Hospital Service Reductions Due to Nursing Shortages

We hear and understand the strong desire of the community and our partner organizations to reopen, and to provide a date by which that will happen. Our action plan has a number of initiatives that are progressing, and we have communicated clearly that these service reductions are temporary and indefinite and we are not able to provide a definitive reopening date at this time. In order to restore services in the Walkerton ED, 5.1 full time equivalent (FTE – 37.5 hours/week) registered nurses (RNs) are required. In order to restore services in the Chesley acute care unit and ED, 3.7 FTE RNs are required.

One of our core principles is providing care that is safe. When we can operate our full services safely, we will reopen.

Nursing staff shortages are not unique to SBGHC, or the Chesley and Walkerton hospitals. There is an overall shortage of nurses in the province, and the large majority of hospitals in Ontario are experiencing staffing challenges. SBGHC made the decision to reduce services to ensure we can continue to provide care that is safe, and to ensure that we do not further deteriorate our staff. SBGHC’s clinical leadership has also been quite thin in the last year, and this has impacted our nursing staff. Steps have been taken to bolster the clinical leadership team.

SBGHC’s Board of Directors is a skills-based, dedicated, and passionate group of volunteers that is committed to ensuring we maintain four strong viable hospital sites in our communities. The decision to reduce services in Chesley and Walkerton was made based on the principals of least harm and using our resources as effectively as possible to meet the staffing needs at this time. At the present time, SBGHC’s Board does not have a Director from the Brockton area, despite extensive recruitment efforts in the community.

We fully recognize that the reduction of services has an impact on recruiting physicians and keeping them in our communities, and also on physicians outside of our organization who are faced with increased patient volumes.  As an interim step, the physician groups in Chesley and Walkerton are working to support their physician colleagues in Hanover by providing secondary coverage in the Hanover & District Hospital ED between 8pm – midnight.

SBGHC welcomes the Municipality of Brockton’s support to improve our nursing retention and recruitment. We believe local partners need to work together to address the significant health human resource challenges facing the Ontario health care system right now, and we need to work together to best position the southern parts of Grey and Bruce Counties to attract and keep nurses.

SBGHC will not engage with a reviewer appointed solely by the Municipality. We will however, work side by side with our municipal partners to address our recruitment and retention challenges. The municipality has no authority over the hospital or its operations, and has appointed this third party reviewer without input or consultation from SBGHC. The appointment of a reviewer under these circumstances is not acceptable to the hospital.

SBGHC’s immediate goal and primary focus right now is to return our services to full operation as soon as possible, and we are taking steps to accomplish this.  We have developed an action plan which outlines a number of strategies around both recruitment and retention which is posted on our website.

To achieve a sustainable staffing model in the short-term due to immediate challenges, 12 options for service reductions across the organization were reviewed, and narrowed to four for further consideration by SBGHC’s leadership team and Board of Directors.

These options ranged from complete closures of programs and services, to modification and reductions of service levels. In the evaluation of the options, the Board wanted to ensure that the care provided at the hospital is safe, and does not further deteriorate our staff.  In addition, the Board wanted to ensure that key programs like the Family Birthing Centre, where mothers deliver over 450 babies annually, was protected.

Of the options considered, moving to reduced hours in the Walkerton ED has the least impact on patients, as 82% of the visits to the Walkerton ED come during the hours between 8:00 AM and 8:00 PM, and there are five alternate EDs open 24/7 within 51 km of Walkerton.

Combining the Walkerton ED closure with the designation of the Chesley Inpatient unit to an ALC unit freed up enough RNs to fill vacant shifts, and allows for a small contingency for sick calls and patient transfers.

Staffing at the Durham and Kincardine sites is relatively stable, and therefore the decision was made to not reduce services in these sites and risk destabilizing these sites.

SBGHC is committed to ensuring four, strong, viable hospital sites in southern Grey and Bruce Counties now and into the future. The plans for the future of the Chesley hospital are to stabilize nursing staff resources and return the inpatient unit to 8 acute beds and 10 seniors’ centre of care beds as a first step, followed by restoring 24/7 ED service. There are no plans to close the Chesley hospital. These service reductions are not signs that the hospital is closing or that it will be closed.

The Chesley hospital is a model example of an excellent small, rural hospital with a very successful and reputable restorative care program. It is our hope that once we have the necessary number of nurses we can return to providing this high quality program in Chesley.

We are very fortunate at SBGHC that we have a young workforce as it means we have a bright future for healthcare in our region, with many skilled and accomplished healthcare workers in the early stages of their careers, and these young staff can develop into seasoned professionals.  A younger workforce does mean we have a larger number of maternity and parental leaves.  We encourage our staff to take their maternity and parental leaves to enjoy this special time with their newborn and young family.  The challenge we are facing today is that we do not have enough applicants to hire to backfill these leaves.

Nursing staff shortages are not unique to SBGHC, or the Walkerton hospital.  There is an overall shortage of nurses in the province, and the large majority of hospitals in Ontario are experiencing staffing challenges.

Yes. Working in a small, rural emergency department requires extensive training and orientation.

