Respiratory care at HSC overburdened, understaffed even before COVID-19, unions say
Province may switch to team-based care, cancel surgeries if demand for ICU care goes up
With more than a quarter of respiratory therapist positions vacant at the Health Sciences Centre and a shortage of intensive care unit nurses, unions are urging people to self-isolate, wash their hands and practise social distancing to prevent an overwhelming surge of COVID-19 on the system.
At HSC, 30 per cent of respiratory therapist positions are vacant, according to the Manitoba Association of Health Care Professionals, which represents allied health care workers.
Respiratory therapists (RTs) work in ICUs and emergency departments and specialize in patients' airways, oxygen needs and ventilator care.
COVID-19 is a respiratory disease with the most severe cases requiring hospitalization and constant ICU care by a registered nurse and an RT. Manitoba's first seven cases have not required hospitalization.
"We're going to struggle with anything more than a few people coming in that need to be cared for," said Bob Moroz, MAHCP president, adding the healthcare unions have been crying out about system capacity issues long before the outbreak.
"There's just not enough of us now to manage the normal flu season. Our folks have been stretched to the max already, doing more with less."
Manitoba has 85 ICU beds between the HSC, Grace, St. Boniface and Brandon. Respiratory therapists work and are integral to all of them, according to Moroz, but at HSC, burnout and stress rates are highest.
Patients generally receive one-to-one nursing care and get ventilation support in ICU, according to the Manitoba Nurses Union.
In January, 246 of 333 critical care nursing positions were filled at hospitals across the city, according to the MNU, with 147 of 212 filled at the HSC. The recent graduation of about 30 nurses from a critical care nursing course will help, according to the union's president, but the situation is concerning.
"The critical care nursing vacancies are still high," said Darlene Jackson.
"There is a bed crunch when it comes to ICU beds and that is a situation when we are not in a public health emergency."
Shared Health Services did not immediately respond to CBC's request for overall respiratory therapy positions, and the union did not have the numbers.
According to data obtained by the Manitoba Nurses' Union in January, the ICU nurse vacancy rate was about 15 per cent at St. Boniface Hospital and 21 per cent at the Grace, not including the 30 recent CCU program graduates, some of whom are licensed practical nurses. Health Minister Cameron Friesen has previously stated that eight per cent is considered a "normal" nurse vacancy rate.
"The public really needs to understand that if this COVID-19 peaks, as it has in some countries, we are not going to be able to manage caring for all the patients requiring care in ICUs and in critical care," said Jackson.
She said that's why social distancing and self-isolation are crucial public measures, as well as proper hand-washing and hygiene.
"When we talk about flattening the curve, it just means slowing it so that those patients that require the care can get the care when they need it over a longer period of time."
Bracing for a surge in cases
Public health officials have been preparing and planning for weeks for a potential surge of COVID-19 cases in Manitoba, and have experience from influenza and H1N1 outbreaks, according to Lanette Siragusa, chief nursing officer and provincial lead for health systems planning and quality.
She said there are 243 ventilators in Manitoba, plus the ones already in operating rooms and another 20 on order.
But they don't run on their own.
"We have been working on those vacancy rates, it is not 100 per cent perfect for sure," she said Tuesday.
She added the province would look at implementing measures, as it has in the past for influenza outbreaks, of using a team-based approach to care for more patients at once.
"There might not be enough critical care nurses for one-to-one, but if we put people together in a model where they have support from a respiratory therapist and another nurse and a critical care nurse, then together they can take care of a larger group of patients," she said.
Shared Health may look to recovery rooms for extra space and nursing capacity, she added. Retired nurses and doctors may also be brought in to care if required, though the preference now is for registered nurses with an active licence.
"I think there's a role for everybody to come and help. So we're not saying no."
While the measures will help, Jackson and Moroz agree Manitoba's system is already operating at capacity.
'Where are they going to go?'
"A safe hospital occupancy rate in terms of bed occupancy is around 85 per cent and most urban hospitals in this country try to function at over 100 per cent capacity and fail," said Alan Drummond, chair of the Canadian Association of Emergency Physicians.
"If it does become a serious illness, where on earth do you think we're going to be able to put people? We have no space in hospitals. Where are they going to go?"
Saragusa added there's a team co-ordinating with the College of Registered Nurses and hospitals to assess where nurses are and where they could be pulled from in the event they're needed.
Jackson added the union has also been working extensively with employers and government to see how members would be deployed to areas in need.
"I think working together we will get through this. But it has to be an entire community public effort, not just government, employers and health care. The public have to understand how important this is."
With files from Bartley Kives