The health-care system is facing a myriad of nuanced challenges at all levels, and patient capping is just one more symptom of that illness.
In a recently submitted Op/Ed piece, the Ontario Nurses Association (ONA) responded to an announcement from Kingston Health Sciences Centre (KHSC) that the number of walk-in patients accepted daily at the Children’s Outpatient Clinic (COPC) at Hotel Dieu Hospital would be limited, with the potential for early clinic closure on days when the cap was reached and no further patients could be accommodated.
In that Op/Ed, ONA cited their “extreme concern” with KHSC’s decision, stating that “capping the number of patients the clinic will see daily will… cause emergency department patient volumes to rise and wait times to increase.”
“While the hospital has cited a shortage of physicians as a reason behind the decision, ONA is aware that more specialized pediatric registered nurses (RNs) are desperately needed at this facility, a fact that has gone unacknowledged by this employer,” ONA stated, claiming, “This employer has reduced RN hours and baselines due to what it says are funding issues.”
Further, ONA wrote that “ONA’s Professional Practice specialists are taking action regarding the shortage of RNs at this facility.”
The ONA statement provided no solid figures, nor did it describe the form of “action” being taken by ONA’s Professional Practice specialists.
Asked for clarification, ONA responded with another prepared statement.
“ONA Professional Practice specialists and ONA local leadership are working with front-line RNs through the professional practice process in several nursing units across KHSC. COPC and KGH ED [Kingston General Hospital Emergency Department] are two of those units that will be directly impacted by the capping,” the organization stated.
“The professional practice process allows the front-line staff to document when they feel that their nursing standards and patient safety [are] being compromised. It allows for the nurses to have a voice and participate in bringing forward potential solutions to the concerns. ONA has been working with KHSC on alternative solutions to high nurse-to-patient ratios since August of 2021 and had been advised that closing beds was not an option.”
Reached by phone for comment, Jason Hann, KHSC Executive Vice President of Patient Care and Chief Nursing Executive, explained that nurse “baselines” refers to the number of nurses needed for a day in any given department.
“We haven’t reduced our baselines due to funding at Kingston Health Sciences Centre,” he asserted, explaining that, actually, there is a shortage of nurses to fill that baseline requirement. “We’re directing more dollars to support nursing levels within the organization… [like giving] bonuses in an effort to recruit nurses, and we’re offering additional shifts to our current nursing staff in an effort to fill vacant shifts. While we still see vacant shifts and increased needs like all hospitals, we’re working hard to recruit individuals to the organization… [but] there are only so many out there… So it’s a larger system issue that we need to mitigate.”
Hann also emphasized, “It’s important that our nurses feel that they work in a supportive environment and can care for their patients and family. So those are the strategies that we’re currently and actively doing.”
Asked about the actions being implemented by ONA and the impact they are having on patient care, Hann stated, “We’re not aware of what action ONA says it will be taking, to be honest. However… we continue to work with the local union partners such as ONA to provide the highest quality of care to our patients… and we share with them what we are doing.”
Further, Hann stated that in the last few years, a number of factors have contributed to staff shortages across the health care sector: “There are retirements, there are a lot more jobs in the system, so there’s more opportunities… we are all in a very competitive market to recruit [and retain].”
He pointed out that 20 years ago there were 10 actively practising pediatricians in the KFL&A region, but now there are only two.
“I don’t know all the reasons and where everyone has gone, but people are leaving, and people are making choices about work-life balance, too,” he said.
As for the COPC, Hann stated that in the six full days the capping strategy had been in effect (between Jun. 1 and Jun. 9, 2023), COPC has closed due to capacity only twice. On those two occasions, the clinic closed only 30 to 40 minutes earlier than its posted hours. And, he pointed out, that the patients who were already in the clinic still received the care they needed: “They still had staff to look after them.”
He said as well that “over the last few months, more than 50 per cent of the visits were from patients and families with non-urgent concerns.” Those types of concerns could have been more appropriately addressed using other resources, such as Health Connect Ontario.
The team at COPC, said Hann, takes a very hard look at who is in the waiting room and needs urgently to be seen, “and we’ll keep going until we have seen every child we can accurately and safely care for… It’s not just a number; there are other factors [to capping], as well.”