The chief operating officer of Stanton Territorial Hospital insists work is being done to address a broad range of concerns among her “exhausted” workforce.
Georgina Veldhorst’s hospital this week suspended labour and delivery services, sending families south to Edmonton instead because too few workers are available to safely staff the unit.
Recently, healthcare workers across the hospital complained that they were being poorly compensated for the hazards of work during the Covid-19 pandemic compared with colleagues in the south.
This week, workers with knowledge of Stanton’s obstetrics unit said the suspension of labour and delivery services was not because of a national shortage of nurses, but because the unit is poorly managed.
More generally, staff for well over a year have complained of working conditions that they feel are counterproductive – particularly a sense that managers are not taking their concerns seriously, workers therefore leave, and so it becomes harder to keep the hospital staffed, a cycle that perpetuates itself.
In a 20-minute interview on Tuesday, Veldhorst set out why she believes the latest staffing crisis has occurred and, in broad terms, how she responds to the criticism made by staff that she and other managers are not listening.
“I have conversations with the staff on a regular basis. There are things that are within our control to fix, and address, and there are other things that are not in our control. It is a very tough environment,” said Veldhorst.
“People raise issues and sometimes have suggestions that go with the issues. Each of those needs to be considered in terms of durability, impact on quality of care and patient safety, and impact on the safety of other staff working in the environment.
“So if I’m raising an issue that solves the short-term problem but creates a long-term problem or puts patient safety or staff safety at risk, all of those things need to be considered.”
Her response comes at the same time as a letter from health minister Julie Green that responds to requests from some workers for better compensation in light of the dangers posed by Covid-19.
As first reported by Cabin Radio at the start of November, workers wrote to all MLAs to say they feel unsupported by senior management, morale is low, and they need “fair compensation” for their hazardous pandemic work environment.
In response, Green wrote in part: “Your letter reflects the pressure and disproportionate demands that the pandemic has placed on those of you at the frontline of the healthcare system, and the significant impacts you have experienced.
“I also recognize that strains on the NWT nursing workforce existed before the pandemic, and that these have been made worse over the past year and a half.”
The minister said extra hazard pay for work during Covid-19 could not be provided “because matters related to compensation are dealt with in the collective bargaining agreement between the GNWT and the Union of Northern Workers.”
In effect arguing that nurses cannot receive hazard pay without it also being provided to downtown office workers, Green wrote: “We do not have a way to break out a group of employees to provide additional compensation without considering all employees through the bargaining process.”
That response was immediately disputed by two hospital workers who, requesting anonymity out of fear of reprisals from management, questioned how no such mechanism could exist and whether the union would genuinely oppose such pay being provided to specific workers in the circumstances.
Asked for an interview on the matter, a Union of Northern Workers spokesperson wrote: “I have passed this along for review and will let you know if Gayla [Thunstrom, the union’s president] or the Local president has some time this week.”
Below, read a full transcript of Cabin Radio’s interview with Stanton chief operating officer Veldhorst.
This interview was recorded on November 23, 2021. The transcript has been lightly edited for clarity.
Ollie Williams: Why has this happened now at the labour and delivery unit? What changed?
Georgina Veldhorst: This is in the context of what’s been happening over the last almost two years in the pandemic and, in turn, the healthcare system has been under incredible stress across the country. Here in the Northwest Territories, we’re not immune to that. It has become harder and harder, particularly in the last six to 12 months, to recruit healthcare staff.
In our obstetrics unit we tend to have some vacancies at all times – ranging in the last year from a half-time position through to three and a half positions in the spring. But we’ve been able to augment that staffing complement with obstetrics labour and delivery trained staff from elsewhere through casual contracts. Through the summer time we continued to be able to do that into the fall. We are now experiencing what other jurisdictions are experiencing as well, in terms of it is more difficult to recruit full-time staff. It is also substantially more difficult to recruit casual staff.
