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Southlake steps back on controversial plan for ICU nursing

A petition by the Newmarket hospital's RNs and RRTs protesting the 'unsafe' critical care nursing model has been read into the legislature by six different MPPs since Nov. 22
2021-08-31-Newmarket Demo-00133
Southlake RNs and RRTs rallied outside of Ministry of Health last summer demanding an end to what they call unsafe practices.

After months of contention between Southlake Regional Health Centre and its ICU nursing staff, Southlake is pulling the plug on hiring under-qualified registered nurses to work in the ICU, according to a memorandum obtained by NewmarketToday.

Janis Klein, Southlake's interim director of the regional cardiac care program and intensive care unit, sent the Dec. 7 letter informing the hospital's critical care task force that the controversial "pre-sponsorship" program would end.

"Through the critical care task force, we've heard that staff are not supportive of the pre-sponsorship initiative, so we will not be moving forward with any new entrants into the program," the memorandum stated.

There was no detail about whether nurses who have already been accepted into the program will be required to undergo the full ICU training or whether the hospital will continue with some form of the team-based model in which more than one patient is assigned to an RN in the ICU.

"There were some people who were enrolled into this program, we need to know what this is going to look like," said DJ Sanderson, region 3 Ontario Nurses Union (ONA) vice-president and a Southlake RN. "If they're going to be moving away from this one-to-one way of caring for these incredibly ill and critical patients, then what is that new model going to look like?"

The hope, moving forward, is that new applicants will meet the proper requirements and those who have already been selected under the pre-sponsorship program will receive the necessary training, Sanderson told NewmarketToday. The union also hopes that even if all ICU nurses are qualified, Southlake will not move away from the standard one-to-one ratio.

"In an ICU setting, we want to maintain that you have one dedicated, qualified registered nurse for each and every ICU patient to ensure that all of their needs are met," he said.

The ONA said it's optimistic this will be "a step in the right direction," and the start of Southlake's willingness to engage in discussion moving forward "to make right what's been going on in the ICU."

The issue continued to draw attention at Queen's Park as late as Monday.

During question period Dec. 6, NDP MPP France Gélinas, official opposition health critic, stated that a 1:1 nurse-to-patient ratio is standard in the ICU because critically ill patients can deteriorate rapidly.

The MPP said Southlake's decision to implement a team-based nursing model in its ICU is raising concerns for patient safety among RNs, RRTs and community members.

"That means that now the one fully trained ICU RN monitors her patient but she must also monitor RNs who are not trained in critical care nursing. That is not one-on-one, Speaker, that is not best practice."

Gélinas then directly addressed Health Minister Christine Elliott, who is also deputy premier and Newmarket-Aurora MPP, saying, "Will the minister of health listen to the concerns of her constituents and act now to make sure that every patient admitted to the ICU gets nothing less than one-on-one?"

Elliott made no mention of Southlake in her response and did not directly address her constituents' concerns about the hospital's adoption of a team-based nursing model.

Instead, she listed the actions Ontario has taken to combat the provincewide nursing shortage while assuring that Ontarians "will receive excellent quality care in nursing and any other resources that they need."

"How is this safe, Speaker? This is a cut to the ICU, this puts patients at risk. Nurses, respiratory therapists and a concerned community feel like they are not being heard by their MPP, the minister (of Health)," said Gélinas.

"It's absolutely gobsmacking," Sanderson. "There's one hospital in the Newmarket-Aurora riding and Minister Elliott has refused to engage us on this important issue. The response talks about generalities on nursing in Ontario and money spent but it's still not addressing this incredibly important issue that's going on at Southlake with putting untrained, unqualified RNs into a terrible situation looking after these incredibly ill patients.

"Even though she is minister of health for the province, her primary concern should be the constituents in her riding."

A petition by Southlake RNs and RRTs to change Southlake Regional Health Centre's critical care nursing model has been read into the legislature by six different MPPs since Nov. 22.

"Good goodness gracious, I am so thankful to the folks at Southlake, to our frontline health workers. I absolutely support this petition. I’ve signed my signature to it," said Dr. Jill Andrew, MPP for Toronto-St. Paul's, after reading the petition at Queen's Park this week.

The petition, entitled "Stop Unsafe Patient Care & the Erosion of Quality Critical Care at Southlake Regional Health Centre in Newmarket," has garnered 4,300 signatures to date.

Southlake's practices, the petition states, puts patients at risk and is "driving away the expert and experienced ICU RNs this hospital can’t afford to lose."

The practice in question is a team-based nursing model in which critical care trained and non-critical care trained individuals work together in a team approach, according to Critical Care Services Ontario.

This means that applicants previously turned down for ICU positions due to a lack of educational qualification are reconsidered and learn on the job working with critically ill patients, according to the ONA. New job postings lowered the requirements for these positions.

In a previously provided email statement, Southlake refers to the act of hiring under-qualified RNs for the ICU as a pre-sponsorship program without providing 16 weeks of critical care training.

The petition follows numerous attempts by RNs and RRTs to get Elliott to listen to their concerns and intervene to stop Southlake after a request by RNs in July to meet with Southlake's board of directors was denied, Sanderson said.

"That is my community hospital. That is where my friends and family go when they need health care. I am appalled at the fact she refuses to address this situation," said Sanderson.

Elliott has yet to extend an invitation to the nurses to discuss the matter, he added.

"The fact that we're not getting anywhere with the CEO and leadership at Southlake (is) why we're asking the minister to please intervene to stop this plan so we can have a reasonable discussion and make sure that whatever plan does get put into place is best for the patients involved, the residents of Newmarket-Aurora and the nurses and respiratory therapists that work there," said Sanderson.

Sanderson said public support has been tremendous. When the RNs demonstrated outside of Elliott's office last summer, many members of the community not only signed but marched along with them.  

"We want this hospital and this minister to take our concerns seriously. This is a resource of critically trained RNs and RTs that has been stretched so thin. Not just with COVID but for years and years. To expect these folks to supervise newer RNs who are still without the training is the wrong decision."

"Were hoping that even going forward that Minister Elliott still takes the opportunity to meet with us and meet with the staff there to discuss these serious concerns. Doug Ford quoted back in May, 'We're going to make sure we listen to frontline doctors and nurses,' I think at the very least Minister Elliott, after everything that's happened, still owes these folks a discussion as to how to make Southlake, the one hospital in her riding, the best hospital it can be," he said.

When contacted Tuesday, Southlake declined to provide comment before Thursday.

"We are recruiting staff and expanding our comprehensive specialty training program for critical care, which supports nurses to build their career through side-by-side education, training and support in order to become fully trained Intensive Care Unit (ICU) nurses. Staff will be partnered with existing ICU team members and will work within their knowledge, skill and ability. We are continuing to engage with staff in the ICU," Southlake said in a previously emailed statement.

Southlake has said it implemented the plan as a result of the broader system-wide staffing shortage in critical care units at hospitals across the province.

"The pandemic exacerbated challenges that were already present with recruitment for critical care nursing," Southlake stated. "With quality and patient safety as top priorities, like other hospitals across the province, Southlake has developed a plan to address these pressures while we work to build back the critical care work force."

Elliott's office did not respond to a request for comment.