June 3, 2021
The Honourable Brian Pallister
Premier of Manitoba
204 Legislative Building
450 Broadway
Winnipeg, MB R3C 0V8
The Honourable Kelvin Goertzen
Acting Minister of Health and Seniors Care
450 Broadway
Winnipeg, MB R3C 0V8
Dear Premier and Minister:
The Emergency Physicians at Winnipeg's Health Sciences Center, St Boniface Hospital, and the
Grace Hospital wish to express grave concern over the state of nursing in our emergency
departments (EDs). Many senior experienced nurses in our EDs have resigned, while many
others are planning to leave. Morale and staffing are at all-time lows. We view the situation as
critical, unsustainable and in need of immediate action.
Like many things in our complex health system, the reasons ED nurses are leaving are
multifactorial, but in our view, the effects combine to make ED nurses feel undervalued,
unsupported, abandoned, and frankly disrespected by their hospitals, the WRHA/Shared Health
and the provincial government. We wish to highlight this issue now in the hope that immediate
action might stave off a deeper crisis.
The workload for EDs, with the increasing numbers and acuity of COVID patients, is exceptionally
high. Everyone who comes to the ED could have COVID, and the hospitals rely on our ED nurses
to find and isolate COVID cases before admission. Furthermore, the ongoing meth crisis has
resulted in unheralded levels of psychosis and agitation within the department, with physical and
verbal aggression happening at unprecedented levels. Many of these patients have COVID as
well. Other patients arrive at our EDs critically unwell, requiring prolonged, direct contact and
multiple high-risk procedures. Often the highest risk procedures, such as intubation of COVID
patients, occur in the ED before admission to critical care units. Our ED nurses bear the brunt of
all these challenges while intimately assisting our sickest patients.
Yet despite the demands and significant risks of caring for COVID patients in the ED, when the
provincial government negotiated a COVID wage benefit with the nurse's union, specifically
geared towards nurses who worked with COVID patients, they excluded emergency nurses. This
was inexplicable and showed a lack of understanding and respect for ED nurses' additional
workplace risks. ED nurses were predictably offended and dispirited. In the context of exhaustion
from consecutive shifts and mandated overtime, many lost their sense of commitment to their
EDs, and worse, their sense of commitment to the system. This is a recipe for burnout.
Consequently, most ED shifts now operate short of nurses, particularly senior nurses. It is a
regular occurrence to see a portion of the ED closed because there are not enough nurses to
staff it, or for the nurse-in-charge to be struggling to find enough senior nurses to attend to the
next critically ill patient that might arrive. This is affecting patient care and should never be
acceptable.
To fill nursing vacancies, departments have turned to hiring newly graduated nurses. While we
value and respect their skill, training, and enthusiasm, they cannot immediately replace the
experience and wisdom of a seasoned ED nurse. Furthermore, newly hired ED nurses typically
require additional experience and training before looking after the sickest patients. This places
an even heavier burden on the senior nurses who subsequently continue to work under the
constant threat of mandated double shifts; an exhausting and frankly unsafe practice. This further
contributes to burnout.
The ED is a uniquely chaotic and unpredictable environment. Multiple sick and injured patients
can present simultaneously. Nurses, like physicians, need to be able to multitask and
prioritize. ED nurses develop an invaluable skill set resulting in better and safer patient care. This
takes time and experience to master. The loss of even one experienced ER nurse on shift affects
the functioning of the entire team and, by extension, patient care. The loss of multiple such nurses
in the midst of a pandemic, is frankly dangerous. Action must be taken now.
While everyone in healthcare and beyond feels the stress from the COVID 19 pandemic, we see
morale amongst ED nurses at the lowest point in memory. ED nurses are our colleagues, our
partners, and our friends. We witness their collective suffering and exhaustion and find it
disheartening and unacceptable. Dysfunction in EDs will significantly impact care for the public,
not only for COVID-related problems but for all aspects of acute care. We implore the government
to immediately address this vital and time-sensitive issue to avoid further losses of ED
nurses. This needs to start with acknowledging their essential role in the care of COVID and other
critically ill patients and readjustment of their wages and benefits in a manner that is
commensurate with their contributions to the health of all Manitobans.