Here in the Northwest Territories, the staff have had cancelled leave through the pandemic. They’re tired, you know, the last four or five months have been highly stressful with the surge that’s happened here. We normally have anywhere between one, two, and three vacant positions. That has in November increased to four and now we’ve had two additional nurses leave. So we’re up to six, and we cannot get the casual staff to augment that staffing need.
People with due dates from December to February are affected right now. What makes the health authority confident enough to put an end date of February on that, or could this yet be extended?
We are doing our best not to extend that. We try to forecast as much as we can in terms of the future. We have engaged an agency to help with augmenting our staff. We have now had two offers that will start in January from agencies. We also, with our own recruitment efforts, have a new staff member starting in January. Those people need some time to onboard and to be oriented so that they’re fully functional and can contribute to safe care. We will continue, through this period, all efforts to recruit staff and to retain those that we have. With the additions that we know are coming on and with our ongoing efforts, we’re feeling pretty confident that we will be able to serve the population of the Northwest Territories after that time.
Having said that, it is a very competitive environment. And as you know, the healthcare system across the country has been stressed and that is going to play out in the future. So we will continue to do all efforts to safely staff the hospital. With what we know is coming, we’re feeling pretty confident that we can begin full services in February.
You mentioned retention briefly in there. People who work at the hospital wonder what the retention strategy is. What are you doing?
I mentioned the challenge of the last 20 months. Hospital work is pretty stressful, this is on top of that. We have under way a number of strategies to gain a deeper understanding of what might help with retention, enhancing our retention strategy. There are exit interviews happening, there is a survey happening. There is engagement with staff in the hospital. Before we put additional solutions to that, we need to get a better sense from our front-line staff in terms of what would help them with the retention strategy.
I might be able to help on that front. Your staff tell me that at the moment, the normal shift at Stanton’s labour and delivery unit involves three nurses: one dedicated to labour and delivery, and two to postpartum, who care for people after they’ve given birth. And one of those two postpartum nurses must be labour and delivery trained. The nurses who do those jobs say that staffing level, Georgina, is too low. Dangerously low. And it means people in active labour often do not get the one-to-one care that they’re supposed to. Nurses tell me they’ve complained about this for years and it hasn’t changed. Why is that staffing level set that way, and why is that concern not acted on?
The staffing level in obstetrics has been three staff on, on days and nights. Over the last 10 years or so, the overall level of number of births has steadily been going down. We are currently at about 540 per year. There have been requests to add a fourth nurse at all times. The nature of obstetrics is that we have significant swings in the volume, the number of patients that are delivering at any one time. So the staffing level needs to hit that sweet spot in terms of being able to navigate the normal swings that happen in obstetrics. When the volume exceeds the number of staff that we have, we do make every effort to bring in additional staff. When we’re in this tight staffing situation and when staff are already picking up significant overtime, it becomes more difficult to call in additional staff when the number of patients increases.
Whether four staff are needed at all times? We are currently looking at that. We’ve looked at the pattern of staffing. We’re also having conversations with the staff on the unit in terms of: what are other things that are taking their time, that are frustraters, that are stressing them? One of those pieces that regularly comes up is we also have a number of novice staff. So we make every effort to have a balance between local staff, which is better for retention over the long term, and experience coming in from elsewhere. But we need to provide them the training so they can become trained obstetric staff. That takes some time. We work with organizations in BC and Alberta to increase the training and the skill level of our staff. Currently, of our nine staff, two of those are not labour and delivery. They have training in obstetrics, but not that labour and delivery component.
It’s a complex issue. There isn’t a simple solution to it. We’re working together with the staff and the management team, and our partners within the greater authority and within government, to understand the issues that make these roles stressful, and to look at what we can do to decrease the stress level.
How many active labours can a labour and delivery nurse safely work on at once?
