Unionized doctors and nurses from Stanton Territorial issued a response to the NWT health authority’s proposed “alternative” ER care models with the potential of “virtual support” measures. The proposal released in June had suggested possible alternatives to in-person emergency physician coverage at Stanton ER amid what medical professionals agree is a “staffing crisis” in the North.
In a joint statement, Dr. Courtney Howard, President of the NWT Medical Association, Gayla Thunstrom, President of the Union of Northern Workers and Megan Wood, Chief Executive Officer & Registrar, College and Association of Nurses of the Northwest Territories and Nunavut called on the territorial government to address what they said is a crisis. They cautioned of the importance of 24/7 in-person emergency physician coverage as “essential and non-negotiable” at Stanton Hospital.
“Northerners deserve a high-quality, caring, culturally-safe healthcare system that is aligned with standards across Canada. Yet this summer, Stanton Territorial Hospital is operating without guaranteed in-person emergency physicians. As the Northwest Territories’ main referral site and only Level 3 trauma centre, this staffing crisis poses serious risks to patient safety. Staffing plans now include regular 12-hour physician shifts and an untested “virtual ER” model where no physician is physically present,” they wrote in the joint statement.
Tamara Holliday, president of Local 11, for the United Northern Workers, who represents the nurses and doctors at Stanton, told True North FM that the lack of 24/7 physician coverage at Stanton territorial hospital over the summer is “incredibly dangerous.”
“A lot of the members come to me with a lot of apprehension, particularly around this virtual physician. Considering we are the largest hospital for in two territories and we are the receiving site for some of Nunvavit and all of the Northwest Territories, not having a physician on site is absolute insanity. This would never be allowed in a southern hospital and the fact that it’s allowed here and our government has not been stopping it immediately, I find incredibly disheartening and alarming.”
Holliday said that doctors and nurses at Stanton are concerned about what some of the proposed alternative ER care models could mean to patient safety.
“So not having an emergency physician on site would just be incredibly dangerous because when you have an emergency you don’t get warning, it just comes and so each minute that you’re waiting for specialists to come in or trying to connect to a virtual physician is taking away from that patient’s life. So having that physician on site is just a massive risk to patients and I think it also puts nurses at a lot of risk. I think there’s that pressure to act beyond our scope to make sure this patient is okay, but you can’t do that. That puts us at risk for disciplinary action. It’s also just beyond our skills. In emergency medicine, we work in a team with nurses and a physician,” explained Holldiay.
Many nurses and doctors have felt the challenges coming to a head, especially over the last few years.
“Healthcare never recovered since Covid and we just keep having these additional stressors on the healthcare system,” said Holliday.
“We need immediate change to have proper recruitment and retention. We need to have these conversations between the government and frontline workers directly so that they can find out what we need to keep the Healthcare system functioning,” added Holliday.
On June 4, NWT’s Health and Social Services Authority announced the contingency plans in place at the Emergency Department at Stanton Territorial Hospital for when staffing levels are “below optimal.”
In the announcement, representatives from the health authority acknowledged their critical role as the referral site and entry-point to higher level of care for all residents of the NWT and the Kitikmeot Region of Nunavut,
“The health authority said that in order to ensure NWT residents have continued access to Stantons’ ER department during staff shortages, the health authority “may at times” adjust shift coverage using what they call “alternate staffing approaches” including Staffing with 12-hour physician shifts, rather than the existing 8-hour shift preferred model. The health authority also said they planned to explore “innovative care models” that can help address staffing challenges and enhance service and program delivery,including “assessing virtual care options”
The health authority said that while they acknowledge that measure like these are not an ideal or sustainable in the long term, they’re “a necessary short-term mitigation measure” to keep ER doors open during during staff shortages.
Back in May, N.W.T. doctors and medical professionals expressed concerns that the ER at Stanton Territorial Hospital would experience staffing shortages by summer.
NWT doctors spoke at the Legislative Assembly, saying the situation was at a “crisis point.”
“There’s real danger that we won’t be able to keep the emergency room open over the next few months if there’s not a change,” Dr. Courtney Howard told the assembly.
In response, the health authority said they would do what they had to do to keep the ER open.
“The NTHSSA will use every available avenue to ensure operations continue at full capacity, and if a reduction of services is required, details on what that looks like will be shared through NTHSSA Communication channels at the earliest available opportunity. Physician staffing can be quite dynamic in the north. As of today, we do not have any service reductions to announce. Residents can rest assured that the Stanton Territorial Hospital Emergency Department will not close, even if alternate service or staffing models are required,” said Krystal Pidborochynski., who is the communications director at the health authority.
In response to yesterday’s joint announcement, Kim Riles, CEO for the NWT Health and Social Services Authority told True North FM that there are no changes being made to the service delivery model at the Stanton Territorial Hospital Emergency Department.
“The NTHSSA continues to plan to have staff at STH ED 24/7, 365 days a year with fully qualified ED physicians. This is the operating model for that facility and is the standard the NTHSSA will always work to achieve,” said Riles
Riles acknowledged the physical shortages are a problem and said that contingency plans are something the hospital is required to have in place for “unexpected” disruptions.
“The reality of physician shortages both in the Northwest Territories (NWT) and across Canada is such that there may be times that there are unexpected vacancies such as sick calls or travel disruption, or known vacancies that may result from an inability to backfill leaves or vacancies in positions where we are unable to achieve our staffing quota,” said Riles
The health authority is working to address chronic challenges.
“Across the NTHSSA we continue to actively engage with our staff to better understand the challenges, and work collaboratively toward sustainable solutions, recognizing that some of these solutions may be temporary while longer-term strategies are developed,” Riles said.
Virtual care models have not been put in place as yet at the Stanton ER.
“Recently, some draft internal information about contingency planning that included, in part, the use of virtual care, was shared with the media before it was finalized. The information shared with media was proactively shared with staff to gather input and feedback, it was not a finalized plan. While we understand that there is a high level of interest in our work, it’s unfortunate that preliminary drafts of material were made public before it was ready to be shared more broadly. This only causes confusion and can be misleading to the public,” said Riles.
“While virtual care is one option the NTHSSA is exploring to support contingency planning, it’s only one of several ideas under consideration and would never be viewed as a replacement for in-person care, but rather a contingency approach that could be used in the event of a severe shortage scenario. More work, including input from staff, is still required, as was shared in a public notice that was issued by the NTHSSA on June 4,” added Riles
