Ken McGeorge: Travel nurses and health authorities; scapegoats recruited

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The media has covered travel nurses and health authority collaboration well and the Auditor General is asking questions. What did you know and when did you know it? Then, in classic New Brunswick fashion, the fingers come out in pursuit of where blame can be ascribed; anywhere but government! There is a lot of blame to go around and government should refrain from overreacting.

Travel nurses? The need was created because the issues in the nursing profession have been allowed to fester untreated for 20 years. The pandemic was the tipping point with the enormous pressure placed on direct care workers by a public health crisis of unprecedented proportions. This, combined with the distress caused by the politics of COVID-19, was unlike any public health crisis in this lifetime. Public health officials and government at all levels were inventing solutions that were created in an environment in which there was pitifully little factual, tried and true information.

The public was scared to death with the publicity and the response taken by various levels of government, based on information they accepted, in good faith, from the World Health Organization and the federal authorities. The media kept the sense of panic going with the incessant news coverage; they, also, were learning for the first time.

On a regular basis, for more than 20 years, the nursing profession has been sending warnings regarding the public policy governing the profession. The Nurses Union kept the warnings coming about burnout, workplace issues, distress with workers, staffing levels. The Nurses Association has had its hands full in dealing with issues brought to them by their members, in addition to the issues of the registration examinations that have caused much distress.

Professional nurses themselves have been very discreet, as professionalism requires, but anyone with a nurse in the family or circle of friends knows their descriptions of workplace distress which has had, over the years, many causes, seldom about compensation rates. Depending on where you work, as a nurse, you may or may not be able to get your entitled vacation due often to short staffing and scheduling issues. There have also been many stories over the years of RNs, having undergone four years of education, not being able to get full-time work, often being offered two or three days per week. Workplace toxicity has also been a recurring theme in private discussion with some of the best.

Then, of course, there has been the issue of declining enrollment and the debate over how many nursing training positions government should fund. When I was asked for a professional opinion on that topic a few years ago, my response was: it isn’t that simple. Dealing with nursing is not a mathematical or bookkeeping question. It is a complex issue requiring knowledge, diplomacy, firm understanding of nursing practice.

So, when serious numbers of good, professional nurses sought to retire in and around the time of the pandemic, what were the health authorities to do? They had operating rooms to staff, emergency departments, acute care wings to staff and more. With the public still reeling from the distress of COVID associated with public and government pressure to keep services operating you go for a solution at hand regardless of cost. To fail to do that would be to allow surgery to be reduced, emergency services to become even more distressed than normal, acute care units to sit empty.

The shortage of professional staff was and is a systemic issue. That the profession has been calling for help and leadership for decades goes without question. The systemic issues should have been on the table in high-level planning involving selected, informed persons, knowledgeable of the relevant public policy issues to be dealt with. Those discussions, not conventional labour, association, or university negotiations, should have been happening 15 to 20 years ago. This is not a government budget discussion but clear public policy and health systems structure.

To their credit, government did, in 2019, publish a nursing resource document that seemed to have involvement by many of the right people. It did not have detailed strategy included with it and it is unclear as to how that document has an impact on the status of the professional staffing.

The medical and nursing professions have been the anchors of the health system worldwide. It is true many other professions are needed to support, perform sophisticated diagnostics and therapeutics and so much more. But central to the system and the governing legislation is the predominance of both professions. And both have been undergoing professional metamorphosis over the last 20 years. Public policy in New Brunswick is only beginning to catch up.

My educated guess is travel nurses will be necessary for a while until the staffing at both health authorities stabilizes a bit. That may be months; it may be much longer. We just need to become accustomed to hefty bills for a while.

Similarly, the issue expressed by Premier Blaine Higgs of the collaboration between the health authorities drew a headline. Just what does that mean and what does government intend. If the intent is to start micro-managing efficiencies by merging microbiology labs between the two hospitals in Moncton, that is the wrong fight to have right now. It is an issue that has had civil servants speculating about possible cost savings since 1997 and, perhaps, earlier.

There have been lots of illustrations of great success at clinical level in the health authorities of professionals collaborating on programs; there is more of that activity than may be realized. If government is intent on seeing more collaboration, I would look for small wins, low-hanging fruit. For instance, both hospitals struggle with the number of patients awaiting long-term care. The number of highly expensive acute care beds occupied by frail seniors, who deteriorate while they are there, is not only distressing but embarrassing. That is a fixable problem, but not without strategy that starts with government.

Collaboration between complex health organizations requires a culture of collaboration to be modelled and fostered. Government is not good at that, frankly; collaboration does not appear in the DNA of government, at least in the health and long-term care sector traditionally in New Brunswick.

In 2021 I asked a senior medical official in one of the large hospitals the same question about collaboration between health authorities. His response was they wanted to do more but government keeps getting in the way.

The current initiatives to modernize primary care is one such illustration where the health authorities are demonstrating that they are perfectly capable of carrying out reform; they just need government to express a clear vision then get out of the way. Both health authorities, in their ways, are doing great work with Vitalite appearing to be having serious traction in achieving what has been discussed and witnessed in other provinces for 20 years.

Both health authorities have some very good, dedicated staff with terrific motivation. Government has never demonstrated its ability to manage health care. Its role is to establish a clear vision and ensure the people who are doing the execution have the tools they need to carry out their jobs. When government steps across the line from regulation and casting vision to operations, things don’t usually end well.

Ken McGeorge, BS,DHA,CHE is a retired career health care CEO, part time consultant, and columnist with Brunswick News; he is the author of Health Care Reform in New Brunswick and may be reached at kenmcgeorge44@outlook.com or www.kenmcgeorge.com