By Sue Tiffin
Emergency departments at hospitals in Haliburton County could be closed during certain hours and days in the coming weeks.
In an open letter to residents of Haliburton County, Carolyn Plummer, president and CEO of Haliburton Highlands Health Services, said ongoing challenges of staff shortages could lead to the closures, and that the situation could “persist for some time.”
“We want to share with you some of the obstacles facing our organization and the impacts it may have on you,” wrote Plummer, on behalf of the HHHS board of directors, in a letter first posted on social media on Nov. 22. “Our continued challenges around staffing and nursing capacity mean that, in the coming weeks, it is very likely we will need to reduce service at one of our emergency departments, including closures during certain hours and days.”
Plummer said the letter was being shared to prepare residents, “as much as possible for this in advance.” She noted that HHHS had been speaking about staffing challenges throughout the pandemic, but that “health human resource shortages pre-date the pandemic,” and exist provincially as well as throughout the country and world.
“It has been a particular problem in rural communities, and there are other locations in Ontario that have been forced to reduce services due to a shortage of nursing staff,” wrote Plummer. “This has been compounded by more typical staffing challenges, including retirements, injuries, parental leaves, and health issues, as well as factors influenced by the pandemic, including burnout and stress.”
Plummer told the Times on Nov. 23 that HHHS is primarily dealing with a shortage of registered nurses and that staffing models mean it’s not simply a matter of positions, but also shifts and schedules. HHHS is actively recruiting for an emergency department physician, registered nurses, and registered practical nurses.
“Although we have cast a net far and wide, seeking support from staffing agencies across the country and other healthcare organizations across Ontario, health human resource issues are everywhere,” wrote Plummer. “If we are unable to find adequate staffing, we will have to close one of the emergency departments during a set number of hours and days. This situation may persist for some time and we may not be able to forecast when we can resume full operation at both emergency departments.”
No decision has been made yet about which emergency department will need to reduce services.
“Patient and staff safety has been and will continue to be at the forefront of our discussions,” wrote Plummer. “We will also continue to be led by our values of compassion, accountability, integrity, and respect. To make this difficult decision, we will consider typical volumes of patient visits to each emergency department; current staff schedules, gaps, and staffing models; the geographic location of each Emergency Department in relation to communities across Haliburton County; and feedback from our partners, including but not limited to the Ministry of Health, Ontario Health East, and Haliburton County Paramedic Service.”
If the situation continues and HHHS reduces service at one of the emergency departments, Plummer said this decision will be communicated to the community as soon as possible, no later than 48 hours in advance of a planned reduction of hours or closure. However, HHHS will, said Plummer, “continue to do everything we can to find, hire, and train the staff needed to keep both our emergency departments open, and explore all possible support options and opportunities.”
She asked that those in the community refer qualified staff to HHHS, noting permanent, full-time positions are available, as well as part-time and casual positions and that “as much as possible, access care through your family doctor or nurse practitioner whenever possible.”
“While this is not the situation anyone wanted to face, we are heartened to know that our incredible team at HHHS, our local health and emergency service providers, and the community as a whole will do all we can to keep each other healthy and safe,” said Plummer.
Plummer stressed the current staff shortage is not related to the vaccination policy in place at HHHS, that the staffing issues had been building and HHHS had been trying to deal with them for some time.
Initially Plummer had said at a Sept. 23 board meeting that HHHS would not have a vaccine mandate in part because the requirement for mandatory vaccines might lead to even more drastic staffing shortages. That decision was reversed after the provincial government, on Oct. 1, announced that COVID-19 vaccinations would be mandatory for all long-term care home staff in the province.
“The vaccine policy process is one that has evolved over time; the decisions have been difficult, and have not been made lightly,” Plummer told the Times in October in response to the change. “When the initial iteration of our vaccination policy was implemented, our vaccination rate was lower – i.e., fewer staff were vaccinated; also at that time, we were facing significant staffing challenges. Like several other smaller hospitals and healthcare organizations, we were concerned that a vaccine mandate could result in the need to reduce or even close some of our services. We also knew the policy would evolve as the overall situation across the province evolved. At this point in time, more and more healthcare organizations are mandating vaccines, and the Ministry of Long-Term Care has now mandated vaccines for all long-term care staff, including those at HHHS who staff our two long-term care homes. Based on the need to support equity across the organization while also creating a safe environment for our patients, residents, clients, and staff, we updated our policy accordingly. At the time of the most recent policy revision, our staff vaccination rate has improved and our staffing challenges are less acute than they were several weeks ago.”
Plummer said at that time both positive and negative feedback had been received regarding the initial policy direction and the revised policy direction.
“I want to be clear that we were beginning to project this staffing shortage before our vaccination policy came into effect and the policy has not impacted our shortage of registered nurses,” Plummer told the Times. “Prior to November 15, 97.4 per cent of staff were either fully vaccinated or had received one dose and were able to continue working with regular testing and proof of their intention to receive their second dose once they are able. No registered nurses were placed on leave or resigned due to the policy, and the majority of the small number of staff on leave are in support areas rather than direct patient care.”