Sask. nurses detail 'chaos and crisis' at one of province's busiest hospitals

A nurse working in the emergency room of one of Saskatchewan's largest hospitals says she is "praying" nothing tragic happens as staff and resources are stretched to the limits.

"There are 90-year-olds walking out that have paid taxes, and they deserve to be in rooms, and you just can't provide care for them and there are kids [too]," said the nurse, who in one instance says she witnessed a 90-year-old with chest pain leaving without care.

CTV News has agreed to protect the identity of the nurse and withhold the name of the hospital where she is employed because she fears professional reprisal for speaking out.

The long-time ER nurse said when she first started working, a waiting room filled with 20 patients was a "busy day."

"Now we're sitting at 40 to 50 patients in the waiting room and 100 people in the department," she said.

"So there are triage nurses taking care of 50 patients sometimes and these people are sick, they have abdominal pain, they may not need a cardiac monitor, they're not quite sick enough to be in a room immediately, but you can only do so much from the desk," she said.

"So you're just kind of praying that nothing happens … it's really a big guessing game. You use your experience, but it's just a horrible situation to be in. You feel really crappy at the end of the day," she said.

Psychiatric patients can spend days locked in a hospital room waiting for the appropriate care and support, another nurse who works at the hospital who spoke to CTV News said.

CTV News is also protecting her identity.

"So you can imagine you're coming in with severe depression, suicidal ideation, psychotic symptoms," the nurse said.

"We just lock you in a room — if you're lucky, for four days — I cannot think of anything more detrimental to someone's mental health than that," she said.

The nurse told CTV News she now avoids ER shifts, although she is an experienced emergency nurse.

"I love the work and I love that way of helping people. I'm literally scared [of losing my nursing] license every time I go down there because you can be the best, most attentive, caring, nurse in the world and it's just a numbers game. Eventually, there's going to be a critical incident," she said.

"Like a diagnostic being missed or people not being properly monitored for medications or for whatever their symptoms are. People just having to wait so long that it is actually causing harm to them," she said.

"For example, if you have someone with stroke symptoms and then you have a trauma coming in, you have someone whose heart stopped — and this happens all the time — they all come in at the same time. You only have so many bodies to help those people," she said.

"That's not how it should be if you had full staff and the space to put people," the nurse said.

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She said verbal abuse and physical violence are so commonplace that only the most extreme scenarios warrant a call to security — something that is becoming more common.

"In emerg, you're already used to dealing with violence all the time. So if you're calling a 'code white,' it means someone is literally being attacked, tearing apart a room. You need six security guards," she said

She estimates "code whites" are called a couple of times a shift now.

A third nurse CTV News spoke with on the condition of anonymity, who also is employed at the same hospital, said she and others are bearing witness to "chaos and crisis" each day they report to work.

"We've seen a number of nurses either leave the profession or leave their position," she said.

At their heart, she said the issues stem from a staffing crunch. However, the nurse said she is not confident that the Saskatchewan government's current recruitment push will ease the pressure.

"They're spending hundreds of thousands of dollars going overseas to recruit nurses that really don't have the skill set or the knowledge base that our own nursing students that we graduate in [our] own province have," she said.

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The nurse, who has nearly 20 years of experience, said the work of getting the last large cohort of internationally-trained nurses up to speed largely fell on the shoulders of their fellow RNs.

"Twelve years ago or so, we had the first batch of Filipino nurses come through and I was in ICU at that point. It took a lot — like I'm talking months — if not years. The program over there is completely different than our nursing program here," she said.

It's worth noting internationally educated nurses, even those scooped up in large-scale government recruitment efforts, are required to complete bridging education and other licensing steps to ensure they are qualified to work in the province's health care system.

However, the nurse believes the province would be better served — and would potentially save money — by focusing more on recruiting Saskatchewan's nursing graduates, already familiar with the province's healthcare system.

