Nurses’ union at Hamilton Health Sciences raising operating room safety concerns at Juravinski and other hospitals

The Ontario Nurses Association (ONA) says patient safety is being put at risk at Juravinski and other Hamilton Health Sciences hospitals in Hamilton by HHS' move to replace scrub nurses with operating room assistants (ORAs) in the operating rooms.

HHS has implemented a health care provider that is not regulated in a nursing role," said Maureen Williamson, president of ONA Local 70 that represents about 2,800 nurses in the HHS system, including about 225 operating room nurses. This greatly impacts the safety of the patient."

Williamson said HHS stared using the ORAs last spring at the Juravinski, General and McMaster hospitals.

She noted the assistants receive substantially less training than registered nurses.

The OPR is getting 22 hours of online learning and some practical work," Williamson said. It might total 12 weeks compared to four years (for a registered nurse)."

Williamson said an OR team includes a scrub nurse and circulating nurse.

She noted the scrub nurses work closely with the surgeon and the circulating nurse moves around the OR looking after the overall patient experience and ensuring everything is done correctly.

She added there is no shortage of OR nurses.

The union shared its concerns with HHS officials last June when a letter signed by 85 per cent of OR nurses was given to management.

A group of OR nurses also met with HHS officials.

Williamson said the officials listened to their concerns but did not respond.

On Sept. 1, the union forwarded the letter to HHS president and CEO Rob MacIsaac and members of the HHS board of directors.

The union has also asked for a meeting with MacIsaac.

Williamson said, so far, there has been no response.

We are asking that you intervene immediately and stop the ORA from replacing a regulated nurse in a scrub nurse role," the letter states.

The letter goes on to outline potential OR issues.

Imagine you or your loved one is coming in for a routine gallbladder surgery," the letter states. You assume you have access to the best quality care from a highly qualified, fully knowledgeable, expertly skilled surgical team. What if that loved one had an adverse reaction to anesthesia, sedation or requires an emergency airway, or tracheotomy to enable them to breathe? The ORA, because they are not a regulated health-care provider, does not have the knowledge or skill to respond. They work under the supervision of a regulated health-care provider and cannot do any tasks without delegation. Controlled acts of intervention that are often needed cannot be delegated to the ORAs.

"Even if an intervention could be delegated, there is no way during an emergency situation for the nurse to ensure the ORA can safely perform the task or provide the required supervision to ensure their competency in performing the task because their attention is focused on other urgent patient care needs."

The letter also states HHS is assigning ORAs to mix and handle medications in violation of the College of Nurses medication administration standard.

HHS communications adviser Wendy Stewart provided the follow statement:

The safety of patients is our steadfast priority as we work to address a significant surgical backlog and global nursing shortage. OR assistants provide additional technical support to our surgical teams by managing sterile instrumentation and maintaining the sterile field of the OR, integral to patient safety. They work alongside surgeons, anesthesiologists, nurses and other members of the surgical team. Current hospital employees who are eligible for this role must complete the OR Assistant Certification training program administered by Mohawk College.

The program includes 375 hours - comprised of 220 hours of scheduled synchronous or asynchronous class activities, self-study and two practice labs, and two weeks of clinical placements. This is followed by a minimum of three months on the job training under supervision in the OR."

Stewart said there are seven ORAs that support orthopedic, gynecology/gyne-oncology, urology, plastics and general surgeries.