MONTREAL - Union representatives call chronic understaffing at the Lakeshore General Hospital's emergency room "critical," and say steps need to be taken immediately to relieve overwhelmed nurses.

The comment comes after nurses on the evening shift at the Lakeshore General Hospital's emergency room refused to report for duty Saturday evening when the ER was overloaded with patients. The staff returned to work at 8 p.m. after the hospital brought in more employees to cope with overcrowding.

While the situation had eased Sunday, Roberto Bomba, affiliated with nursing union Fédération interprofessionnelle de la santé du Québec, it remains dire.

"Things are critical, but better than yesterday. We feel that the evening and the night will be manageable," he said.

Nurses did not report for their shift Saturday when staff of five nurses and five nursing assistants was scheduled.

"They feel that working here this evening puts their licence at risk, so they decided to walk off the job," said Bomba.

The emergency room's maximum is 31 patients; Saturday afternoon, the Pointe Claire hospital's ER rose to 55 patients. By 8 p.m., the hospital brought the ER's number down to 47 thanks to opening up beds in other parts of the hospital.

Extra staff was also brought in to cope with the influx of patients.

Hospital officials said they recognized the gravity of the problem.

"This is far from ideal. Unfortunately we're dealing with a situation of staffing shortage, and we also have an overcrowding situation. We're dealing with bed accessibility," said Diane Somerville, director of general services for the Lakeshore.

"We're the only ER in the whole of the West Island and we have a huge volume of demand we're trying to respond to," she said.

Bomba said nurses felt they would not be able to adequately care for over 50 patients with five nurses.

"On (the day shift) it could have been functional, however on evenings, when you should be 12 or 14 nurses to cover an emergency room, and you're only five, that's a huge problem," he said.

Nurses felt the best course of action was to have day staff remain on overtime, he explained.

"Licensed nurses have to work under safe conditions, it's their licence that comes in play, and if something were to happen, we know these people wouldn't be protected under their employer," he said.

The hospital and the union agree the Lakeshore General Hospital did not have the same problem for the overnight shift and is not anticipating the same issue Sunday.

Saturday was the first time nurses have refused to report for duty at the Lakeshore General Hospital.

Somerville said the hospital is working to resolve the ongoing problem.

"We're trying to put in place some immediately solutions, but some of the things we're doing in terms of solutions don't have concrete results immediately and I hope we'll be to resolve this within a short period of time," she said, pointing to short term solutions such as hiring more nursing assistance, reorganizing schedules, and working to attract and retain staff.

"We'll manage this immediate situation as we have to, we'll do whatever is necessary to survive this, but we'll also try to address this problem so it's not continual," she said.

Somerville and Bomba agreed it is difficult to predict how many patients a hospital will receive from one day to the next.

Barring life-threatening emergencies, all ambulances were detoured to other hospitals Saturday evening.

The ER remained open to patients, though officials urged those who needed medical assistance – but were not facing a life-threatening emergency – to visit a clinic.