Stretching critical-care nurses to care for multiple COVID-19 patients at once doesn't work, nurses say

Critical-care nurses assigned to the sickest COVID-19 patients at Winnipeg's Health Sciences Centre say patient care is suffering because one-to-one care is no longer possible.

The traditional ratio is one critical care nurse for each patient who is unstable, sometimes multiple nurses if necessary, said a signed letter from 60-plus critical-care nurses demanding the province reconsider its approach.

But with COVID-19 hospitalizations mounting, in November the province started stretched nurses into taking care of multiple patients at once.

Under the new team-based approach — quarterbacked by a nurse, with support ranging from respiratory therapists to physiotherapists — the ratio is "significantly diluted" to one-to-two or one-to-three at HSC's medical intensive care unit, the letter alleged.

"These patients require constant monitoring which we are unable to do," said the letter, which was presented Monday by the Manitoba NDP. 

The memo went on to say that critical-care nurses asking to work additional shifts to lessen the load on their colleagues are being denied if the current two-nurse allotment is filled.

This new arrangement also includes a "nurse extender" — another health-care professional — to help. The letter said these staff members, while appreciated, have little or no critical-care training.

"We fear this new pod model is being implemented not only to stretch capacity temporarily, but also reduce nurse-to-patient ratios permanently as a cost-saving endeavour," the letter said.

'Patients will almost surely die'

The Dec. 18 letter follows some emails from nurses, which alleged to upper management that "patients will almost surely die in this environment" and "patients are already suffering from neglect." The emails were publicized last week by the NDP.

Uzoma Asagwara, the party's health critic, said working conditions have deteriorated to the point where these nurses are filing workload staffing report forms and occurrence reports on every shift, as the letter indicates.

That decision shouldn't be taken lightly, they said at a news conference Monday.

"This is the nurses letting us know that on every single shift there are enough concerns, there are enough issues that are taking place that they're actually making occurrence reports on those matters," Asagwara said.

"That's their way of indicating very clearly to management, to administration and to people in general that what is happening at the unit level is not sustainable and it's not safe."

Shared Health chief nursing officer Lanette Siragusa said she wasn't aware at Monday's press briefing of the nurses' complaints.

The critical-care teams meet daily to discuss challenges and opportunities to do better, she said.

"We have … based it on what other jurisdictions have done, and it is absolutely not our intention to put any professional or patient in an unsafe situation," she said.

In a statement, Shared Health said the creation of teams of staff will ensure patients receive support during a period of unprecedented strain on the health-care system. The move will not be permanent. 

Manitoba Nurses Union' president Darlene Jackson said the critical-care nurses are bothered that consulting firm KPMG was enlisted to expand hospital capacity. 

"Every time a consultant is involved, we seem to go into an area where it's more of a cost-saving and it's more of a way to ensure that care is provided in the least expensive way," she said.

KPMG was previously hired to find efficiencies in Manitoba's health-care system.