What went wrong inside Yellowknife’s obstetrics unit
The suspension of labour and delivery services at the Northwest Territories’ main hospital is a consequence of local failings, not a national staffing shortage, workers involved say.
In a news release on Monday, the NWT’s health authority attributed the suspension to a “national nursing shortage and high demand across all jurisdictions for nurses.”
However, staff with direct knowledge of the obstetrics unit’s operation say the closure is at best tangentially related to that national shortage. They say the real issue is staff keep leaving because the unit is inadequately managed, placing staff in dangerous and stressful situations.
“I’ve been in the most terrifying situations of my life there,” said one person, referred to as Worker 1 in this article.
Cabin Radio spoke with three current and former employees who have significant, recent, and verified experience of working at Stanton’s obstetrics unit. Their names and any identifying information are not being used as they fear reprisals or the loss of their jobs if managers are able to work out who they are.
Worker 1 continued: “I’ve had to run out of my delivery room, where three people are delivering at once, hear the bell go, run into the middle of a resuscitation on a newborn, only to find out a 28-weeker is about to deliver and I’m going to be in the nursery with two unwell babies while I’m abandoning a postpartum who delivered 20 minutes ago, because we have no help.
The workers who spoke to Cabin Radio say there are two main issues: shifts at the unit are not appropriately staffed, and managers have refused to address that concern for years. As a result, nurses leave and the working environment worsens – to the point where too few staff remain and services are suspended.
“It’s not a nice place to work,” said Worker 1. “It’s hard to read the things that management releases because most nurses find they are blaming the pandemic and nursing shortage, which does exist, but isn’t the reason for ongoing issues at Stanton.”
Worker 2 said: “This is not an issue of a national nursing shortage. This is an issue of extremely poor management from years back. This is not new to Stanton. We had been saying for so long that we could not believe the place had not shut down yet.”
Regular one-to-one care ‘impossible’
On any given shift in the obstetrics unit, Stanton assigns three nurses. Nurse A is dedicated to labour and delivery. Nurses B and C are assigned to postpartum – in other words, care of mother and baby once birth has taken place.
Of the two postpartum nurses, one must also be trained in labour and delivery so they can help Nurse A if needed.
Workers with experience of working those shifts say that staffing level is dangerously low and places staff in stressful environments where they cannot guarantee patient care.
“We’ve been asking since I started to staff four nurses there. The ability to provide safe and appropriate care at the current level is basically impossible,” said Worker 1.
“Anyone in active labour should have one-to-one care. We provide such great care, the nurses that work there are so good at what they do, that often the public raves about the care they receive from us. We don’t let on to them that we’re rushing between three different rooms.”
Worker 3 described being the only labour and delivery nurse available when four deliveries were taking place at once. “No one got one-to-one care,” they said, describing sustained efforts over years to convince management that a fourth nurse per shift is needed.
That nurse could be a labour and delivery nurse or could be a charge nurse without assignment. In many hospitals, a charge nurse coordinates what’s happening on a unit and is not assigned specific patients, meaning they can pitch in to help anywhere on the unit as required if demand escalates.
At Stanton, the obstetrics unit’s charge nurse is one of the three nurses that already has assignments, meaning they must coordinate the unit on top of what is often a full patient workload.
One-to-one care is the standard for someone in active labour. On Tuesday, Stanton chief operating officer Georgina Veldhorst – who holds ultimate responsibility for many staffing decisions – told Cabin Radio: “If they are in active late-stage labour, then a woman needs one-to-one care.”
Worker 2 said: “That almost never happens at Stanton. Very frequently in Yellowknife, there is more than one person in active labour. Sometimes there are six at a time. I have been in a position where I have been monitoring four women in active labour by myself.”
Worker 2 said monthly meetings take place in which nurses “beg management to give us a fourth nurse.”
“We were trying to prove with numbers and statistics and everything why we need that fourth nurse,” they said. “We were not being told no but it was being pushed aside, pushed aside, pushed aside. To the point that our nurses are leaving.”
‘This unit is terrible’
Workers with experience of Stanton’s obstetrics unit reject the notion that the national nursing shortage is a significant factor in this week’s suspension of services.
They say the stress of working with too few staff scheduled, and the feeling that nobody is listening to that concern, is a much bigger problem.
“If there is a national nursing shortage, we would be seeing this everywhere,” said Worker 2. “There is a nursing shortage, but that’s not why labour and delivery at Stanton has shut down.
“We have lost the majority of our very good nurses on the unit. We have in the recent past had nurses move here and immediately turn around and leave. We have had locum nurses turn up … they literally look us in the face and say, ‘I would never work here full-time, this unit is terrible.’
“Everyone knows how bad the working conditions are because there are just not enough nurses.”
Worker 3 said: “I don’t know if there are words. The point we have reached is unimaginable. It’s the entire reason people are leaving. There is no voice, there is no hope, there is no change.
“We just had two nurses leave who had asked for part-time positions. They were told no and so they left.”
Veldhorst confirmed two nurses had left the unit in recent weeks, creating a total of six current vacancies on the unit. Workers with knowledge of the unit say eight or nine nurses are currently employed, where a pool of at least 15 would ideally be available.
The issue of part-time work is an example of a concern where workers and management appear to have separate understandings.
“We have a lot of women. In general, nurses in Canada are in their child-bearing years,” said Worker 3.
“Having children and working full-time shift work is not easy. There’s no dayhome in Yellowknife allowing you to drop your kids off at 7am. Things don’t work for shift workers in this town.”
As a result, nurses with young children like the idea of part-time work at Stanton that would allow them some ability to raise a child while retaining their job.
Veldhorst says offering that part-time work presents a challenge.
“We do have a number of positions that are part-time,” said the chief operating officer, “but we need to maintain that balance of being able to staff the unit and being able to help staff meet their own needs.
“It’s tricky to strike this balance between meeting staff needs and meeting the operational requirements to support safe care for the public.”
However, if full-time nurses who are denied the move to part-time work simply decide to leave, the hospital is left in an even worse position.
Workers interviewed for this article said they could count eight to 10 trained labour and delivery nurses who have taken other jobs in Yellowknife – at local clinics, for example, or desk jobs at the Department of Health and Social Services – rather than remain on the obstetrics unit.
If working conditions were better, they say, that supply of nurses would solve Stanton’s staffing problem, and the suspension of services, in an instant.
Staffing ‘sweet spot’
Veldhorst insists work is being done to address staff concerns, though she questioned the obstetrics unit’s request for a fourth nurse.
“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,” Veldhorst said.
“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.”
Veldhorst said staff had also expressed concern about “novice staff” needing more training, and said that was being worked on.
More broadly, she said: “The challenge we have is that it is a very competitive market out there across the country. That healthcare workforce is exhausted. That gap in terms of the advantage of working in the North has decreased.
“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.”
Yet workers say Veldhorst and hospital managers have been told of these problems for years, the problems have not gone away, and something now has to give.
For the time being, the thing that has given way is Yellowknife’s ability to deliver babies.
“I wasn’t surprised,” said Worker 2 of Monday’s service suspension. “It’s been something we’ve said for years. We’ve gone through these things so many times as people keep leaving.
“OK, so this is finally happening. It’s really sad, though.”