Two years ago, on New Year’s Day morning, it seemed babies were popping out on an almost assembly-line basis at Cowichan District Hospital but Jan. 1, 2016 was very different.
No babies were born at Cowichan District Hospital at all that day.
Unfortunately for the families involved, there could have been several births in Duncan but the mothers had to be sent elsewhere because CDH didn’t have enough staff for the operating room and emergency services.
Sending the moms elsewhere is called diversion, according to maternity staff when the time finally came to photograph the New Year’s baby for 2016 on Jan. 3.
“Island Health confirms two patients requiring a higher level of care were diverted from Cowichan District Hospital on New Year’s Day due to staff shortages in the operating room,” said Kellie Hudson, Island Health spokesperson.
“We are working to address the staff shortages. No patients were at risk at any time.”
Registered midwife Selina Boily said she thought it was “unfair” to the local families who were planning their lives around a birth at CDH, but safety had to come first.
“Diversion means that we are unable to staff the OR, which means we are unable to provide emergency services to provide the level of care that would be the standard for safety. In order to make sure we have a standard that everyone is expecting of our hospital for the safety and well-being of moms and babies we have to shift the moms, at huge cost, to other hospitals which have OR and facilities for emergencies,” she said.
“We didn’t have OR nurses. There were staffing issues.
“Unfortunately it’s happening more often recently. It happened Dec. 23, Dec. 25 and Jan. 1.”
“Like health authorities across the province, and health care organizations across Canada, Island Health is experiencing nursing shortages in speciality areas like emergency rooms, operating rooms and intensive care units,” Hudson said.
“Our rural and remote areas have been a challenge for some time, as it takes a special person and special circumstances to want to live in these areas. Retirements are another key factor, although we have not yet really seen the impact of this as nurses are working longer than we had forecasted. This will shift over the next few years.
“How many vacancies we have is difficult to say with accuracy because this is such a dynamic environment. However, we do acknowledge the shortage; that’s why we are working with advanced education to expand educational opportunities,” she said.
Another staffer said that before that it had been quite a few years, maybe nine years ago, since she’d encountered diversion.
Boily said when it happens there’s a big impact.
“It’s unfortunate,” she said. “Especially for the moms and their families. It has a significant impact on the families in our community. It also has a significant impact on the expectations that we have as a community that when people come here they are going to get the care provider they wanted and the level of care that is expected of a hospital.”
People who are expecting to enter hospital soon should not worry, though, she said.
“I think there is a huge commitment on the part of the care providers to provide a level of care that we can be proud of.”
Another health care professional at the hospital added, “I think we provide amazing obstetrical service here and have great care providers and a great interdisciplinary group of family doctors, midwives and obstetricians. It’s unsafe when we can’t provide OR services. So, the hospital, to mediate that, will diverge.”
“Ideally a hospital will try to plan for that. We won’t do inductions on that day, and if someone presents an early labour, they are transferred out. The problem is that obstetrics is very unpredictable. And so we feel it puts the community of mothers and babies at risk when this happens. If this was predictable, we’d have bankers’ hours. But we don’t. No one can predict who is going to present and when and the level of care they are going to need. So, when people just show up expecting care, it’s playing games, and it’s really unfair when they’ve come this far,” she said.
However, the midwife continued, finding a solution is not easy.
“It’s challenging. There has to be a will on the level of everybody to provide that service but it needs to be supported both by the administration, VIHA, and the community itself. If it’s chronically understaffed, then people get tired and are unable to meet those expectations. And that’s unfortunate. But the reality is we cannot pretend to provide a service and then not have it available. That impact will be on the safety and well being of babies and mothers. Unfortunately we can’t allow that. Not many people know but it’s becoming more and more of a problem.”
What can be done?
“We have to look at adequate staffing levels on all levels. It’s much more complex than I can understand but we need to be able to offer those minimum standards. Somebody has to realize that that is going to impact the quality of care,” Boily said.
Many people are finding they are forced to work harder and longer these days and hospitals seem to be no different from the general population.
“The problem is we will limp along and nobody will know unless something tragic happens. And we are waiting for that to happen; that is the unfortunate part. And so it’s just not an acceptable level of risk. Not to families and not to the level of care we’re proud of,” Boily said.
“Island Health is also working with our BC Nurses’ Union partners on new recruitment and retention incentives,” Hudson said. “We are working to post positions in anticipation of retirements and internal movement to speciality nursing positions. This will occur early in the New Year.”
She urged any qualified nurses looking for a post to call 1-888-296-3963.
“Our nurses are ultimate professionals, always striving to deliver high quality, patient-centred care with compassion and commitment,” Hudson said. “They are valued members of our health care teams.”