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Island Health says no emergency rooms on northern Vancouver Island will permanently shutter as an ongoing staffing crisis continues to force temporary closures in small communities.

The overnight closure of the Alert Bay ER is being extended another two weeks due to a lack of nurses, Island Health announced last week.

The nightly closures of the Cormorant Island Community Health Centre emergency room were originally scheduled until Aug. 16, but now the ER will continue to be shuttered daily between 7 p.m. and 8 a.m. until Aug. 31.

Alert Bay residents fear the closures might become permanent.

The impact on the island community’s ER follows repeated temporary closures and patient diversions at the Port Hardy and Port McNeill ERs in July and August.

There’s a 40 per cent vacancy rate for staff nurses at the Port Hardy and McNeill sites, and COVID-19 sick calls are compounding the problem, said James Hanson, Island Health vice-president of clinical operations for Central and North Island.

“We are not at all satisfied with the situation in the North Island, and access to care in that region is a huge priority for us,” Hanson said, adding the health authority is working non-stop to try to reduce the service gaps, but at this point is not considering combining staff at ER sites to guarantee more consistent service.

“We're doing absolutely everything we can to avoid that,” he said.

In addition to constant nursing recruitment efforts, in the short term, Island Health sends out system-wide requests for staff from more populated centres in the South Island to volunteer to fill gaps that might arise suddenly due to sickness, he said.

The increasing reliance on temporary contract nurses is contributing to the hollowing out of public health care and will likely only aggravate the nurse staffing crisis, says health policy researcher @a_longhurst.

Staffing shortages in rural and remote communities existed before the pandemic, with the health authority relying on private sector contract nurses, or agency nurses, to fill the gap, Hanson said.

However, now that the medical staffing crisis is a problem across the province — in rural and urban communities — even agency nurses are in short supply, he added.

“Health-care systems as a whole, not just Island Health, but in B.C., Alberta, Ontario and even throughout the world, are relying on more agency and private nursing than they ever have,” Hanson said.

Island Health is making some headway in establishing an “internal agency” of travel nurses from within the health authority to fill gaps in smaller communities, he said.

Island Health is asking staff in the South Island if they would temporarily relocate to underserved regions like Alert Bay, Hanson said.

“We’d provide transportation, housing, anything they need to make that transition.”

Island Health has increased funding to the North Island and is looking to overstaff the region so it can better weather staff absences, Hanson said.

“I’ve given the approval to hire several more lines of nursing so that we're not as vulnerable to short-term sick calls as we currently are,” he said.

“The challenge is trying to find folks to come in and live in the region permanently.”

To achieve more consistent staffing, Island Health wants to negotiate different terms with nursing agencies that would see contract staff making commitments of six to eight months in the North Island.

The health authority is also working with communities to secure accommodations for staff given the lack of available housing, Hanson said.

Andrew Longhurst, a health policy researcher at Simon Fraser University, said that heavy reliance by health authorities on agency nurses is a quick-fix form of creeping privatization that will likely only aggravate and perpetuate the nursing and primary health crises at greater expense to the taxpayer.

“It’s a really vicious cycle that hollows out public sector nursing,” Longhurst said.

It’s no wonder nurses — burned out by the pandemic, family obligations, staffing shortages coupled with heavy workloads, and mandated overtime — are exiting the public system for the private sector, he said.

Contract or agency nursing pays better, even if it doesn’t provide job security or benefits that come with unionized work in the public health-care system, he said.

And however welcome the extra help from agency staff might be, it means more work for the public nurses, who have to train and supervise better-paid private peers to familiarize them with a facility or unit.

Relying on temporary or agency nurses isn’t sustainable, doesn’t ultimately address long-standing staffing concerns, and can lead to compromises in the quality and continuity of patient care, Longhurst said.

Rather than scrambling to hire nurses from abroad, it makes more sense to figure out why nurses are leaving the public sector in the first place, Longhurst said.

“What is driving the workload in our health system? I think that’s a much more nuanced conversation,” he said.

The province needs to take action to ease pressure on the health system by doing more to contain surging COVID-19 numbers, following expert recommendations to stem the toxic drug crisis straining the emergency response system, and bolstering primary care, particularly for seniors who don’t have access to family physicians and care for chronic conditions or home and community supports.

“Too many older adults continue to rely on acute care to have their ongoing health-care needs met, or they end up in a moment of crisis because they haven't had that ongoing care,” Longhurst said.

“Then they end up in a hospital bed and that means that other resources are shortchanged because the system is trying to provide care to too many people.”

A provincial focus on team-based care would help meet communities’ primary health-care needs, attract more doctors to public practice and ease the burden on ERs, Longhurst said.

Team-based care is essentially a public community health hub staffed by doctors and supported by a range of medical professionals, such as mental health counsellors, nurse practitioners, pharmacists and social workers, he said.

“The idea here is you’re sharing the workload in a way that is allowing those professionals to work at the top of their skill set,” he said, adding fewer people would end up in ERs with chronic issues that can’t be adequately addressed at those sites.

Hanson noted that recruitment for the North Island isn’t focused solely on nurses, but on all medical professionals.

“Regardless of what role they play … I want them in the community,” he said.

“But I don't want to be in a place where we're constantly taking new nurses, new people to the region. We're trying to get to a point where we have more consistency in the environment.”

Rochelle Baker / Local Journalism Initiative / Canada’s National Observer