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Manitoba nurses pen letter citing concerns over staff-patient ratios

WINNIPEG — A group of critical care nurses from the Health Sciences Centre Medical Intensive Care Unit (MICU) have penned a letter to the Manitoba government expressing their concerns regarding a new model of care that’s diluting nurse-patient ratios.

According to the letter, which is addressed to Premier Brian Pallister and Health Minister Cameron Friesen, the usual model of care in the MICU is based on the Australian College of Critical Care Nurses’ (ACCCN) workforce standards for intensive care nursing. The nurses note this model of care is endorsed by the Canadian Association of Critical Care Nurses, is based on an evidence-based review, and was developed in collaboration with nurses.

“This Model has demonstrated to have: improved patient outcomes, the lowest rates of patient restraints and sedation, hospital-acquired infections, and demonstrates the best interactions with patients and their families,” the letter says.

The letter goes on to say the ACCN model of care is typically based on nurse to patient ratios of 1:1 for unstable patients and 1:2 for unventilated, stable patients. In some instances, if a person has particularly complex needs, they might even require multiple critical care nurses.

“The literature demonstrates that as nurse to patient ratios increase, the quality of care provided drops significantly with each new patient added into the mix,” the nurses say. 

“In this situation, critical care nurses do not have time to: complete lifesaving care, provide medications, complete treatments and assessments, link with other professionals, and sadly, support the patient’s family.”

According to the nurses, HSC’s new pod model of care, which leadership recently implemented, was developed by a third-party consultant from outside of Winnipeg and doesn’t include input from the critical care nurses.

The letter says under this new pod model, the nurse to patient ratios are diluted at ratios of 1:2 and 1:3 for non-COVID-19 and COVID-19 patients.

It adds that the ACCN workforce standard doesn’t include a 1:3 ratio.

“The critical care nurse typically buddies with another critical care nurse who has a similar assignment,” the letter says.

“These patients require constant monitoring which we are unable to do, as our current patient population level of care is within the 1:1 ratio. With COVID patients there are additional challenges with donning/doffing PPE and entering/exiting isolation rooms or red zones.”

The letter notes each pair of nurses is assigned a ‘nurse extender,’ adding that sometimes other allied health professionals are directed to help critical care nurses. However, in both of these cases, the worker has only received minimal training on their duties.

The letter adds that critical care nurses have tried to sign up for extra shifts, but are denied if the allocated number of nurses has already been reached. It also says that nurses are filling out workload staffing report forms and occurrence reports on every shift.

“We are exhausted physically and emotionally with many nurses exhibiting signs of burnout,” the nurses say.

“We are missing breaks and staying past our shift to complete our documentation and tasks. We are constantly worried about the care we can safely provide to our patients, while keeping ourselves safe.”

The letter ends by asking the province to reconsider this approach and find a safer model of care; recruit and retain critical care nurses; work with nurses and critical care experts to safely expand capacity, and for confirmation that the new pod model of care won’t be permanently adopted in the MICU or other ICUs in the province.

OFFICIALS SPEAK OUT

NDP Leader Wab Kinew shared the letter at a news conference on Monday, referring to it as ‘concerning.’

“These nurses have sent this letter at a professional risk to themselves,” Kinew says.

“They are probably concerned about potential career impacts, but I think their concern for their patients weighs even stronger in their minds than that.”

Uzoma Asagwara, the NDP health critic, says the letter captures what the daily working conditions are like for MICU nurses, highlighting the part about daily occurrence reports.

“What this means is that should a critical incident take place, should something devastating happen on the unit, the nurses have done their due diligence in reporting the conditions in which these circumstances were able to occur,” Asagwara says, noting that this letter indicates that nurses aren’t being heard.

Lanette Siragusa, Shared Health’s chief nursing officer, says they haven’t implemented the team-based models of care everywhere.

“It is absolutely not our intention to put any professional or patient in an unsafe situation, but it is a very different way of working,” she says.

“So we’ve always said and we will continue to work with our teams in critical care. They meet every single day. They document where there are opportunities to do better, where there’s challenges and they also post where they’ve followed up and made some solutions.”

Siragusa says she doesn’t doubt there are challenges in changing models of care, but the focus needs to be on how to do better, how to improve working collaboratively, and making sure things are safe.

CTV News Winnipeg has reached out to the Manitoba government for comment.

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