How will Hamilton’s hospitals balance mandatory vaccination and significant staff shortages?

Hamilton's hospitals have a nursing shortage that has been exacerbated by the pandemic with teams regularly working short-staffed.

Demand for nurses is massive and the pool is exhausted," Hamilton Health Sciences (HHS) said in a statement. Nurses are taking much-needed vacation time, some are not wanting (or) able to pick up extra work because they are very tired, and it seems there is some higher turnover than the prior year."

The shortage puts Hamilton's hospitals in a difficult position as they determine what COVID vaccine policy to put in place for staff by Sept. 7 as mandated by the province.

It's unclear exactly how many staff are vaccinated as the deadline to self-report was Sept. 1.

At HHS, 60 per cent of staff and physicians had self-reported as of Aug. 25 and of those, 84 per cent were fully vaccinated.

St. Joseph's said Aug. 26 that at least 74 per cent of staff and 70 per cent of physicians were fully vaccinated, but self-reporting was still underway. St. Joe's did not say what percentage of staff and physicians had self-reported at that time.

At the same time, they already have hundreds of job openings.

At minimum, the province requires unvaccinated hospital workers to provide a legitimate medical exemption or complete an education session. They will also have to go through frequent testing.

But hospitals have the ability to go further, such as Toronto's University Health Network, which plans to put staff who aren't vaccinated by Oct. 8 on unpaid leave for two weeks. After that they face termination.

Ontario's chief medical officer of health said some children's hospitals are also implementing more stringent measures because the majority of their patients are too young to get vaccinated, but he didn't name which ones. McMaster Children's Hospital is part of HHS.

They've made the decision to move beyond our directive to embrace immunization as the means by which they are going to hold their staff accountable," said Dr. Kieran Moore on Aug. 24. I support them given the populations they serve."

In addition, he said academic and research hospitals are embracing mandatory immunization" to protect vulnerable patients. All of Hamilton's hospitals are in this category.

Our recommendations were always a baseline," said Moore.

So far Hamilton's hospitals have been tight-lipped about their plans, giving no details.

We are still in the process of formalizing our vaccine policy and the details of its implementation," St. Joseph's said in a statement.

But with significant shortages, there is a question about whether the hospitals can afford to lose unvaccinated staff. Neither St. Joseph's nor HHS has a handle on exactly how many are at risk.

The hospitals also don't have exact numbers for how many staff they've lost over the pandemic, particularly nurses. HHS said it would take considerable time and resources" to determine and require a paid freedom-of-information request.

They should have that," said Doris Grinspun, chief executive officer of the Registered Nurses' Association of Ontario. It's simple human resources tracking and if they don't have it, it's very problematic quite frankly because how do you know if you have a shortage or not ... To staff your units, you need to be able to predict who you have, including the skill mix necessary - which type of nurses."

Staffing units has been a regular problem over the pandemic, leaving nurses caring for higher ratios of patients.

Our units have worked short-staffed and we try to balance the workload pressures across the organization," said St. Joseph's. We recognize that staff have gone through a prolonged stressful time through COVID."

HHS said, Our teams are regularly working short-staffed. We have daily processes that address workload and how we provide care across our organization."

HHS had 280 vacancies as of Aug. 31, including 150 nursing jobs. At times over the pandemic, HHS has had postings for almost 300 nurses.

Postings may not lead to applicants or positions being filled," said HHS.

St. Joseph's didn't provide recent numbers, but it had 76 jobs posted in October.

Staffing, and particularly nursing, shortages are a national issue, including at St. Joe's," said the hospital, adding it's aggressively working on multiple recruitment strategies."

Those include a virtual career fair, a mentorship program, increased training opportunities in specialty areas and working with colleges to increase the number of nurses graduating.

But competition for the limited pool is fierce as Grinspun says shortages have only become significantly worse" over the pandemic, particularly for registered nurses.

Some are leaving the profession altogether and some are going to the U.S. ... where they offer them the sun and moon in terms of compensation, better workloads and career development," said Grinspun.

You have 18 months of relentless work for all nurses," she said about the pandemic. They just can't do it anymore ... They've had it."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com