Load shedding in hospitals | When a handful of nurses change the game

A handful of nurses motivated to make a difference.

Caroline Touzin
The Press

Five nurses from Jean-Talon Hospital (HJT), to be more precise. Five others at Fleury Hospital. And seven at the Sacred Heart Hospital.

Over the past four weeks, in the midst of the fifth wave, that’s what it took to change the lives of 512 patients awaiting surgery.

Many of these patients have cancer.

So many patients convinced that the extent of the load shedding caused by the force of the fifth wave would compromise their chance of going under the knife at the start of 2022.

The Press tells you about the creative solution of the operating room teams of these three hospitals of the CIUSSS-du-Nord-de-l’Île-de-Montréal which allowed patients to be operated on, despite the current load shedding.

In the health network, load shedding is when an employee is asked to leave their service to lend a hand elsewhere, where the needs are more urgent.

In popular parlance, the term is also used to describe the cancellation or postponement of operations and appointments deemed less urgent to make room for patients infected with the coronavirus.

The great effect of a few

So how could such a small number of nurses make such a big impact?

At the end of December, due to the meteoric rise in hospitalizations due to COVID-19 combined with a record absence of healthcare staff due to the virus, operating theaters began to idle again (operations reduced to 50%) in the province.

Except for urgent cases, it was impossible to carry out operations requiring hospitalization, for lack of sufficient personnel on the floors.

Several nurses from the operating room were then about to be moved elsewhere in the network. One more time.

It was imminent.

This is where Régis Godin and the D^r Michal Nowakowski – two operating room managers at HJT – had an idea that would change everything.

“I found it appalling that we weren’t operating when I had staff,” says Mr. Godin, acting head of the operating room at HJT.

What if the nurses in the operating room were to lend a hand in day surgery? thought Mr. Godin and the D^r Nowakowski. The advantage of day surgery is that it does not require hospitalization, except in cases of rare complications.

Surgical waiting lists keep getting longer due to the pandemic. Those in day surgery are no exception.

Cancer patients are on this list.

However, the staff of the day surgery department had already been offloaded to other floors due to the high number of absent colleagues, knocked out. by the virus. In this context, no one-day intervention could take place.

However, the tasks of nurses are very different in these two departments. In the operating room, they assist the surgeon during the operation. In day surgery, they are not “physically” in the operating room. They prepare the patient before the operation and take care of post-operative care, ensuring that the patient is fit to go home the same day.

With a short training given to nurses in the block, it would be possible, the two managers thought. The D^r Nowakowski was inspired by what he observed during trips to the regions as a “troubleshooting doctor”.

This is already done in small hospitals far from large centers, in the Magdalen Islands and Gaspésie, in particular, explains the anesthetist. The nurses there have to be versatile, doing both operating theater and day surgery.

But the nurses still had to be motivated, otherwise the project was doomed to failure, specifies Mr. Godin, himself a nurse by training.

“This is where we feel the most useful”

“We would all have liked to stay in the operating room, it’s our specialty,” says nurse Guillemette Manzoni. But the day surgery department, that’s where we feel the most useful and efficient right now, since that’s what comes closest to our expertise. »

Met at the end of January, on the day surgery floor of the Jean-Talon hospital (HJT), the nurse shows us her list of patients for the week. There are cases of breast cancer, hernias, bariatric operations, stoma closures.

A column of numbers catches our attention: 825, 594, 853, etc. This is the number of days the patient waited. Thus, for a bariatric operation, some have been waiting for almost three years.

These days, patients cry with joy, others utter cries of happiness when they enter the hospital to finally go under the knife, says the nurse.

Longest-waiting patients and oncology cases are given priority for day procedures, says Dr.^r Michal Nowakowski.

“Imagine a woman who learns that she cannot have her tumor removed for two, four, sometimes six months because of the critical situation in hospitals. Think of the anguish at the idea that the cancer is not developing in her during all this time, ”continues nurse Guillemette Manzoni, visibly happy to be able to have an effect on the lives of these patients.

live in fear

This anxiety, Annik Bergeron knows it too well. The 46-year-old mother was diagnosed with breast cancer on November 3. She was then offered a total mastectomy of the right breast and reconstruction. Her oncologist tells her that the whole thing will take place during a one-day operation after the holidays.

However, from mid-December, the stress of M^me Bergeron climbs with the cascade of announcements from Quebec on the critical situation in hospitals. What if I can no longer be operated on in January? she says to herself. “I was afraid that the cancer would develop,” says this associate director of compliance and scientific review in a bioanalytical laboratory.

During these stressful weeks, her two teenagers – great athletes – limit their contact as much as possible to avoid putting their mother’s fragile health at risk. The life of the whole family is on hold.

When M^me Bergeron receives the call from the hospital on January 13 – for a one-day intervention on the 17th – she is surprised. The word is weak. “I consider myself lucky to have had the operation so quickly,” she says. The nurses had great energy; very caring. »

Drop of water in the ocean?

A drop in the ocean when you look at the surgery waiting lists that have been growing for two years?

In Jean-Talon, between January 10 and February 4, “it’s still 193 patients operated on in day surgery instead of 0 if we had not found this solution”, underlines Mr. Godin, enthusiastic .

Thanks to this idea – but especially thanks to the will of the nurses, insist the managers –, for the same period, Fleury carried out 189 and Sacré-Coeur 131 (total of 512).

“The impacts of load shedding will be felt for a very long time”, warns the D^r Kowakowski.

“In all seriousness, the time before we can return to the level of our waiting lists before [la pandémie] is not of the order of months, but many years, continues the anesthesiologist. So each patient that we can operate at the moment, in the middle of load shedding, is important. »

“We were more creative, more agile”

Operating theaters closed while hospital beds are free.

These images from the first wave of the pandemic still haunt surgical teams.

” [À l’époque,] we were ready to welcome the patients, but we had to close the operating rooms “on the order of Quebec to prepare for a possible arrival of patients with COVID, recalls the D^r Pierre Garneau, head of surgery at the CIUSSS du Nord-de-l’Île-de-Montréal (NIM).

“The directives came from the ministry [de la Santé]. No one moved. We were more contemplative, he recalls. But we tore our heads off to see so many empty beds. For us, there was an incongruity because we knew the state of our waiting lists. »

Greater autonomy for hospitals

Today, in this fifth wave, the lack of beds is also problematic, underlines the D^r Garneau, “but it’s not because we kept beds empty, it’s that we no longer have staff”.

As the Ministry of Health has allowed hospitals greater autonomy in this fifth wave, the CIUSSS of the NIM has been able to devote resources to day surgery, explains its head of the surgery department.

Result: by giving priority to oncological cases, this CIUSSS was even able to reduce certain waiting lists. “For breast cancer, our waiting list is better than it has ever been,” said Dr.^r Garneau.

“We learned lessons from the first wave, says the head of operative pre-admission at the CIUSSS du NIM, Manon Rolland. And we used it for the fifth wave. We better anticipated our human resource and hospital bed constraints and we were more creative, more agile. »

That being said, “despite all the good solutions put in place”, overall, it will take years to make up for the delays accumulated in surgery during the pandemic, warn M^me Rolland and the D^r Garneau.

But at least, in this umpteenth wave, the surgical teams feel less helpless.