Nursing shortage at Yellowknife obstetrics unit leads to workplace complaint, appeal

The manager of approximately 90 nurses at Stanton Territorial Hospital is appealing a conduct committee's decision to restrict her from any leadership, managerial or supervisory nursing roles after the committee found she failed to adequately staff the obstetrics unit during two shifts last year. 

According to the decision, made in February, the lack of staffing "[caused] an unsafe work environment ... and a threat to public safety."

According to court documents, the obstetrics unit — which takes care of women in labour and new babies — was understaffed for a five-hour day shift on June 28, 2018 and a nearly 12-hour night shift starting on July 6, 2018.

Erin Vallillee, who was working the night shift on July 6, filed the complaint against her manager, Tracy Matesic.

Matesic is a registered nurse who has been working at Stanton hospital since 2003. She's been a manager since 2013, with her role including overseeing the obstetrics, pediatrics, operating room, recovery, surgical daycare and endoscopy units. 

In her complaint, Vallillee said Matesic didn't do enough to make sure there were nurses covering absenteeisms. 

Each obstetrics shift typically includes three registered nurses, two of which must have labour and delivery experience. The goal is to have one nurse available for each patient.

During the night shift on July 6, there was one nurse working in the obstetrics unit who was fully trained in labour and delivery, while one was still in training, and the other had some previous experience. 

According to the transcripts of a three-hour interview between Matesic and Jan Inman, director of the Professional Conduct Committee for the Registered Nurses Association of the Northwest Territories and Nunavut, Matesic states she called, emailed or texted every obstetrics nurse possibly available for that shift, but didn't have any luck filling the voids. 

But the analysis from the Professional Conduct Committee says Matesic "stated that she did not exhaust all options," noting that Matesic only notified the hospital's Patient Care Coordinator of the July 6 night shift shortage at 3:00 p.m. that day. 

Austin Marshall, Matesic's lawyer, says this is a "live issue" before the courts.

5 deliveries within 7 hours 

In a statement to Inman, Vallillee said the shift was "truly frightening."

She said there were five deliveries between 7:30 p.m. and 2:30 a.m. There were no complications during the deliveries, but Vallillee's statement indicated a constant need to monitor the labouring women, as well as give support to women who had delivered and needed things like breastfeeding help.

There was also an emergency that night in the psychiatric unit that required assistance from people who were helping cover obstetrics.

Vallillee said that as manager of the nurses in the obstetrics unit, Matesic had a duty to ensure the obstetrics unit was a safe environment, including potentially coming in to work the shift herself. However, it states she was "unresponsive" to phone calls advising her of the unsafe work environment, and "unrealistic in her proposed plans."

In a letter included in the court affidavit, Dr. Theresa Hansen, who was the labour and delivery doctor on call on July 6, 2018, said she was aware of the nurse shortage, but everyone handled the situation well because there were no complications with the deliveries.

Court documents also state that if a complication had arisen, the on-call doctor could have approved a labouring woman in stable condition be medevaced to Edmonton, while Yellowknife staff attended to the complication. 

However, the committee found that there was evidence to support the allegations against Matesic, leading Inman to write her a letter stating that limitations on Matesic's work — namely to avoid any leadership, managerial or supervisor nursing roles — will be posted on the public registry, and a notice will be sent to all Canadian nursing jurisdictions. 

The committee noted in their decision that the solution of medevacing a patient was "not in keeping with [the] commitment" put forth by the Truth and Reconciliation Commission's recommendations to keep a birthing person with their family.

Several conditions were placed on Matesic's return to her management and supervisory duties, including taking a course on reflective practice or nursing leadership, and submitting a detailed work plan and time management schedule for the committee to review.

Case in court Friday

Marshall, Matesic's lawyer, says new documents will be introduced to the judge on Friday, and the judge will decide if those documents can be entered into the appeal. 

Concerns about nurse staffing levels at Stanton have continued into 2019. 

Last month, one nurse, whom CBC agreed to keep anonymous, said she was genuinely concerned about patients' safety due to a nurse shortage in every unit at the hospital. 

A spokesperson for the Northwest Territories Health and Social Services Authority told CBC at the time that there was a 13 per cent vacancy rate in full-time-equivalent nursing positions at the hospital in June 2019.