'Devastating' effects of chronic staff shortages push Winnipeg ER doctor to consider quitting

A Winnipeg physician says his emergency department is reaching its breaking point and, for the first time, he's thought of quitting. 

"It's a hard thing and a devastating thing to feel when you stare back at your patient's eyes, feeling almost like you've failed them," Dr. Kristjan Thompson, an emergency room physician at St. Boniface Hospital and former president of Doctors Manitoba, said Tuesday.

He spoke in the wake of a Twitter thread on Monday, in which he wrote that many colleagues have left in the last few months due to unreasonable working conditions and significant burnout and moral distress.

He repeated those comments Tuesday, saying "every single physician that I work with at St. Boniface emerge tells me that this is the worst they've seen things.

"We're all spread thin right now."

Thompson, the current board chair for Doctors Manitoba, said he wrote the post after "a particularly difficult day" at the hospital. Like other city hospitals, the wards, ICUs, waiting rooms and hallways at St. Boniface are backed up with patients due to shortfalls across the health system.

When that happens, the ERs become the overflow for the system, he said.

"I come in to work and I see all the stretchers and a packed hallway and folks that are waiting in pain, that are suffering. As hard as it is for me to see, I can't imagine what those folks waiting are feeling."

Many people go to ERs because they have no other option. A lack of outpatient mental-health resources means ERs see many people in crisis, Thompson said.

Others could be served by a family physician, but there are more than 150,000 Manitobans who cannot find one, "and many others who can't get in to see their primary-care physician in a reasonable amount of time," he said.

Thompson's voice cracked with emotion as he described one patient who waited more than 18 hours on Sunday with a bowel obstruction. Another waited more than 10 hours and was diagnosed with a heart attack.

The conditions he and others faced on Sunday made it the first day Thompson ever thought about quitting.

A major frustration is that several hospital beds are actually empty but cannot be used because there are not enough nurses to safely staff them, Thompson said, also noting more rural ERs closed this summer due to staff shortages than ever before.

"We cannot keep doing this dance. Something has to change," he said.

'Staggering number' of doctors report burnout

Later this week, Doctors Manitoba will release an analysis of physician resources in Manitoba as compared to other provinces and data about the well-being of doctors in Manitoba, Thompson said.

He previewed some statistics, including that 67 per cent of respondents report feeling morally distressed that the level of care they provide is not what it should be. Fifty per cent report experiencing high, or very high, levels of burnout.

"This is a record high. It's a staggering number," Thompson said.

He is urging health-care leadership to take immediate action to recruit doctors, nurses and allied health professionals. But that must also come with "laser-focused efforts" to retain existing staff, he said.

The province also needs to implement an ER surge protocol and increase in-patient capacity, as well as capacity at long-term care and personal care homes.

On Tuesday, Health Minister Audrey Gordon and Premier Heather Stefanson announced $12.5 million for a new training centre for nurses and other health-care professionals at Red River College Polytechnic in Winnipeg.

Asked about Thompson's concerns, Stefanson said the challenges are being faced by governments in every province.

"I know there's troubles, but we're taking steps to make it better," she said.

Gordon said she will also announce a plan within the next week to address recruitment and retention of nurses. That will likely include efforts to bring private agency nurses and retired nurses back into the fold.

Dismayed after uncle's 48-hour wait

Nicole Ward, a former Winnipegger who was in town visiting family, said she feels dismayed by the health-care system after her family's experience this past weekend. 

Her uncle, who has end-stage bile duct cancer, went to Health Sciences Centre on Saturday because his biliary drain was malfunctioning and bile was accumulating in his body, Ward said. He also had a blood infection.

"They told us it was going to be a very long wait. They couldn't tell us how long, but that there were people with a stroke and heart attacks in the hallways that had been there for a while, that there was someone with a broken hip in the hallway, that all the hallways were filled with people in gurneys, that there was nowhere to put them," she said.

The senior, whose drainage site was infected, waited around 48 hours before he got it removed and replaced, as well as a second drain put in. She said it took about 40 hours for him to be admitted from the ER to the ward. 

During his wait in the ER, Ward, who is a research scientist at Vanderbilt University Medical Center in Tennessee, checked on her uncle often.

She urged staff to check his vital signs after several hours and asked for a glass of water for a woman curled up in a ball with vomit lying in front of her.

Hospital staff are trying their best, she stressed, but it's not enough.

You see the signs all over [the hospital] that say, 'Patients first,' and right now, it's no one first.- Nicole Ward, family of cancer patient who waited nearly two days for hospital admission

"You see the signs all over [the hospital] that say, 'Patients first,' and right now, it's no one first," Ward said.

At one point, she called a longtime physician friend in Winnipeg to ask if it was better to take her uncle to his hospital instead. She was told it wasn't worth it. 

"He was working and he told me he was literally treading water, and he's a 20-year veteran of the ER," Ward said.

"He told me he had 27 patients in his waiting room and that we were best to stay" at HSC.

One doctor who spoke on the condition of anonymity for fear of retribution said hospitals normally see an uptick in patients at this time of year, but the nursing shortage has left them unprepared.

"Emergency is so badly backed up and so poorly staffed that the patients who are there aren't getting the proper monitoring. If you're in a corner in a hallway with chest pain or a fever of 40 degrees and there's no nurse to check on you, then by the time they get to you, you're sicker."

Manitoba Nurses Union president Darlene Jackson is calling on the province to implement some of the same monetary incentives other provinces are using to entice and keep people. It could bring back some nurses choosing to work for private agencies instead, she said.

Through the pandemic, Jackson said nurses would tell her the workload is overwhelming, but they were confident it would subside.

Nurses can't 'stick it out': union

"What we're finding is that nurses are saying, 'It's not getting better, it's getting worse, and I can't stick it out,'" Jackson said.

"We really need to put a thumb in that dam because it's not just a bleed anymore, it's a hemorrhage. We are hemorrhaging nurses out of our public health-care system."

Ward said she's grateful her educational background gives her insight into the medical system so she can advocate for her uncle. She said it's clear from her visit and her discussions with medical professionals that the health-care system is reeling.

"It's scary, and you know what scares me more is that the nurses, the doctors, the physician assistants, the nursing assistants, the clinical nurse practitioners — it worries me when they're scared. It worries me when they want to quit."