In the early months of 2020, residents in six communities across New Brunswick let out a sigh of relief after hearing that proposed healthcare reforms, that would have cut overnight emergency room services, would not go ahead.
But over a year later, two of those emergency departments are facing temporary service reductions, resulting in calls for long-term solutions to the human resource shortages driving the closures.
The slate of proposed changes were announced by then-Health Minister Ted Flemming and the heads of both regional health authorities. The reforms would have seen emergency departments in Sussex, Sackville, Perth-Andover, Ste-Anne-de-Kent, Caraquet and Grand Falls closed overnight.
But just weeks later, the reforms were cancelled after widespread backlash. Instead, the province launched a province-wide consultation tour, the results of which have yet to be released.
Then, on June 11 of this year, Horizon Health announced that the Sackville Memorial Hospital’s ER will close from 4 p.m. to 8 a.m. on weekends.
On July 9, the health authority said Hotel-Dieu of St. Joseph in Perth-Andover would close daily at 6 p.m. — even earlier than the February 2020 plan called for.
Sackville mayor Shawn Mesheau says the service reductions have stirred up some of the same feelings of anger the community experienced in 2020, but says it shows the importance of addressing HR shortages across the system.
“Ultimately what it’s done is stirred up the thoughts of what happened in February of 2020, but really what we’re dealing with healthcare-wise is something ongoing that we’ve been dealing with for many years,” he said.
Horizon has said the Sackville closure is temporary, but no date for a return to normal has been given, as just six of nine registered nurse positions in the ER are filled.
Mesheau says the hospital plays a crucial role in the community, providing primary healthcare for the thousands of students who spend part of the year attending Mount Allison University, while also attending the the emergency needs of the town and surrounding area.
He says that the next round of healthcare reforms needs to reflect those dual needs.
“First and foremost, we have to get our ERs back to that 24/7 coverage,” Mesheau said.
“But where do we go after that and not be in a position where we are reacting to announcements and actually being part of the collaborative process?”
In Perth-Andover, Horizon said that the service reduction will last until September. But Mayor Marianne Bell isn’t particularly confident in that projection.
“We’ve seen more problems than we have innovative solutions to the nursing shortage,” she said.
“If we saw some action from Horizon and the Department of Health, we could feel more confident. But we aren’t seeing an increase in training positions, we don’t see a contract for the nurses.”
In both cases, the critical issue is a shortage of nurses. According to the union, it’s an issue that isn’t going away.
“The nursing shortage is getting worse,” said Paula Doucet, president of the New Brunswick Nurses Union (NBNU).
“This is just the tip of the iceberg when it comes to the lack of human resources that we have to currently deliver healthcare in all of our communities across the province.”
Doucet says there are 854 permanent vacancies in the province — up about 150 from April of this year. She says working conditions and pay continue to be a barrier to recruitment and as fewer nurses are continually asked to do more, conditions only deteriorate further.
“If we have 25 units that are open but you only have enough staff to man 20 of those units, hard decisions need to be made,” Doucet said.
“The long-term effects this is having on the system is not conducive to healthy work environment.”
The NBNU has been without a contract since the end of 2018 and Doucet says she sees “a light at the end of the tunnel” in negotiations, but says the union, health authority and the government will need to come together to address the ongoing issues in working conditions.
Health Minister Dorothy Shephard says the roots of the shortage are deep and that it’s not a problem that can be solved quickly.
“None of this is a switch. It is an evolution. We are digging deep and we are working really hard at getting nurse recruitments,” Shephard said.
“As with other medical professionals, the shortage is not for New Brunswick alone, but now we’ve seen where we’ve been and we know where we need to go.”
So far this year, Shephard says the province has recruited 72 nurses internationally. She says that number is normally in the teens. Enrolments in nursing schools are up too, but are still down from 10 years ago.
In the five-year period between 2010 and 2014, the province saw 5,517 enrolments. That dipped to 4,069 over the next five years, leaving a gap of 362 potential graduates.
“I’ve never indicated that fall will bring an end to all of our challenges, In fact, I’ve said repeatedly that these challenges are not going to be overcome overnight,” Shephard said.
But the reduction in services in the short term has opposition parties questioning past promises of the government.
In the wake of the cancelled reforms in 2020, Premier Blaine Higgs promised that hospital cuts would not happen under his government. That promise, along with the arrival of the COVID-19 pandemic, allowed Higgs to pass the 2020 budget and avoid an election that looked increasingly likely in the weeks before.
During the election campaign that summer, Higgs said that hospital cuts were not on the table. Both the Liberals and the Green Party view these current service reductions as a violation of that promise.
“They’re using the nursing shortage to justify it,” said Liberal health critic Jean-Claude D’Amours. “Or to just say, ‘We have no choice, this is the reality we face in New Brunswick.'”
“There’s no plan to make sure in a week, in a month, in two months, that all the services will be back on track.”
Green MLA Kevin Arseneau says it’s up to the government to ensure that the current situation doesn’t continue to worsen.
“It can’t get worse,” Arseneau said.
“You talk with healthcare professionals, you can’t let it get worse. The government has a responsibility right now to keep it at status quo and start pushing it uphill.”
Back in Perth-Andover, Bell says she isn’t sure the premier’s promise was a practical one to make. But now, she wants to see a plan for how exactly the province will deliver healthcare to her community and those like it.
“We can’t demand to have the emergency room open or have acute care beds in our facility if there truly are not nurses available to staff the positions. We’re not asking for unsafe levels of care,” she said.
“It’s just frustrating that long-term improvements in recruiting and retention aren’t being made so we don’t have these crises.”