A Winnipeg woman with lupus says the loss of a specialized team of nurses who delivered intravenous treatments at the Health Sciences Centre is causing unnecessary delays in care and discomfort for other patients, as well as putting added stress on hospital staff.
Under the Winnipeg Regional Health Authority's consolidation plan, a team of nurses who specialized in intravenous care was reduced by about 15 registered nurse positions in November to cut costs. A PICC — or peripherally inserted central catheter — team of six nurses was created in its place, with different responsibilities.
It's something Debbie Dohan says is affecting the care she, and patients like her, receive.
Dohan, who has lupus — an autoimmune disease in which the immune system attacks healthy tissue — has been visiting the infusion room at the HSC at least once a month for the past eight years to get blood work and central-line care.
She has a port-a-cath, which is a device inserted under the skin that goes into a vein, through which blood is taken or treatments given.
'It's not [the nurses'] fault that the care is not the same as it was before. It's [that] there isn't enough staff. It's scary.' - HSC patient Debbie Dohan
Until November, she said, "the care has always been so wonderful."
Now she says she's "finding it difficult, not only for myself, but seeing other patients sitting there crying, because they're being poked and poked and poked. And I'm not feeling good and I'm tired, and I'm sitting there waiting and waiting and waiting for someone to help me."
Dohan said since the loss of the IV, or vascular access, team of nurses in November, she's had to make two visits to the hospital instead of one for the same intervention on several occasions, because of how busy the PICC nurse is.
Dohan's port-a-cath often clots with blood, which is cleared by a special medication called TPA — tissue plasminogen activator — before her line can be accessed for medications or blood work. In the past, a nurse on the IV team has administered and withdrawn this medication, she said, without delay.
Now, she has to wait several hours for a PICC nurse to be available to get the TPA put in her line. Since the medication takes several hours to work, she's had to return the next day on her past "six to eight visits" to get the TPA taken out and her blood work drawn, because the infusion room closes in the evening.
"When you're not feeling good already, you're sore — with lupus you're very sore, you're fatigued — I was not having a good day," she said of her last visit, earlier this month, when she was sent to a room in a different part of the hospital to wait four hours for the PICC nurse to give the medication.
"It's very upsetting. It's very upsetting. It's not fair to the nurses. It's not fair to the PICC nurses," she said.
Other patients face delays
But the loss of the IV team isn't fair to the patients either, she added.
The infusion room is an open area in the rehab building at the HSC where day patients go for all kinds of IV medications. The intravenous team used to start all of the patients' IVs each morning, but now that's up to the infusion room nurses — who may not have the level of IV experience the previous team had — and it adds to their regular workload.
"People that have constant infusions, meaning their veins are being poked a lot, they get a lot of scar tissue build up, and they can't get an IV in anymore. So if the nurses can't get an IV in, and there's no PICC nurse to come put an IV in, [the patients] go home," said Dohan.
She said she's seen this happen at least twice, and recently rode in the elevator with one woman who was "extremely upset" she would have to return the next day for her medication because no one could start an IV that day.
Dohan said without the IV team, if infusion room nurses can't start an IV they have to bring in the PICC nurse, which is also causing delays in care.
"The IVs are getting started later, which means patients are staying longer, which means paying more for parking or cancelling Handi-Transit," Dohan said.
"People coming in from out of town, they're phoning … and saying, 'Don't come yet, I'm not finished.' It's delaying a lot of patients," she said.
Concerns for patient care
The president of the Manitoba Nurses Union is concerned about patient care, given the increased workload of the PICC nurses. They are not supposed to be starting IVs, said Sandi Mowat — they're there to take care of the central lines.
"There's one [PICC nurse] for the whole building so sometimes she can't get to her calls in a timely fashion," said Mowat. "She has many other assignments."
She said she would argue that one PICC nurse per shift to service the entire hospital, as well as the Children's Hospital, is not adequate, especially if they're starting IVs in addition to their central line duties.
'I just would hope that someone is looking at what impact this has had on patient care and evaluating if the decision was correct.' - Manitoba Nurses Union president Sandi Mowat
"I still don't understand where the savings is in all this. If there's patients that aren't being able to receive their treatment, that causes problems first of all for the patient, but then the patient has to be rescheduled," she said, adding the clinics are very busy.
According to the College of Registered Nurses of Manitoba, TPA administration is within the scope of practice of all registered nurses, but that may depend on policies of individual hospitals.
"If the infusion clinics wanted to have the RNs working there do that, then we would suggest they would have to look at the staffing very closely and they would likely have to add extra staff," said Mowat.
The union president is concerned the effect of the changes goes beyond the nurses she represents.
"I just would hope that someone is looking at what impact this has had on patient care and evaluating if the decision was correct and if not, [is] looking at what they can do to improve patient care."
Worried about the wait
Dohan is apprehensive about her HSC visit next month, because she doesn't know how long she'll have to wait for the PICC nurse.
"One person cannot do the whole HSC. When I was there to get it taken out, it was the same lady that put the TPA in on Thursday," she said. According to Dohan the two talked about how busy the nurse was.
She hopes the Winnipeg Regional Health Authority and the province hear her call to add more PICC nurses, even if only a couple.
"It's not [the nurses'] fault that the care is not the same as it was before. It's [that] there isn't enough staff. It's scary."
In a statement, a spokesperson for the HSC wrote, "We are very sorry to hear about the patient's experience and are concerned about the issues she has raised related to her care."
The spokesperson said it is unusual for a patient to need their central line cleared out as often as Dohan, and the hospital plans to reach out to her to understand how to "better meet her needs."
The spokesperson said the shift from the IV team to a model where all nurses start IVs has been occurring throughout North America and already occurs at other hospitals in the city. However, the spokesperson said the transition at the HSC "has experienced some growing pains as all nurses build their skill and competency."
But Dohan is still concerned about the patients — including herself — for whom the PICC team is still called for, and insists reducing the complement of specalized IV nurses from 21 to 6 is too drastic.
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