Doctor says 3 ICU patients to one nurse is 'ridiculous'

As Winnipeg hospitals brace for the peak of third wave hospitalizations, signs are emerging that there is not enough nursing staff to care for the expected influx of critically ill patients in the coming weeks.

Normally ICU nurses provide one-to-one care with some exceptions, but now they're taking up to three patients at the Health Sciences Centre, St. Boniface Hospital and the Grace Hospital, although health officials say the sickest patients will still be assigned their own nurse.

"Covering three to one is ridiculous," said Dr. Anand Kumar, a Winnipeg intensive care physician and infectious disease specialist who does not believe hospitals will start rationing ICU care based on a triage protocol.

"They're just going to stretch the nurses more and more," said Kumar.

"When [the system gets] this stressed, there are limited ways you can respond to it," he said.

"You can ask inexperienced nurses to do a lot more than they're ready to do. You can ask more experienced nurses to cover multiple patients."

Kumar says patients who would normally be admitted into the ICU are remaining on the wards because there are no ICU beds available.

"Bad stuff is going to happen," he said. "A certain portion of [patients] will again deteriorate and have to be managed emergently on the [ward] with less support and less equipment."

A spokesperson for Shared Health says the demands of COVID-19 have put enormous pressure on critical care staff but safe patient care is always the first priority.

"Some patients will require 1:1 care, others may be appropriate for 1:2 care and others awaiting transfer to a ward may be appropriate for a higher ratio where the clinical team determines it to be safe," said the Shared Health spokesperson in an emailed statement.

Shared Health would not say what the maximum number of patients per ICU nurse would be.

• Manitoba transfers 3 COVID-19 patients to Thunder Bay hospital

At the Grace, the ICU medical director acknowledged the level of sacrifice made by nurses in that unit by imploring them to take care of their most basic health needs.

"Eat, hydrate, breathe...go pee," read an email authored by Dr. Heather Smith obtained by CBC News.

"Self-sacrifice will not work. We cannot run into a burning building."

She said it is still possible to provide safe care, adding, "I will NOT call this the new normal."

Manitoba Nurses Union president Darlene Jackson says nurses are concerned that they will always be expected to work short staffed with no breaks and forced overtime.

"Nurses are terrified that the staffing situation right now is going to be the new normal," said Jackson.

Jackson says she regularly gets calls from sobbing nurses who are exhausted and emotionally crushed by the decisions they are forced to make because of short staffing.

She heard from one ICU nurse who had to choose between which of her two patients she could comfort as they took their final breath.

"Patients are truly dying on their own ... she had to make a decision about which patient she would hold their hand while they died," said Jackson.

"That absolutely broke her."

When asked to comment on what the email to Grace ICU nurses says about the working conditions at the hospital, a WRHA spokesperson wrote "it demonstrates leadership, teamwork and compassion for her colleagues, and a commitment to getting the job done for our patients."

The WRHA says staffing levels in critical care are being expanded as needed at the Grace and at other critical care facilities to address the ongoing patient surge via the reassignment and redeployment of staff from other areas.

Fifty-one nurses have been redeployed to Winnipeg ICUs from Concordia Hospital, Misericordia Health Centre, the Pan Am Clinic, Seven Oaks Hospital and Victoria General Hospital.

Only five of the 51 nurses have recent ICU experience and the rest came from working in an operating room, surgical unit, recovery room or post-anesthesia care unit prior to redeployment, according to the spokesperson from Shared Health.

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