By Christopher Foulds
Kamloops This Week
Elective surgeries at Royal Inland Hospital were cancelled last week and again this week due to an influx of patients evacuated from wildfire-impacted areas elsewhere.
The cancellations come on the heels of memos obtained by KTW and other media outlets detailing that the hospital is overcapacity and that some departments are severely short of nurses, who have left the job due to being overworked.
The cancellation of all elective surgeries this week and last week — more than 200 procedures involving knee, hip, shoulder and back procedures — was confirmed to KTW by Dr. Scott Hughes, one of eight orthopaedic surgeons at RIH.
Only urgent cancer- and trauma-related elective surgeries are proceeding.
“Our patients, who have waited two years for a hip replacement, two years for a shoulder repair, three years for a back surgery, etc., are being told their surgeries are cancelled and will be rescheduled when time permits,” Hughes said.
“It is completely unacceptable.”
Hughes said the issue is not having enough resources — staff and operating room time.
Hughes has echoed other doctors and nurses who have told KTW and other media that Royal Inland Hospital is faltering, with staff morale at low levels.
“We are losing doctors, nurses and allied staff to other centres as we fight a seemingly unwinnable fight,” he said.
“This needs more attention and our community can no longer act passively. Action has to be taken. The new [patient-care] tower will not change the tide without further resources and staff.”
In other words, no amount of operating rooms will help fix the problem if they are not staffed properly.
Hughes’ concerns come just days after KTW reported on capacity and staffing issues at RIH.
A memo obtained by KTW notes the hospital is over-capacity as it deals with COVID and non-COVID patients and an influx of patients from other communities.
For example, when the City of Merritt was placed on evacuation alert on Aug. 15 due to the threat from two area fires, patients and staff at the Nicola Valley Hospital and Health Centre were sent to Royal Inland Hospital.
In addition, 40 residents of long-term care homes in Merritt were relocated to Ponderosa Lodge next to RIH.
The memo also noted patients needing to be admitted to hospital in Merritt, 100 Mile House and Lillooet are being sent to RIH.
An RIH employee, who did not want their name published for fear of employment repercussions, said colleagues are continuously working in extremely short-staffed situations and patient care is becoming increasingly unsafe.
“The nurses and staff have pleaded with the managers and directors for help, but it seems to have fallen on deaf ears,” the employee told KTW.
“I have never experienced the hospital to be in such a disarray as it is today. On top of the nurses working extremely short, it seems they’ve also decided to keep the ward clerks dangling in a position of unknown. The directors have taken the majority of the clerks’ jobs and given them to the nurses and doctors.”
The employee said staff are exhausted.
“Nurses, doctors, unit clerks, care-aids, you name it, are dropping like flies and moving away from our hospital, even with record numbers of patients coming in.”
In an Aug. 20 CBC story, a nurse said about two-thirds of ER nurses at RIH have recently left their jobs.
Hughes said he is speaking out because he feels the public should be aware of what it happening in a public facility so they can use that knowledge to advocate for change.
While the influx of patients from areas under wildfire-related evacuation alerts and orders led to the the most recent elective surgery cancellations, Hughes said the problem with resources, a troublesome new online charting system and the hospital operating at or over capacity is something that existed before the stressors of evacuees and COVID-19 patients arrived.
Hughes noted elective surgeries are only done during the day, from about 8 a.m. to 3 p.m.
“So, you know, even before this wildfire situation, we were still dealing with cancelled surgeries simply due to bed capacity,” he said, noting a significant percentage of patients in the Kamloops area, perhaps 25 per cent, visit other communities for elective surgeries.
While reports that about two-thirds of nursing staff in RIH’s emergency department arose in the media on the weekend, Hughes said there is also a shortage of operating room nurses.
“We’re extremely short in our operating rooms and we’re extremely short in the recovery room, where patients go after their operation,” he said.
Hughes said he has worked at RIH for nine years, during which time there has always been a shortage of staff.
“It’s a bit of a snowball effect,” he said.
“You get short on nurses and other nurses start taking overtime work. That overtime, work becomes more and more difficult because of the number of patients in our hospital, the overcapacity situation. Nurses begin to get burnt out and they may seek somewhere else to potentially work or they go down just to part-time.”
Hughes said the problem can be seen in the fact there is an “exceedingly low” retention rate among training nurses from Thompson Rivers University.
“I don’t know what the number is, but it’s rare that we see a student nurse become a full-time nurse in our operating room and it’s a matter of culture,” he said. “They see that the nurses are working overtime. They see that the nurses are being burnt out.”
Hughes called it “this evil sort of spiral that we get ourselves into that is really, really hard to get out without paying attention to it.”
Hughes likened the morale among RIH staff to that which might be found on a foundering sports club.
“I see it in my colleagues’ eyes. I see it in the way the nurses speak there. There’s an are of tension. It’s just like a losing baseball team. You don’t want to show up to the field every day if your team keeps losing.”
Hughes noted it is not necessarily the leadership at RIH that should be targeted when calling for change.
“Because they’re trying, they really, are. I have friends and colleagues that are fighting that fight, but you know, promises are one thing, but then action is totally different.”
While acknowledging that surgery cancellations do impact his income, Hughes said that is not the reason for his call to action.
“Even though it’s my livelihood when my operating room is cancelled, that’s not what I care about,” he said. “I care about the fact that, you know, Mrs. Smith has been waiting two years for a shoulder replacement and it’s now cancelled and she’s being told, ‘Well, we’ll reschedule you when you have time.’ That not acceptable anymore.”
BY THE NUMBERS:
A sample of wait lists for elective surgeries in Interior Health and at Royal Inland Hospital, as of July 31, per the Interior Health website:
Knee replacement: 1,528 cases waiting in IH, of which 496 are at RIH;
Hip replacement: 806 in IH; 215 at RIH;
Spinal/back surgery: 504 in IH; 260 at RIH;
Shoulder surgery: 353 in IH; 77 at RIH;
Sinus surgery: 230 in IH; 67 at RIH.
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