legislation. The bill limits increase in compensation for nurses to one per cent each year over a three-year period. The wage-capping has led to an exodus of nursing staff and has been a contentious issue in the last few months. “After the bill was introduced, young nurses left for the United States, older nurses retired early,” Hoy says.

In September, the ONA challenged Bill 124 in court, stating that it violates rights to freely negotiate. The outcome remains pending.

As the shortage worsens, hospitals have been putting significantly greater amounts of funding toward hiring nurses from private agencies. Hoy describes the use of private agency nurses as “abuse of the health-care system.” Increased reliance on temporary agencies can cost hospitals significantly larger amounts of money and raises questions about the trend of privatization in health care. Recently, the Ontario government proposed a plan to hire 225 additional nurse practitioners for long-term care. The ONA has argued that the initiative will take three years to implement and will be inadequate in addressing the needs of Ontario’s 627 long-term care homes.

Concerns regarding privatization of health care have come forth in recent months given Ontario’s recent statements. A plan put forth by the Ontario government outlines goals to bolster private clinics to reduce surgical wait times. The plan, along with Bill 7, proposes to transfer patients that are deemed to need “alternate levels of care” out of hospitals and into long-term care homes to transfer the burden of care away from hospital systems. Patients that decline being transferred to a long-term care facility, which may be up to 150 kilometres or further away, will be charged $400 per night for staying in the hospital.

Whether or not the Ontario government has underlying aims of pushing hospitals into further use of temporary agencies through mismanagement of the nursing shortage remains difficult to say. Nonetheless, as the nursing shortage worsens, we must remain cautious about privatization further creeping into the Canadian health-care system, especially given its potential effects on smaller and rural centres.