'An embarrassment to the health-care system': Nurses reveal issues they see on the job

New data shows that errors are growing in Canadian hospitals, as one in 17 hospitalizations from March 2022 to March 2023 involved a patient experiencing harm, according to a new report from the Canadian Institute for Health Information (CIHI).

That is an estimated 145,000 Canadians who went in for treatment and may have ended up with an infection, pneumonia, medication error or bedsore.

"This is the third year in a row that we have seen an increase in the wrong direction," Kate Parson of the CIHI told CTV News.

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"The numbers may be surprising to some folks. But ultimately, we want to get this information out there in order to drive change."

Compared to the previous year, the report says there was a 20 per cent increase in hospital-acquired urinary tract infections, and a 25 per cent increase in aspiration pneumonia, where patients inhale fluids or food leading to lung problems. In addition, the report found a 50 per cent increase in pressure ulcers or bedsores, a rise that may also be linked in part to better data keeping.

The report for the first time provided data showing that hospitals relied heavily on overtime and agency staff to provide patient care, with the measured harms linked closely to staffing levels.

There was a 17 per cent increase in sick time from nurses that removed the equivalent of 6,500 nurses from the health-care system, and approximately 14 million hours of overtime clocked by nurses in 2022-23 --- a 50 per cent increase over the data from 2021-22.

Much of it is forced overtime, says Deb Lefebvre, a registered nurse in Kingston, Ont.

"We don't have enough nurses and we are unable to leave our patients without adequate oversight," Lefebvre, who is also a board member of the Registered Nurses of Ontario, told CTV News. "According to our legislation, it would be known as abandonment if we were to leave our patient, so yes, we are trapped."

It's led to an exodus of nurses, those in the industry say, citing exhaustion and high levels of burnout. Those who remain are stretched, and some admit it is putting patient care at risk.

"We're so understaffed and the pace is so fast," said Miryam, a nurse working in an Ontario hospital, in an interview with CTV News.  

Miryam is a pseudonym. She asked not to be identified, saying she feared losing her job. She said she spoke out because she wanted Canadians to know there aren't enough nurses to care for all the patients properly, and that she is seeing the harms reported in the CIHI report grow.

Bedsores develop when a blood supply is cut off from the skin due to prolonged pressure. They typically develop in older and less mobile patients when nurses don't have the time to monitor their skin or turn patients to prevent pressure injuries. In the past year, Miryam has seen two of her own patients die, and says pressure injuries were a likely factor in these deaths.

“The interventions need to be swift and they need to be aggressive. But there's no time for that because every service is strapped,” she adds. "My mental health has taken a nosedive ... I take it very seriously but this is my role. And when we don't provide the best care ... I grieve the loss of opportunity."

Complaints to managers, she said, are usually dismissed.

"I've even been told to, like, 'walk away' and to not let it bother me and things like that...because I think it's not in their wheelhouse of concern, I guess," said Miryam.

Although she contemplates resigning, she says, she instead works longer hours of unpaid overtime to help vulnerable patients.

"I kind of feel like in my job, I'm not allowed to get mad, so I just end up feeling sad,” Miryam said.

When told this story, Linda Silas, president of the Canadian Federation of Nurses Unions, bristled.

"She's seeing the bedsore grow and grow and grow because of a lack of proper nursing care, and that's an embarrassment to the health-care system," said Silas.

USE OF AGENCY NURSES UP 80 PER CENT

The CIHI report also found that there was an 80 per cent increase in the hours billed by private or agency nurses and health workers working in hospitals in 2022-23, compared to the previous year.

While the numbers made up a small part of the total volume, about one per cent, paid hours grew from 850,000 in 2020-21 to 1.5 million hours in 2021-22

But the growing presence of agency nurses didn't lower the rates of harm to pre-pandemic levels.

Nurses have told CTV News that there is often little teamwork when they are on duty, as well as a mismatch between their skills and the demands of the hospital job. One study published in the journal BMJ Quality and Safety reported that nurses who are called up from agencies "are not effective substitutes for RNs who regularly work on the ward."

"These agency nurses are literally flown in and flown out. (It's) breaking this continuing duty of care. This means patients are missing important nursing care,” said Silas.

It boils down to safety, Silas said, adding that patients are as important as passengers on aircraft.

"Pilots will have limits on how many hours they can do but there are no limits on hours nurses can do and mistakes, omissions and patient errors happen," she said.

SOLUTIONS

The CIHI report says the key to reducing harm to patients is keeping staff nurses at work.

That includes offering flexible working hours and filling more staff positions to ensure there are enough nurses familiar with the hospital systems with the time to treat a set number of patients.

In the U.S., some states have begun to pass legislation to ensure there must be a minimum number of registered nurses on duty for various patient loads, called the RN-to-patient ratio.

California, for example, has had mandated RN-to-patient ratios since 2011. Data showed there were lower rates of hospital-acquired infections and lower rates of patient readmission after discharge because of problems, along with improved satisfaction among families.

Advocates say the costs of increasing and retaining hospital staff will be offset by reduced harms and the longer hospital stays those harms cause.

"It's very important that Canadians pay attention to this data," said Lefebvre. "If we do not make the investment in our health-care system, if we do not ensure that there are adequate nurse professionals at the bedside, these numbers will only worsen."