Union claims made Thursday of a registered nurse shortage at long-term care facilities are supported by licensing records obtained independently by CBC News through freedom of information legislation.
All long-term care homes with 30 or more residents are required to have a registered nurse 24 hours a day. Since 2013, 15 facilities, all in rural Nova Scotia, self-reported instances where they failed to meet that requirement, according Department of Health records.
The 2015 licence issued to the Mahone Nursing Home Bay owned by the MacLeod Group notes the home failed to meet the requirement in every year between 2010 and 2014.
"As such, the administrator shall continue efforts to recruit additional RN staff and submit a plan to investigation and compliance to meet this requirement," Nova Scotia Health and Wellness wrote when it issued the licence in August 2015.
MacLeod Group did not respond to an interview request.
No sanctions for RN shortage
The failure to meet mandated registered nurse staffing — in some cases on multiple occasions — has not resulted in any sanctions, according to licence renewals.
The facilities cited are owned by the largest companies in the province, such as Shannex, MacLeod Group and Gem Health Care Group. Operators interviewed by CBC News readily admit the shortage is a challenge.
"Over the last number of years, we have had shortage with RNs," said Debra Boudreau, an administrator of Tideview Terrace, a brand new long-term care facility in Digby. It failed to meet staffing requirements in 2014 and 2015.
"We've increased our complement of licensed practical nurses," Boudreau said. "We've given them some support and maybe a little additional training and we've used them to fill those vacant shifts that would normally have been filled by an RN."
Licensed practical nurses fill the gap
At Tideview, two managers are registered nurses and on call 24 hours a day in case they are needed by LPNs, Boudreau said.
LPNs refer urgent cases to other health-care professionals, including the on-call RNs, as well as doctors and emergency health services.
The use of LPNs is a practice that if not sanctioned, is accepted by the provincial government.
Tideview is not alone.
In "isolated situations" at Shannex facilities where an RN is not on site, it's usually because one has called in sick and a replacement cannot be found, spokesperson Heather Hanson said in an email to CBC News. Shannex also relies on LPNs to fill the gap.
"When required, LPN collaboration with the RN on call would occur over the phone. Once an action plan is determined, they would decide together whether the presence of the RN is required on site," Hanson said in the email.
On Thursday, the Nova Scotia Nurses' Union held a news conference to release a report on the shortage, claiming a "crisis" in long-term care aggravated by the shortage of registered nurses in facilities where there are more patients who are ill.
Operators say shortage not a 'crisis'
Operators reject the claim the shortage is a crisis.
"We have RNs. We have LPNs. We have allied health members on our care teams and they all work collaboratively," Boudreau said of Tideview.
"While we would all like to see additional resources and have more bodies, at the end of the day we function and we provide the best care that we can."
Shannex refused to comment directly on the nurses union report.
"Safety is central to all of our decisions," Hanson said in the emailed statement.
"We always have an experienced and capable LPN on site, to ensure the safety and well-being of our clients. Having 24-hour access to an on-call RN and manager ensures ample opportunity for collaboration and quick responses for client care."
The nurses union made 15 recommendations to improve long-term care in Nova Scotia. Around 6,900 people live in long-term care in 90 facilities across the province.