She also said while the current stopgap measure of bringing in highly-paid travel nurses  from other provinces may appear to be filling a need on paper, the reality is quite different depending on the experience of the nurse.

"They're just kind of a body that fills with space. Yes, they're an RN and they're trained, but they don't have these additional skills and practices that we have, they have a smaller scope of practice, basically," she said.

"So we end up taking the sicker patients … they get a less acute assignment, generally every shift because they can't properly care for those people and it ends up being a higher workload on us as well as substandard care," she said.

"[The travel nurses] don't pay taxes to Saskatchewan. They come in here and work for six weeks. They're also guaranteed more hours than a regular full-time employee."

At the same time, she said she's provided letters of reference for Saskatchewan nursing graduates seeking work in other jurisdictions as travel nurses because they've been unable to find full-time jobs.

"I know fourth-year nursing students that are graduating this spring, have not had a single reach-out from the [health authority] whatsoever. If they tried to get a job, all they were offered is casual employment," she said.

"The government could say, you know, we're gonna hire 100 new grads and give them a $5,000 signing bonus," she said.

The nurse told CTV News she and her colleagues are hesitant to publicly offer solutions they think might improve health care in Saskatchewan or to speak about the conditions they are facing.

"It's like we've got a gag order. We're cautioned, nobody can speak out," she said.

"Yes, we're nurses, but we are taxpayers. We have family," she said.

"We have a right to an opinion of how our healthcare system is delivered. We elect these officials every four years into government and I don't understand how it's turned around that I work for them and that I need to abide. It's so backward."

When asked about its approach to hiring recent nursing graduates, the Saskatchewan Health Authority said "recruitment work is continuously underway to personally connect with students."

In an emailed statement, the SHA outlined steps it takes to recruit nursing students such as clinical placements, "targeted messaging" and "connecting personally with students."

It said 114 nursing graduates have been hired from both within and outside Saskatchewan since Dec. 1.

Graduate nurse licensing allows nurses to begin working prior to passing the National Council Licensure Examination (NCLEX) — which is the final step before full RN licensing.

However, there is no firm number available to know how many of the province's nursing graduates are finding jobs in the province.

The Saskatchewan government relies on a voluntary survey that occurs once every five years, which seeks to capture responses from post-secondary graduates, two years after they finish their studies.

While the most recent edition of the survey shows 89 per cent of responding RN grads found jobs, an emailed statement from the province said the results do not "represent specific outcomes for every graduate" due to the survey's optional nature.

The University of Saskatchewan (U of S) and the University of Regina (U of R) also rely on voluntary surveys to loosely gauge graduate employment.

The executive director of the College of Registered Nurses of Saskatchewan (CRNS) said the regulatory body has information on how many grad nurses are licensed in the province and statistics related to NCLEX attempts, but it also doesn't know how many of Saskatchewan's grads end up working full-time in the province.

"The issue is better data is needed and the health workforce data is not standardized," Cindy Smith said.

She said the gaps in health workforce data are an issue across Canada.

"Employers have a bit of information, schools have a bit of information, we have a bit — as regulators — a more coordinated approach would be better," Smith said.

Smith said the CRNS and other regulators are working toward a pan-Canadian unique identifier for RNs that would make it easier to keep track of labour trends.

The nurse who told CTV News she was concerned about the province's retention of new grads said Saskatchewan's former health authorities used to be more proactive in their approach to recruiting new grads.

"There may be somebody from human resources that does a small thing, but back in the day, the managers from different units used to actually come to the colleges and talk to people and get them interested and then sign them on," she said.

"We used to have a mentorship program that if you are a brand new grad, you would get a three-month mentorship with a senior nurse in an area which then allowed you that ability and flexibility to then obtain employment on that unit," the nurse said.

She said she and other nurses are interested in helping to solve the problem and have offered on numerous occasions to assist with recruitment by volunteering to meet with students.

She said the health authority has yet to take them up on the offer.

"You know, it's not rocket science," she said.