Lakeshore Hospital ER a 'time bomb' due to critical staff shortage, chronic overcrowding: report

The conclusions of a 317-page report released in October on the Lakeshore General Hospital’s emergency room are unequivocal: current staff shortages are "extremely worrying," both for the health-care professionals and the patients.

"With the current staffing situation, this is a time bomb," wrote independent expert and nurse Marie Boucher about the hospital in the Montreal suburb of Pointe-Claire.

Given that more than half of the positions are vacant, management has to face the fact that "an emergency plan must be put in place…in emergency," she stated.

Boucher prepared the mediation report for Montreal’s West Island CIUSSS and for a Quebec nurse’s union, the Fédération interprofessionnelle de la santé du Québec (FIQ).

The report obtained by CTV News describes a work environment where staff is overburdened with tasks that only increase in number and intensity, with this year described as the worst ever.

The facts related in the report are not new to those who know the file well, said Kristina Hoare, a nurse and spokesperson for FIQ in the West Island.

"The report really does reflect the reality and the cries made by the staff over and over again, since 2018," Hoare said.

Since then, she said, the FIQ has fielded more than 500 complaints from ER nurses at every level of the profession.

The overtime requirements at Lakeshore are unusually demanding because the emergency room is missing 52 per cent of its full-time staff.

In 2021-2022, 27 per cent of the hours worked on evening shifts and 25 per cent of the hours worked at night were overtime hours.

"So that means they've already worked eight hours and they have to do another eight hours. It's when you're tired, you get cranky, you aren't maybe as respectful for your co-workers. It's a vicious circle," said Hoare.

She pointed to two types of difficult situations that have become part of nurses' day-to-day realities in the ER that stood out for her as she went through the report herself and read their testimonies.

"That patients are being put into briefs because the staff do not have time to take them to the washroom," she said.

"The fact that patients are being restrained because there's not enough surveillance in the emergency room…because they do not have enough eyes, hands and bodies they cannot assure the safety of patients or [their] well being," Hoare said.

The health-care workers reported being exhausted by the work conditions and also by a "toxic" environment in the hospital’s ER.

"Indeed, the climate was characterized by almost all [91 per cent +] of the respondents as heavy, negative and harmful to employees," Boucher wrote.

Boucher noted that the burden brought about by staff shortages is compounded by the increase in the number of patients seeking emergency care.

Included in the report are emails that read like pleas for help, sent by nurses to supervisors or managers following particularly difficult shifts. Their identities have been protected.

"The triage nurse was completely overwhelmed with patients and it is a direct result of her being alone," one extract reads. "Both nurses had no breaks. This situation is not unique."

Other extracts describe situations in the ER as "incredibly dangerous," "unsafe and unacceptable."

Another staff member writes that colleagues want to speak up about the intolerable conditions but "many are now afraid of retribution," the report said.

While most hospital emergency rooms in the Montreal region are gasping for air, Hoare singled out St-Mary's Hospital ER as "heading in the same direction," as Lakeshore General.

"It's starting to have occupancy rates that we've never seen before for St. Mary's," she said.

She said the West Island health authority which manages both institutions will need to apply any potential remedies to both health-care sites before the situation at St. Mary's deteriorates further.

URGENT RECOMMENDATIONS

Boucher's report makes a series of short-term and long-term recommendations that focus on improving the safety and quality of care for patients and work conditions for staff.

Within the next six months, the Lakeshore should work on dealing with the constant overflow of patients in the ER to reduce overcrowding, she wrote.

"Just because it has been a problem for several years does not mean that it is acceptable. The quality and safety of patients, especially those on stretchers, are not assured," Boucher wrote.

She suggests recruitment activities prioritize the ER, stressing that it is "vital" they hire 30 new health-care professionals within six months.

At the same time, she called on managers to make every effort to retain the staff who care about the patients and who despite the burdens "choose to come to work in these conditions every day."

"I think her use of the expression ticking time bomb really emphasizes the feeling of the staff and what we've been trying to denounce for years and years," said Hoare, adding she hopes this report will make the government finally take notice.

A spokesperson for Montreal's West Island CIUSSS said a joint committee has been established with the unions to find "sustainable solutions."

"We have taken note of Ms. Marie Boucher's report and the recommendations are currently being analyzed by our teams in order to identify any adjustments to be made to the action plan already underway," Hélène Bergeron-Gamache wrote in an email.