‘On the cusp of collapsing’: The crisis in our emergency departments is a consequence of poor public policy
Posted on August 9, 2022 in Health Delivery System
Source: TheStar.com — Authors: Enxhi Kondi
TheStar.com – Opinion/Contributors
Aug. 8, 2022. By Enxhi Kondi, Contributor
Welcome to any emergency department in Ontario; the wait time is currently several hours. More beds are no longer the answer.
Welcome to any emergency department (ED) in Ontario; the wait time is currently several hours. For some, this wait will have little negative effect aside from frustration, but for too many others, this delay will be fatal. As difficult as it is, acknowledging the unacceptable disaster of our EDs is the first step we must take toward a solution.
EDs are designed as a specialty unit to treat emergent life- or limb-threatening conditions, usually functioning on a triage basis with the sickest patients treated immediately. In special circumstances — and increasingly more so in rural communities — EDs have also historically provided a partial degree of social medicine, serving as a literal doorway to any health-care resource for which public access is otherwise lacking.
In recent years, exacerbated by the pandemic, our inappropriate overreliance on EDs to meet needs that are better served by community services has led to the present crisis of ED overloading, patient harm and dissatisfaction, staff fatigue and exodus, and overall deteriorating quality of care.
“The health-care system is broken,” an ED nurse tells me. “People come in for all kinds of nonemergencies that should be managed from an outpatient clinic.” Most patients tell her they feel left behind or neglected by Ontario’s health-care system.
Community care — family doctors, outpatient clinics, mental health services and home care, to name a few — are often misconstrued as inessential since they do not treat immediately life-threatening issues. However, judging by how the lack of these services results in an influx of acutely ill patients in EDs, these services are absolutely vital to our population.
Dr. Adil Shamji, a current Liberal MPP and an ED physician of 10 years, echoed a similar concern in our interview last week. He says that undersupported community resources closed during the pandemic, leaving people “with nowhere else to go.” This is one of the fundamental changes leading to a dramatic increase in ED workloads: “If they can’t afford to go to the private sector, which very few people can do, the only place left to go is the ED.”
The other pressing issue is rapidly worsening workforce attrition. The nursing shortage affecting all areas of health care is especially notable in EDs, as nurses seek respite by leaving for more manageable clinical areas or jobs.
As a former ED nurse explains, “quite frankly, emergency nurses simply aren’t valued enough or compensated appropriately. The ED is arguably one of the most difficult departments to work in, and one which requires a lot of skill. I loved my job but the conditions just became too poor to make it worth it.”
A nurse is the first and last person an ED patient will interact with. Nurses are critical to ED operations; as long as there is a nursing crisis, there will continue to be an ED crisis. Shamji confirms this. “In the ED, I simply would not be able to serve my patients without having nurses around; they do procedures that I can’t do, they have longer relationships in the ED with patients than I typically do, and they are absolutely vital in patient safety.”
Asked about the role of medical staff in solving this crisis, Shamji says “we can’t continue to ask more of health-care workers because there’s nothing left to give.” They are not able to “prop up poor public policy and poor government decision-making anymore. It’s asking too much.”
For several years, Ontario has been facing parallel compounding issues of funding cuts to health care, especially in the community, and devaluation of health-care workers, the largest group of which are nurses. It seems these issues have finally converged to create the perfect storm of our present crisis. We need a systemic solution that focuses less on infrastructure and more on the people working within it; more beds are no longer the answer.
As another nurse tells me, “our health-care system is on the cusp of collapsing. It is simply not working anymore.”
This is the second in a six-part op-ed series looking at the nursing crisis in Ontario. Enxhi Kondi is an emergency department nurse in the GTA.
https://www.thestar.com/opinion/contributors/2022/08/08/on-the-cusp-of-collapsing-the-crisis-in-our-emergency-departments-is-a-consequence-of-poor-public-policy.html?source=newsletter&utm_content=a07&utm_source=ts_nl&utm_medium=email&utm_email=0C810E7AE4E7C3CEB3816076F6F9881B&utm_campaign=top_138825
Tags: budget, Health, ideology, jurisdiction, mental Health, standard of living
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