Yes, the Family Birthing Centre will remain operational 24/7 and continue to support moms and their babies.

Yes, the CT scanner will remain operational to provide after-hours coverage for the Walkerton inpatient unit, and emergency/inpatient coverage for other SBGHC sites.

SBGHC’s Board of Directors is a skills-based, dedicated and passionate group of volunteers that is committed to ensuring we maintain four strong viable hospital sites in our communities.  The decision to reduce hours at the Walkerton ED was made based solely on the number of vacant RN shifts at the Walkerton site, and number of RNs that would be freed up to fill vacant shifts as a result of this change. At the present time, SBGHC’s Board does not have a Director from the Brockton area, despite extensive recruitment efforts in the community.

In the collective agreement which was most recently negotiated between SBGHC and the Ontario Nurses Association (ONA), the agreement does not currently have language for casual Registered Nurse (RN) positions.  Given the current environment, work has already begun to revise the agreement to allow for casual employment of RNs.

Offering incentives to recruit nurses is outside of the collective agreement we have in place with our union partners, and also outside of an agreement that SBGHC has with other South West regional hospitals not to offer incentives.  Recruiting nurses away from other partner organizations will only create staffing pressures somewhere else within the system.  The nursing staff shortage is a system-wide issue that requires a system-wide response.

• The reduced hours of operation will go into effect Monday, December 27^th at 8:00 PM.
• The Walkerton Emergency Department will be open daily from 8:00 AM to 8:00 PM, and closed from 8:00 PM to 8:00 AM.
• EMS (Ambulance) will be on bypass after 8:00 PM to transport patients who require Emergency Department services to the nearest 24/7 ER.

If you are in need of immediate medical attention, call 9-1-1.

The closest 24-hour Emergency Departments to Walkerton are listed below.

No. Reducing the Emergency Department operating hours in Walkerton is an interim decision to allow time for the nursing staffing complement to be stabilized.  Active recruitment and training will continue with the intent to resume 24-hour ER services as soon as possible.

There is an overall shortage of nurses in the province, which is being compounded by burn-out after 20 months of navigating the pandemic, the unique nature of rural nursing practice, a younger work force that has resulted in a large number of maternity leaves, and more nursing opportunities available across the system that provide a more attractive schedule (i.e. Monday to Friday without evenings and weekends).

Recruitment and retention of Registered Nurses (RNs) is also very challenging in rural communities. Nurses are required to develop a high degree of competency in a number of clinical domains and specialties, and new graduates can often be unprepared to work in a rural setting without significant orientation and mentorship.

There is an overall shortage of nurses in the province, which is being compounded by burn-out after 20 months of navigating the pandemic, the unique nature of rural nursing practice, a younger work force that has resulted in a large number of maternity leaves, and more nursing opportunities available across the system that provide a more attractive schedule (i.e. Monday to Friday without evenings and weekends).

No. SBGHC has not yet implemented a mandatory vaccination policy. SBGHC’s COVID-19 Vaccination Policy was implemented on September 7th, 2021 for staff and professional staff that provides three options:

·         submit proof of full vaccination against COVID-19;

·         submit written proof of a medical reason for not being vaccinated against COVID-19;

·         complete a mandatory education module, and rapid antigen testing must be completed within 48h prior to coming to work.

Failure to comply with the policy means that staff would be removed from the upcoming schedule, and physician privileges would be suspended.

All new staff, physicians, students and volunteers must be vaccinated. Currently, 95% of staff are fully vaccinated, and 96% have received at least one dose.

The highest volume of patients (82%) are seen during the hours of 8:00 AM to 8:00 PM.  Typically, the volume of patients seen in the Emergency Department at the Walkerton site during the overnight hours are very low. During the overnight hours between 8:00 PM to 8:00 AM, the Walkerton ED sees an average of 4.6 patients/night.

Alternate Level of Care (ALC) patients no longer require acute care and are awaiting placement in the community (i.e. long-term care, group home, home with home care support).

SBGHC’s Chesley site currently has a total of 18 beds with 10 Seniors Centre of Care beds that care for this patient population, along with 8 acute care beds.  It is intended that the Chesley hospital will transition to become a 20 ALC bed unit.

SBGHC has on average 20-22 of its 60 inpatient beds occupied by patients that are designated ALC.

Access to placement within the community has become more challenging over the last 20 months.  To address infection control requirements, COVID guidelines now restrict long-term care (LTC) homes ward rooms to 2 residents, where previously they would have been home to 3 or 4 residents. This change has removed 147 LTC beds across Grey Bruce, resulting in less destinations available for patients who have finished their stay in hospital.

In addition, the staff and nursing challenges are also impacting the contracted service provider organizations (SPOs) which means the SPOs have less staff available to provide home care, making it more challenging for the hospital to discharge patients home.

No. SBGHC’s Chesley site will continue to operate as a hospital with a 12-hour emergency department, 20-bed ALC unit, and Laboratory/Diagnostic Imaging services.

SBGHC intends to return the Chesley hospital to a hospital with acute beds in the future.

ALC patients do not require acute care, which allows more RPNs and PSWs to be used in the staffing model, and less RN coverage is required.