That all depends on the stage of labour that a woman is in. If they are in active late-stage labour, then a woman needs one-to-one care. If they’re in labour but it’s earlier-stage labour, they need less intensive care. If they’re postpartum, after delivery, they also need significantly less care. It really depends on the stage of labour that the person is in. On top of that, what’s the total volume of people that are in labour and delivery, postpartum? And then the other piece that happens is women coming in for assessments, in terms of getting an assessment of where they’re at and whether they need to come in. That also happens. So there’s a mix of things that happen. The piece where they need one-to-one care is when they are in late-stage active labour.
And do they always get that at Stanton?
We do our best to do that. And we put in significant effort, when we don’t have it, in terms of finding resources to support that care.
I have also heard concerns that a lot of the nurses who work here, they have young families, they sometimes want to work part-time so they can balance shift work with having young children. How is that encouraged and allowed? Can people get part-time work?
The ongoing challenge is meeting staff needs and wishes and to safely operate the hospital and, in this case, the obstetrics unit. That’s an an ongoing balance that we try and strike. We do have a number of positions that are part-time that are, for example, 0.7 or 0.8. But we need to maintain that balance of being able to staff the unit and being able to help staff meet their own needs. We also have several relief positions that don’t have a committed schedule, but that also doesn’t allow for stable staffing of the unit. It’s tricky to strike this balance between meeting staff needs and meeting the operational requirements to support safe care for the public.
More broadly, we’ve had staff from quite a lot of units at the hospital get in touch over the past two months. Of course, they’re all tired. They’re all frustrated. And some of that is pandemic-related. They uniformly say the big issue here is that they don’t feel listened to – that meetings are held, staff convey what are quite deeply held concerns that they have, and nothing happens for years on end. And it’s not a new issue. They’ve been reporting that for some time now. What are you going to do about that widely held perception among your employees that nothing they say matters?
I mentioned earlier about a number of efforts under way to gain a deeper understanding of the frustrations and the issues, that might help with solving that. The challenge we have is that it is a very competitive market out there across the country. That healthcare workforce is exhausted. We used to have, you know… that gap in terms of the advantage of working in the North has decreased. And the workforce is exhausted and hospital work is challenging. And it’s a balance between meeting all those needs and being able to operate a hospital in a safe way.
That’s going to be an ongoing challenge. And the challenge is just going to get tougher, given what the healthcare workforce has gone through both here and across the country. We’re working with the work that we’re doing in terms of gaining a deeper understanding, and at the same time working with across government and with our system partners to look at what we can do to support that.
I do have to press you though, Georgina. I’ve spoken to enough staff that I feel as though I’ve got a representative sample. They uniformly say it’s not to do with the national shortage – maybe a little bit of it is – but the issue here is the challenge, not of working in hospitals in general, but of working at this hospital. Do you see that your staff feel that way?
You know, I engage with – I have conversations with the staff on a regular basis. There are things that are within our control to fix, and address, and there are other things that are not in our control. It is a very tough environment. I’ve been in healthcare for 30 years. This is a tough environment. People raise issues and sometimes have suggestions that go with the issues. Each of those needs to be considered in terms of durability, impact on quality of care and patient safety, and impact on the safety of other staff working in the environment. So if I’m raising an issue that solves the short-term problem but creates a long-term problem or puts patient safety or staff safety at risk, all of those things need to be considered. It’s a challenging environment. I don’t know what else to tell you on that. It is a very challenging environment.
You did mention a moment ago there that you felt as though things are only going to get tougher as well, which I’m sure is not necessarily what people want to hear. Is there anything you could say that provides some optimism for staff that this is going to get better?
We have a number of improvement initiatives in the hospital, improvement efforts, those will continue. Some of those slowed down a bit in our surge in the summer, because we needed to redirect those efforts to responding to the surge. But the improvement efforts are ongoing. And they will continue. We continue to work at solving our staffing challenges both within Stanton and across the system.
This is going to be an ongoing journey and there’s no quick fix to it. I wish there were.