One night in March, an understaffed hospital in Red Lake, a tiny town in northwestern Ontario, took the drastic step of shutting down its emergency department. Road signs bearing the ‘H’ symbol to guide drivers along the 60-mile route toward the hospital were covered up. The next hospital was more than two hours away.
Sue LeBeau, the chief executive of Red Lake Margaret Cochenour Memorial Hospital, took a picture of the covered hospital road sign. “This is something that moved me to tears when I saw it,” she said.
It was the first unplanned emergency room closure in Ontario since 2006, and it signaled a growing crisis, not just in one province, but across Canada. Since then, dozens of emergency rooms across the country have been forced to close, usually for a night, but sometimes for a weekend, because they don’t have enough workers.
A shortage of nurses — who have been driven away from the profession by unsafe working conditions, wage dissatisfaction, and burnout from the pandemic — has pushed Canadian hospitals to the brink.
With an underfunded public health system, Canada already has some of the longest health care wait times in the world, but now those have grown even longer, with patients reporting spending multiple days before being admitted to a hospital.
Nurses’ unions and other medical organizations are pushing for provincial governments, which administer health care in Canada, to declare the situation a “state of emergency” and direct more funding to address it.
“I don’t use those words lightly,” said Dr. Paul Parks, president of the emergency medicine section of the Alberta Medical Association, an advocacy group representing about 14,000 physicians in the western Canadian province.
“It is really a disaster mode because the definition of disaster in medicine is that the demand outstrips the ability to supply the care,” he said. “That’s what’s happening every day in our hospitals across the country.”
The United States and other countries, including England, are grappling with similar issues. Some U.S. states have tried raising nurses’ wages and Oregon called in 1,500 National Guard to help overwhelmed staff, in desperate attempts to fill the gap.
In Ontario, Canada’s most populous province, the shortage of nurses has recently forced 16 emergency departments to close, according to Ontario Health, the agency that oversees health care administration in the province.
The lack of health care workers means it takes longer for doctors to transfer acutely ill patients to hospitals with more resources and those doctors are waiting longer to find a bed, said Christine Moon, a spokeswoman for CritiCall, a 24-hour consultation line for Ontario doctors, in an email.
It’s a scene playing out across Canada. In British Columbia, a province where almost one million people do not have a family doctor, there were about a dozen emergency room closures in rural communities in August.
In Newfoundland and Labrador, the emergency room at one community hospital in a region of more than 300,000 people closed from July 1 until August 29.
In Saskatchewan, the union representing nurses in the province said the emergency room at Royal University Hospital in Saskatoon was 200 percent over capacity in late August because of the nurse shortage. The situation was much the same when Tasha Jiricka, a 24-year-old with fibromyalgia, a chronic pain condition, arrived there by ambulance earlier that month.
With intense stomach pains and unable to eat or drink, Ms. Jiricka, was assessed by nurses who thought she should be admitted, but for three days there were no open beds in the 407-bed hospital. She sat in the emergency waiting room, in pain, until one became available.
“Honestly, the only thing that got me through were the other people who were waiting,” said Ms. Jiricka in a phone interview from her hospital bed.
“We have a work force that is exhausted, demoralized, and looking at the door after toiling through the pandemic, suffering real wage cuts and working in an environment that is often unsafe for them,” Michael Hurley, president of the Ontario Council of Hospital Unions, said at a news conference in August.
To help address the crisis, the nation’s health authorities are trying to attract nurses from abroad and retain current or recently retired staff.
Jean-Yves Duclos, Canada’s health minister, announced last month that he was reinstating the position of chief nursing officer, a person who helps shape national policy, and a role that the government scrapped a decade ago.
“We need to support our nurses, make sure they are heard and that their challenges are met with solutions,” he said at a news conference alongside Leigh Chapman, a nurse and researcher who was appointed to the position.
Canada spends more on health care than all but four countries. Last year, the federal government provided 42 billion Canadian dollars for health care through a funding arrangement that increases by at least three percent per year to each of the country’s 13 provinces and territories.
But provincial leaders say that’s lower than the five percent yearly increase in the costs associated with delivering health care and are pressing the federal government to boost annual funding by at least 28 billion Canadian dollars.
Although provincial governments have ultimate control over financing for health care, including the power to raise taxes, their leaders say they can’t afford it.
In Ontario, the provincial government capped wage increases for most public sector employees in 2019, citing budget issues. Unions representing health care workers there blame the staffing shortage on the cap and the chronic underfunding of health care.
“Frankly, we need to make working in hospital better paid and safer,” Mr. Hurley, the hospitals’ union president, said, calling for financial incentives to increase the hiring and retention of experienced nurses and the addition of more full-time positions that would include insurance benefits. About 30 percent of Canada’s nursing jobs are part-time, according to data from the Canadian Institute for Health Information.
In Toronto, severe staffing shortages prompted the University Health Network, a group of five facilities that are home to some of Canada’s foremost health researchers, to issue a critical care bed alert, a warning to other emergency facilities that a hospital would not be able to readily accept transfers of critically-ill patients, said Dr. Kevin Smith, chief executive of the hospital system.
The warning typically lasts a day or so but at the health network’s Toronto General Hospital, the alert was in effect between July 22 and Sept. 2.
“Increasingly, I think many of us realize we are not going to, in the short term, train our way out of this,” said Dr. Smith. “We can’t produce nurses quickly, with the exception, possibly, of some foreign graduates.”
That’s an option that some provinces are turning to. Ontario’s health minister, Sylvia Jones, directed licensing authorities to “make every effort” to register health professionals who were internationally trained “as expeditiously as possible,” according to letters sent last month to those authorities.
Even before the pandemic, emergency departments were among the most dangerous work environments in hospitals.
Health care workers experience workplace violence at four times the rate of other workers, and half of those incidents happen in the emergency room, according to a 2021 statement by the Canadian Association of Emergency Physicians.
That violence, coupled with the increased level of risk that nurses are shouldering by serving more patients with less help even as the pandemic endures, has accelerated burnout.
“I think we’re just going to keep losing people because at a certain point, you don’t keep working in that environment,” said Dr. Carolyn Snider, the chief of emergency medicine at St. Michael’s Hospital, one of two trauma centers in downtown Toronto. “That is my biggest worry.”
In a 2019 parliamentary committee report on the issue of workplace violence, health care workers said that fewer staff led to more violence because patients and family members become frustrated with the lack of attention.
It’s something Cathryn Hoy, president of the Ontario Nurses’ Association, hears about regularly from the members of her union: punching, spitting, kicking, and two stabbings in the last six months, she said.
“Nursing is the backbone, and the heartbeat of health care,” she said. “Unless health care touches you, you don’t think about it.”