Workload reports written by on-shift Winnipeg nurses show concerns over patient safety and employee burnout in city hospitals and long-term care homes, largely as a result of understaffing.
Nurses are expected to fill out a reporting form when they experience workload problems while on the job that did or could have had an impact on patient safety.
Reports obtained by CBC News offer a rare insider's view of nurses' workload-related issues in Winnipeg's health-care system.
CBC News obtained more than 100 of the forms via an access to information request. Prior to releasing the information, officials redacted the names of the nurses who filed the forms.
In 2009, city nurses filled out more than 2,300 of the forms. That total is up from 2005, when just over 1,900 were filed.
Among other things, the reports note the date, staffing levels and working conditions at the time. An immediate supervisor is offered a chance to respond on the same form to the concerns.
40 patients, 2 nurses
Among the nurses' concerns were insufficient staff, lack of beds and too many patients to manage.
In one report, a nurse working an overnight shift at the Misericordia Urgent Care Centre in June 2010 noted 40 patients were waiting after 11:30 p.m., but only two registered nurses were on duty.
The nurse indicated the situation presented a number of potential hazards to patients, including the possibility of injury, missed vital-sign abnormalities and lack of communication. The nurse also reported that the situation created a risk of staff injury and burnout.
The supervisor's notes upon learning of the report suggest the issues presented are nothing new.
"This situation is not uncommon and is very dangerous for staff and patients," the supervisor stated. "I concur [with] nurses that staffing numbers should be increased on nights."
A survey of other reports CBC received filed by nurses at St. Boniface Hospital in Winnipeg detail workload concerns in the facility's obstetrics units. Some note problems with overlooking patients' vital signs and improper feedings. In one, a supervisor flags a staff shortage issue surrounding the scheduling of breaks.
"Was post-partum nurse watching 10 pts. [patients] because of breaks?" the supervisor questioned in the report.
'No safety cushion'
The Manitoba Nurses Union said its research showed understaffing is the reason 80 per cent of the forms were filed.
'I don't think there is necessarily a correlation between workload forms and patient safety. I am not saying there isn't — I am just saying there isn't necessarily' —Lori Lamont, WRHA's chief nursing officer
"I've come to work exhausted because I had to. Can patient safety be impacted? I'd be crazy to say no to you," MNU president Sandi Mowat said.
"But I do believe that all of us, as nurses, go above and beyond to make sure that doesn't happen."
University of Toronto nursing researcher Raquel Meyer suggested overtaxing nurses can have a direct impact on patient safety.
"When the workload gets too high, it's kind of like running the engine in the red zone. So running at full speed all the time means there's no safety cushion and eventually the engine burns out," Meyer said.
The Winnipeg Regional Health Authority's chief nursing officer acknowledged the workload-related problems, but suggested they are not persistent.
"Certainly we have days when things are incredibly busy and staff get a little bit of a breather a few days later, hopefully," said Lori Lamont, who is also a vice-president of the health region.
The WRHA has added 413 nursing positions in the past five years but still has 788 that remain to be filled, Lamont said. She added that any perceived connections between the workload forms and the quality of patient safety may not ring true.
"I don't think there is necessarily a correlation between workload forms and patient safety. I am not saying there isn't — I am just saying there isn't necessarily," she said.