Sincerely,
Dr. Alecs Chochinov, Emergency Physician St Boniface Hospital
Dr. Robert Sweetland MD HSC ER
Dr. Ron Steigerwald
Dr. Noam Katz, MD, MSc, FRCPC, - St. Boniface Hospital
Dr. Katherine Sullivan MD. FRCPC-EM – Health Sciences Centre
Dr. Tamara C. McColl MD FRCPC Emergency Physician, St. Boniface Hospital
Dr. Jeffrey Klassen, MD, FRCPC-EM - St. Boniface Hospital
Dr. David Lussier, MD FRCPC
Dr. M. Shafiqul ALAM
Dr. Brigitte Reynolds, CCFP-EM
Dr. Jon Broughton, MD, FRCPC Health Sciences Centre
Dr. Jackie Chou, CCFP (EM)
Dr. Ron Maier MD
Dr. Teresa Wawrykow
Dr. Christian La Rivière, MD, FRCPC
Dr. Lisa Omichinski, MD, CCFP-EM
Dr. Rebecca Schindle, MD, FRCPC - Health Sciences Centre Emergency Department
Dr. Jill Geurts, MD FRCPC MPH - Health Sciences Centre
Dr. Shirley Hasdan MD CCFP(EM)
Dr. Stephen Smith, MD, MSc, CCFP-EM
Dr. Chris Cymbalisty MD
Dr. Julian Regehr
Dr. Cheryl ffrench, MD, FRCPC-EM, Health Sciences Centre Emergency Department
Dr. Kyle Burkett, MD, FRCPC(EM)
Dr. Tomislav Jelic, MD, FRCPC, FACEP
Dr. Rob Grierson
Dr. Zoe Oliver, MD
Dr. Phillip Endleman
Dr. Graham Friesen
Dr. Joseph Ringaert
Dr. Deborah Hill, MDCM FRCPC Dip. Sport Med - HSC ER physician
Dr. Mona Hegdekar MD CCFP(EM)
Dr. Harold Peters MD., FRCPC
Dr. Caroline Kowal MD CCFP-EM
Dr. Erin Weldon MD FRCPC(EM) Emergency Physician Health Sciences Centre
Dr. Travis Minish
Dr. Sheila Peters
Dr. Shane Hartry Emergency physician St. Boniface Hospital
Dr. Doug Martin, MD, FRCPC - Health Sciences Centre
Dr. Bryce Makar, MD, FRCPC
Dr. Angela Derksen, MD, CCFP (EM, FPA) - Health Sciences Centre
Dr. Darren Graves
Dr. Murdoch Leeies, MD MSc FRCPC
Dr. Don Schellenberg
Dr. Richard Peters MD
Dr. Wesley Palatnick MD, FRCPC HSC Emergency
Dr. Merril Pauls - HSC Emergency Physician
Dr. Erik Hildahl, MD, FRCPC-EM
Dr. Chau Pham, MD, FRCP-EM, MBA - HSC Emergency Physician
Dr Scott McLeod Arnould
Dr. Gregory Reimer FRCPC
Dr. Michael Boszko MD CCFP(EM)
Dr. C Peterson BSc, MD, CCFP(EM)
Dr. Carmen Hrymak MD MSc FRCPC
Dr. Albert Buchel
Dr. Omer Yusuf, MD, FRCPC
Dr. Anne Finlayson, MD, FRCPC
Dr. Ryan Sustrik
Dr. Ian Surdhar, MD FRCPC
Dr. Vincent Lim, MD, FRCPC - Health Sciences Centre and St. Boniface Hospital
Dr. Fouad Anashara CCFP-EM
Dr. Dan Bellan
Dr. K Hawryluk
Dr. Jeremy Plett
cc.
Dr. Kristjan Thompson, Doctors Manitoba
Dr. Anna Ziomek, College of Physicians and Surgeons of Manitoba
Adam Topp, Shared Health
Mike Nader, WRHA
Darlene Jackson, Manitoba Nurses Union
