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"ICUs lack nurses, MDs warn"

November 9, 2006 -- Today The Montreal Gazette published a piece by Aaron Derfel about a group of Montreal physicians publicly protesting a lack of ICU nurses at the city's hospitals. The article indicates that this means fewer ICU beds remain open, patients undergoing elective procedures must wait longer, inexperienced ICU nurses are "overwhelmed," and sometimes patients transferred from the ICU too early deteriorate and must return. The piece might have provided context on the larger nursing shortage, and done more to show that when nurses are short-staffed, the result is worse patient outcomes, including death. Still, this is a good example of physicians speaking out for better nurse staffing. We thank Mr. Derfel and the Gazette for the piece.

The piece reports that an unspecified "group of physicians" is warning that "[i]ntensive-care units in Montreal's busiest hospitals are sorely lacking nurses and the ICUs can no longer take care of all patients." It quotes two men who are presumably members of this group. Marc Giasson, "chief of intensive care at Sacré Coeur Hospital," reportedly says that (in the piece's words) "many nurses now shun working in the ICU." He also notes that his hospital has only half the ICU beds it did a decade ago, and on some days there are not enough nurses to staff them: "We're in a crisis." Giasson also says that "more experienced nurses" in particular have "deserted the ICUs," so "we get a couple of nurses with little experience who are rushed to treat patients and they are overwhelmed by the severity of the cases."

Jean-Gilles Guimond, "director of intensive care at the Centre hospitalier de l'université de Montréal," reportedly says that ICU physicians have responded by playing "musical beds." This means transferring patients "early" out of the ICU. Not surprisingly, Giasson notes, this sometimes means the patients deteriorate and must return. (We imagine it also means floor nurses are put under tremendous pressure trying to care for patients who should be in the ICU.) Guimond says that the ICU shortage also means cancer and cardiac patients scheduled for elective surgery must wait longer, so the ICU will able to care for them after the surgery.

Providing context, the piece reports that the physicians say they've "come forward" after hospital administrators said there was nothing they could do. However, the piece notes that "the timing of their news release yesterday comes as medical specialists are intensifying their battle with the provincial government over better pay and working conditions," which suggests this is part of a larger struggle between physicians and the government. The piece says Isabelle Merizzi, press attaché to Quebec Health Minister Philippe Couillard, admits there's a shortage of ICU nurses but denies there's a crisis: "We checked the ICUs of hospitals in Montreal and Quebec City and there have been no recent bed closings." The piece also quotes Michel Marcil, director of medical affairs for the Montreal Health and Social Services Agency, as saying that some hospital ICUs might be temporarily (in the piece's words) "short of beds," but that it's "not a chronic problem." But "he too confirmed the ICU nursing shortage, and predicted that it will continue for the next few years until more nurses graduating from universities and colleges enter the work force."

The piece effectively highlights something that does not seem to have occurred too often since the current nursing shortage began in the late 1990's: physicians speaking out forcefully about the shortage's negative effects on patient care. We commend the physicians involved here. Of course, the piece might have consulted at least one ICU nurse. The failure to do so may suggest to some that physicians are the authorities on nursing practice issues, when of course nurses are.

The piece might also have provided more context on the global nursing shortage, which is far from an isolated problem at a few ICUs, but the result of a number of deeper social, demographic, and economic factors. In addition, while a couple of the physician comments suggest that inadequate nurse staffing can affect care, the piece might have hit this harder. When there are too few nurses or too few experienced nurses, patient outcomes are significantly worse, and nurses burn out and leave the profession. Some of the comments may also suggest that the problem is simply finding more nurses, perhaps among new graduates or from overseas. But if part of the problem is a refusal to allocate the resources needed for good clinical practice, nurses will continue to, as the piece puts it, "shun" the bedside. The piece might have included some indication of why experienced nurses don't want to work in the ICU.

We thank Mr. Derfel and the Montreal Gazette for this report.

See the article "ICUs lack nurses, MDs warn" in the November 9, 2007 edition of the Montreal Gazette.