Hamilton Health Sciences creates controversial new surgical role to clear massive backlog
Facing a backlog of 6,600 surgeries and a severe shortage of specialized staff, Hamilton Health Sciences will test a new job in the operating room.
However, the union representing Ontario's nurses says it has grave concerns" about the unregulated role that takes over some of the work of highly trained nurses.
Operating room assistants are expected to be working by the spring in orthopedic, gynecology, urology and general surgeries at Hamilton General, Juravinski and McMaster Children's hospitals. The program is also being piloted at Niagara Health.
We know we have patients waiting," said Leslie Gauthier, vice-president of clinical support services and surgery. Nursing recruitment is a challenge and we want to be able to provide additional supports to our teams to be able to care for those patients."
The hospital network hasn't been able to get back to pre-pandemic numbers for surgery because of a shortage of specialized operating room nurses.
The shortfall is a long-standing issue in Hamilton and across the country. HHS closed operating rooms in Grimsby on weekends in 2019 and offered a $30,000 signing bonus because of a lack of surgical nurses.
The pandemic has significantly exacerbated that shortage, leading to retirements and burnout. Many were redeployed to the intensive care units to nurse the sickest COVID patients.
It's a national issue," said Gauthier. OR nursing is getting increasingly harder to recruit to ... Surgeries are more complex, the hours are longer, there's more work happening after hours and on weekends ... and the training is getting more and more intensive."
The priority at HHS is still to hire operating room nurses or train those who are interested in specializing, which takes about four to six months.
But with every acute-care hospital in the network short roughly five operating room nurses at any one time, Gauthier said they also needed to find another way to clear the backlog of operations left by the pandemic.
HHS has to catch up on about 4,900 adult surgeries and 1,700 in pediatrics.
In addition, there's a predicted surge coming from those who missed diagnostic tests, cancer screening or family doctor appointments during COVID.
We're really trying to plan ahead," said Gauthier. We've got to get back up that we can open to 100 per cent where we were before COVID ... We're looking at all the opportunities we can to be able to provide surgical care."
There's also worry about the number of patients waiting too long for surgery in Hamilton. Surgeon-in-chief Dr. Stephen Kelly says about 50 per cent have been on the wait list longer than what is considered optimal compared to 13 per cent before the pandemic.
The people on the wait list are waiting longer," said Kelly. We need to find out how we can build capacity within our system to look after these patients."
They hope the solution is a pilot project funded by the province's new Surgical Innovation Fund to create the operating room assistant role. Mohawk College is building a 15-week course that will start in January and include additional lab and clinical training.
About 37 staff at HHS have expressed interest. Some work in reprocessing, which means they clean, disinfect, sterilize, prepare, and distribute medical instruments and equipment. Some already work in the operating room, helping to position patients or obtain equipment. Others are foreign-trained operating room nurses, working as health-care aids.
Their new role would be to manage the instruments on the sterile field and is modelled off a similar job in the United States and the United Kingdom.
It's not about caring for the patient," said Gauthier. It's a very technical role of managing the trays and handing instruments and taking instruments back from surgeons."
Kelly called it a vital role in the OR" and stressed it's in combination with hiring more nurses.
We're looking to see whether we can bring this role in, which will allow the nurses to concentrate on the nursing," he said. It's how can we augment the teams, how can we boost the teams to deal with that surgical backlog."
The role taken on by the new assistants is normally part of the job of operating room nurses.
The Ontario Nurses' Association has grave concerns that government monies that are earmarked to help clear a backlog of surgeries and procedures in their communities will be used to hire unregulated care providers to potentially take on nursing roles in the OR," president Vicki McKenna said in a statement.
The actual plan of these hospitals is unclear at this time," she said. However, the limited information shared thus far points to the redistribution of nursing work to unregulated care providers and stretching the already thin registered nurse resources to a breaking point."
Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com