Nurses are on the firing line 24/7 in hospitals and would welcome a key role in designing the Cowichan District Hospital replacement that the government hopes to have built by 2024.
Not only are they welcoming opportunities for input, they would also like very much to have a serious hand in the decision-making on the Island Health steering committee that will be making the final design decisions and recommendations.
BC Nurses Union president Christine Sorensen believes nurses should represent up to 50 per cent of that steering committee.
“Nurses need to be involved in decision making, not just the consultation process,” Sorensen said in an interview. “Nurses are on the front line of delivering services in a hospital. If the north island hospitals design and implementation taught us anything, we now know we need nurses involved in the decision-making process.”
Patient and staff safety concerns are the top priority that nurses want to ensure are dealt with properly; and are best handled during the basic design process.
Sorensen noted that workplace violence has reached a serious level with an incident occurring just about everyday in a hospital somewhere in the province over the course of a month.
The obvious priority, she said, is providing “support and space for the sickest of the sick”, which is what acute care hospitals are about. Around that priority goal are a number of safety issues that have to be taken into account in the design process.
Sight lines are critical as nurses have a duty and a responsibility for the health and safety of their patients. Much of a nurse’s job entails paper work so it is essential the location of the nursing station relative to patient wards be appropriately designed.
Nurses are asking that key card access be built into the design of the new hospital, both for patient and staff physical safety but also for infection control.
Sorensen cited the example of emergency room crises that are increasingly arising because of mental health and drug issues. Emotions are often already high as families anxiously await treatment for a loved one, she said, and the combination can lead to unpleasant and dangerous circumstances.
“The design will have to include appropriate physical barriers for the protection of both patients and staff,” she said, adding that planning must also include integrated protocols for calling for immediate help, as well as staff training in de-escalation of crisis situations.
Sorensen’s design check list includes culturally sensitive spaces catering to the large First Nations population in the region.
Also critical are meeting the needs of the seriously mentally ill and the urgently required services for children and youth.
“Right now,” she said, “these people are being transported north and south for their care, which is very hard on families.”
There are also critical needs outside the hospital environment that could easily lead to a new hospital being “under-built”, she said.
Sorensen agreed in the interview that at any point in time 20 per cent or more of the acute care beds in a hospital are taken up by patients that do not require acute care.
“If there are no corresponding and appropriate services in the community, there is going to be someone in an acute care bed,” she said. These could include patients with mental health and/or drug issues, or an aging patient awaiting transfer to an appropriate long-term care facility.
The question arises: how does Island Health make design decisions for the new hospital in the absence of any clear knowledge of the level of health-related services that will be available in the community at any point in the future?
Sorensen has no easy answer, acknowledging that health care planning is a very complex matter.
On top of planning uncertainties, Sorensen said the nursing profession is facing a critical shortage of nurses. BC has the second lowest nurse-to-patient ratio among other provinces across Canada, she said.
“We have to bring more nurses into the system,” she said, pointing out that the BC government estimates that there will be a need for 20,000 more nurses by 2026.
“We have to seriously review how our education system is working.”
Patrick Hrushowy is a 45 year veteran of journalism, communications consulting, and business background, who just can’t stop writing.