Last May, La Tribune wrote that the situation was critical as the surgical team consisted of just 24 nurses. It should be closer to 75. The teams were already exhausted. Two months later, the situation is even more critical.
The interim president of the Union of Care Professionals of the Eastern Townships (SPSCE-FIQ), Stéphanie Goulet, confirms that as of July 20 only 17 nurses remained in office. If all goes as planned, three nurses are expected to be back on duty from the week of July 23. Therefore, there should be 20 nurses working in the operating room when there are no other staff movements. “In Fleurimont it is even worse than when we left on May 24th. […] It’s very critical, it’s not going well. “The staffing problems are really frightening,” she said in an interview on Monday.
In a memo dated July 14, 2023 from the CIUSSS de l’Estrie-CHUS professional services department, of which La Tribune obtained a copy, we can read that “the situation in the Fleurimont operating room is critical for the night (midnight to 8 a.m.) from Friday to Saturday (July 15), for Sunday evening (July 16) and for the night (midnight to 8 a.m.) from Sunday to Monday (July 17)”. just one nurse instead of 2″.
For the same reason, it is read that various measures had to be taken to limit the impact on patients, in particular “not to accept the transfer of patients with urgent surgical indications”. Requesting hospitals had to refer patients to another hospital. Fleurimont hospital teams also had to “consider the transfer of a hospitalized patient, if that is the case”. [avait] a high risk of having to undergo an urgent and lengthy operation.”
Prioritization of emergencies
Layoffs, job changes or illness-related departures are some of the reasons for the reduction in nursing staff, according to a nurse who prefers to remain anonymous. According to this person, the morale of the troops “is getting worse and worse.” She’s out of breath.
“There’s a lot [patients] that cannot be sent anywhere else. We don’t just serve the Eastern Townships. Elsewhere in the province there are service corridors that result in us having to accept transfers from elsewhere. All of this makes it difficult. We are aware that we can never close the operating room. But the conditions there are no longer worth living in,” explains the nurse.
While the weekend of July 8th and 9th was also difficult, Catherine Forget, Deputy Director of the Oncology Unit in the Department of Specialized, Surgical and Oncological Services, mentions that the CIUSSS de l’Estrie-CHUS gives priority to the most urgent cases for an operation. “The situation at the Fleurimont boulder is difficult. We are not responsible for partial services. A disruption in services is that we cannot offer these services to the population, whereas what we are actually talking about here is a restructuring and modulation of activities in order to prioritize most [urgents]. »
The deputy head of the specialist services, Dr. Suzanne Gosselin, explains that in the surgical field, a classification of the types of emergencies from U1 (imminent threat to the life of the person) to U6 (operation that can be postponed without repercussions) is carried out. “We make sure that the priorities U1 to U3 are set. The consequence is that the things with lower priority are postponed by a few hours or a few days, depending on the priority level. »
She adds that each case is discussed and analyzed within the medical teams. “It’s not an administrative decision. […] Each situation is discussed with the surgeon, anesthesia team and other medical teams involved. »
“We’re not a lot of people who could roll that block. Ever since we appeared in the media, I have had the impression that this is a showdown against management. »
— Nurse wishes to remain anonymous for fear of reprisals
No more urgent surgeries
While the shortage of nurses in the operating room is glaring, the number of urgent surgeries this summer has skyrocketed compared to expectations. “There are always fluctuations in the healthcare network,” explains Dr. Suzanne Gosselin. […] There have been big phenomena like the pandemic where we knew there would be delays in investigating. We can follow the development of the services, but it is very random. »
Ms Forget says several measures have been taken to address the staff shortage. “We have a team of midwives who help us with emergency c-sections, among other things. It takes the pressure off. […] We want to do everything possible to ensure that we can manage the incoming cases in a way that keeps the community safe, even if there is one less nurse. »
The Fleurimont operating room has nine rooms. Five are open this summer, “with pain and misery,” as the nurse reports.
In order to meet the needs, the rosters of the nursing staff are constantly being adjusted, in particular through the redistribution of call services, shifts or compulsory overtime, the nursing staff regrets. “In my view, it will take almost two to three years to rebuild the surgical staff. »
The nursing staff in the operating room are at their wit’s end. “Of those who stay, more than 50% have applied elsewhere. »
attract new people
The training of new nurses in the operating room is a long process, especially because of the complexity of the work. “It’s a delicate balance between keeping people safe and ensuring our employees have working conditions that allow them to remain involved in areas that matter,” reports Ms. Forget.
“The team is so small that it is very difficult to find your way around,” said Stéphanie Goulet.
A super specialized block
The operating room at Hôpital Fleurimont is one of the most complex in the province due to the range of specialized and even super-specialized treatment it offers. Among other things, pediatric, neonatal, cardiac, complex oncological and traumatic surgeries are performed.
“Fleurimont is a block with sub-specialties that cannot be transferred. We still have several operating rooms in the CIUSSS de l’Estrie-CHUS. “Everything that can be done locally in the other blocks has already been transferred,” notes Dr. Gosselin.
“Due to the lack of manpower, we are unable to field these two guard teams. »
— A nurse who works in the CHUS Fleurimont operating room
When urgent situations arise at the same time, a medical dialogue to establish the patient’s condition is essential, says Ms. Forget. “In the event of a disaster, there are always mechanisms we use to keep call lists. We may call people who are not on call but may be available. »
Check the service offering?
It is important for management to review “the service corridors” to gradually move out of this crisis in the eyes of caregivers. “Anything that isn’t done during the day is done through the emergency room entrance in the evening and at night. We’ve seen it since the pandemic began. […] The waiting lists are so long that the disease does not stop progressing because two years have passed. The reality is that people show up in the emergency room. They need to be operated on quickly because they have deficits and it can’t wait any longer,” denounces this person.
Every week the situation worsens in his eyes. “Since I’ve been on the block, I’ve never experienced such an atmosphere. »
Stéphanie Goulet believes that practices must be relocated elsewhere, even for specialists. “It’s in the hands of management. She’s trying to work wonders with the schedules, but inevitably there will be more theater closures than announced. I think specialties have to go to the Hôtel-Dieu or somewhere else. »
Even if the number of nurses present in the operating room is decreasing, there are currently no plans to close the operating room or to divert operations from the CIUSSS de l’Estrie-CHUS, counters Catherine Forget.
The CIUSSS de l’Estrie-CHUS is convinced that it is taking all the necessary measures to provide services to users while improving the daily lives of healthcare workers. “The teams working with the nurses are working hard to improve the situation. Several actions are in progress. We want to work with them and the union that represents them. We do this very intensively despite the summer time. »
Vigilance is “constant” for next weekend, Ms Forget says. “The situation will be similar [que lors des deux dernières fins de semaine]. Our mechanics will be on site to protect users. We knew that summer would be difficult. »