Hospital focuses on staff and culture issues
Listening to staff has been the key to improving workplace culture
As we wait for the Ford government to acknowledge our need for a new medical facility, the leadership at Campbellford Memorial Hospital has spent the past two years focused on changing its workplace culture and meeting staff needs.
Years of financial shortfalls, staff shortages, turmoil at the executive level, and COVID-19, triggered 77 professional complaints by registered nurses in the medical/surgical ward who felt patient care was being compromised because they couldn’t do their jobs properly.
Under the collective agreement for the RNs, those complaints led to an independent assessment committee review in June 2023. The three reviewers prepared a scathing 102-page report in August 2023 that included 141 recommendations for improvements.
Heather Campbell, Vice-President and Chief Nursing Executive, joined the hospital in January 2023, after the assessment process had been triggered but in time represent the organization at the hearings.
“I think there was certainly low morale, certainly feelings of mistrust,” she says in an interview. “I can't say for certain 100 per cent because I'm only speaking for my feelings, but I do truly feel like we've built some good trusting relationships.”
The change has been driven by listening to the frontline nursing staff and responding to their concerns, Campbell says, something they complained wasn’t done in the past.
“It’s all about listening. They just needed to know that we understood their concerns.”
Nurses complained about being short-staffed and objected to a plan that reduced the number of RNs on some shifts. In response, Campbell and CEO Jeff Hohenkerk, who joined CMH in March 2023, have found ways to add team leaders, more RNs, and more support staff.
Those changes allow nurses to nurse, instead of doing other things like catching and removing bats, as one complaint noted.
From April 25, 2017 until June 5, 2023, the nurses filed 77 professional responsibility workload reports that identified issues they wanted management to address, 86 per cent were about inadequate staffing.
“Our representatives have met with this employer and note that our members are pleased so far with the progress made in staffing levels,” says Erin Ariss, president of the Ontario Nurses’ Association. “The hospital is working with us and this has improved morale among the nurses, though there is still work to be done.
“The hospital continues to use agency nurses more often than is the average, though they are now providing the agency nurses with orientation, which is helpful.”
Agency nurses are those hired from companies and paid two to three times the normal wage rate. Hospitals across the country have increasingly relied on them due to a staff shortage. The nurses who work for the agencies make far more than they would as regular staffers and often have better schedules.
Among complaints that led to the independent review, were that agency nurses received no training or orientation on how the local hospital works.
The assessment report says: “It has been well documented agency nurses are not effective substitutes for permanent, experienced registered nurses in terms of patient safety.”
Campbell says the hospital has reduced the number of agency nurses it hires and has a plan to get to zero over the next year.
The hospital is constantly in hiring mode. At the moment, it has 15 nursing openings in the inpatient unit and emergency department, a spokesperson said. The jobs are full-time, part-time, and temporary for parental leave. Also, it has eight non-nursing clinical openings, in the laboratory, diagnostic imaging, pharmacy, and a physician assistant.
So while the municipality is spending more than $150,000 a year to attract physicians, the need for other healthcare workers remains just as great.
Campbell says the hospital has been successful in attracting nurses who are completing their education for extern openings, funded by the province. It hopes to demonstrate the benefits and joys of Campbellford living and persuade some of them to stay permanently.
These local efforts are happening in the context of province-wide contract negotiations between the nurses’ association and the Ontario Hospital Association. Five days of talks earlier this month went no where, and the two sides are set for mediation this Wednesday and Thursday.
Ariss told her 68,000 members that her No. 1 goal is to negotiate staffing ratios. “The last time a deal was negotiated was a full 14 years ago,” she said in a news release. “Unfortunately, what the OHA has tabled would have unimaginable consequences for the nursing and health-care professional workforce and devastating outcomes for patients.”
The Campbellford report says that among the non-nursing tasks RNs have had to do are “answering the phone, collecting garbage and laundry, meal tray collection, cleaning floors.”
In 2021 a nurse complained about having to get rid of an errant bat. “Bat removal should not be an expectation of registered nurses. Nursing responsibilities should include securing the area where the bat was seen and conduct patient assessments to ensure they have not been exposed to the bat and offer reassurance. Security and maintenance staff must be notified immediately and assume the responsibility for bat and bat droppings removal.”
“The RN turnover on the medical surgical unit has been significant, as has the turnover of other regulated and unregulated staff,” the report says. “Since 2017, there has been an almost 400 per cent turnover of part time RNs, 200 per cent turnover of full-time staff and more than 50 per cent turnover of casual RN staff.”
“The reality of being a rural and remote hospital, the escalating provincial wide nursing shortage, along with multiple nursing and HR leadership changes at CMH have created a significant degree of instability for nursing staff,” it says. “These issues in place long before the pandemic was made worse with the impact of the COVID 19 pandemic.”
Executive turnover also has been a problem at the hospital, the report says.
“The Chief Executive Officer (CEO) role has been replaced four times in five years. The CEO, who most recently left the position, had been in the role for only 18 months. The current candidate in the CEO role began on March 20, 2023. The Chief Nursing Officer (CNO) position has turned over four times since 2017.”
The report says Campbell’s role as chief nursing executive is a key one for establishing a vision and culture focused on quality care.
One issue that the nurses raised was safety and the need for more security guards who were better trained. Campbell said the hospital agreed and has switched to a different security service that has guards who are trained to operate in a hospital environment and de-escalate issues.
The nurses’ association says only 22 of the 141 recommendations have been totally responded to, but Campbell says the change in approach and obvious recruiting efforts have led the two sides to move away from the assessment report to a more normal approach with problems handled by the existing hospital association committee. It was the inability of that committee to settle disputes in 2022 that eventually led to the independent review.
“We weren't able to resolve the fact that the building is 70 years old and there are a lot of those issues that I'll never be able to fix in my lifetime until we've got a new building,” Campbell says.
One thing that helped the hospital respond to the issues was that the ministry agreed to fund it for 38 beds, instead of the previous 34, and that extra money was used for staffing.
However, Campbell says the hospital has complained to the ministry that its base funding is not enough to cover all the services it is supposed to provide, leading it to constantly scramble for money or to provide less service than needed.
A greater focus on education and training is also helping the hospital to retain the nurses it manages to hire. In the past, some would have moved on to bigger facilities that offered more opportunities.
“Retention will be an ongoing issue for the next five to 10 years,” Campbell says.
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Thanks Art for keeping us informed. Who would have thought this problem excisted.
How about the covid "vaccine" mandates? I am certain that has a massive impact on staffing.