Overfilled emergency rooms and rising violence are threatening nurses in N.L., union says

A nurses' union rep says nurses in Newfoundland and Labrador are now dealing with a rise in violence in overfilled emergency departments, and is calling for mandated nurse-to-patient ratios to create safer workloads for members.

Yvette Coffey, president of the Registered Nurses' Union of Newfoundland and Labrador, says hospitals are running over capacity, with patients placed in beds in hallways due to overflowing emergency rooms.

Despite the surge in demand, the number of nurses taking care of those patients has stayed the same, Coffey said.

"They're getting burned out, and we need to have safe staffing," she said.

Coffey said she hears about health-care workers facing violence every day. Every other day, a registered nurse files a claim with WorkplaceNL, a government appointed organization that provides injury insurance. 

Data from WorkplaceNL show in 2023 there was about one claim every two days from nurses for all types of injuries, and about one claim every 13 days due to assaults and violence.

WorkplaceNL says the number of claims related to violence is declining, but the union says it's still a problem.

"The violence and the lack of staffing, the increased workload, all of these are occupational health and safety concerns that would never be tolerated in any other profession," said Coffey. "But it's being brushed under the rug."

At St. Clare's Mercy Hospital in St. John's, Coffey said the working conditions in one surgical unit resulted in 11 registered nurses leaving that unit.

To replace them, Newfoundland and Labrador Health Services called in five private agency nurses, she said.

Nurse-to-patient ratios

The union is calling for mandated nurse-to-patient ratios to cut down on violence and reduce turnover. The ratios would determine the maximum number of patients an individual nurse in each unit can care for. 

Each patient added to a nurse's workload decreases health outcomes and increases mortality rates, said Coffey. 

Right now, those ratios can't be determined because the system is relying on 30-year-old staffing data, she said, adding the outdated data is not based on acuity — in other words, the severity of a patient's condition —  it's only based on the number of beds, said Coffey.

The acuity of patients in hospitals has also increased significantly, she said, noting hospital beds would previously hold patients with less severe health problems, like someone recovering from a knee surgery. These days, that's an outpatient procedure, and all the beds are filled with the sickest of the sick, she said. 

"The first thing we need is that core staffing review to know how many nurses should actually be on one unit or in one area, caring for the number of patients they have [and] looking at the acuity of the patients," said Coffey.

Health Minister John Haggie says mandated staffing levels have been tried in the past, and didn't work. 

In the current system, he said patient acuity is assessed on a daily basis by the nurses. In long-term care, he said managers decide what staffing levels are appropriate. 

Health authority spokesperson Jon Oake told CBC news in a statement that NLHS uses a patient acuity approach, instead of fixed nursing-to-patient ratios.

"By considering the complexity and severity of each patient's condition we can provide more personalized and responsive care," said Oake. 

The Health Department also has a health workforce consultant undertaking a core staffing review, wrote Oake. 

Coffey is hoping to see that core staffing review in the next couple of months. 

Nurse vacancies down

Haggie also said the province has had success in reducing the nurse vacancy rate. He said over the past 18 months, nursing vacancies have dropped from 700 to below 400. 

He also said 760 new registered nurses have been brought in.

But Coffey said that number suggests nurses are still being lost. 

"We need to be focusing on retention because we can recruit 900, but if we're losing 400, we're not really seeing a big gain and a big decrease in the vacancy rate," said Coffey.

The union is presenting a slew of other solutions to the government to increase staffing levels and rely less on agency nurses.

They're suggesting alternate scheduling models that provide flexibility and a locum for nurses to travel to Labrador.

The union also wants more nurse practitioners doing primary care, so that fewer patients end up in emergency rooms.

"Burnout has increased, people are leaving, and I think that retention is the biggest thing that we need to be talking about," said Coffey. 

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