Nurses impacted by pharmacist shortage

KIRK SQUIRES
The Packet

Nurses at G.B. Cross Hospital say they are no longer willing to fill the gap left by the pharmacist’s shortage.

"We understand the pharmacy profession is dealing with challenges, however downloading the responsibilities to frontline nurses is an unacceptable solution," said Nurses’ Union president Debbie Forward in a release last week.

Eastern Health plans to add a new nursing position as a short-term solution to the pharmacist shortage. One of the duties of that nurse will be retrieval of medication on weekends.

"Hiring nursing staff to specifically fulfill this role on weekends for up to one year is even more unacceptable. While nurses have some pharmaceutical education and experience, they certainly cannot replace a pharmacist," says Forward.

G.B. Cross normally has a contingent of three full-time pharmacists. With a full compliment a pharmacist would be on duty for the day shift on Saturday and Sunday. Several months ago one of the pharmacists left the area. Because of the added workload on the remaining pharmacists the decision was made to close the pharmacy on weekends. Pharmacists would only be available on an on-call basis during that time. That has since been reduced to pharmacists being available by phone only for questions and clarifications. In the absence of a pharmacist during the weekend shifts, nurses have been assigned to retrieve medications for in-patients.



Concerns

Forward says while nurses do have knowledge around medication, they are concerned about liability and quality of care in this situation.

"I don’t want to minimize the nurses’ role or our capacity to look at contraindications, allergies and interactions between drugs. That is part of our responsibility," stresses the Union boss, "But we don’t have the knowledge of a pharmacist.

"That is their expertise. A pharmacist has the required knowledge and education to ensure that medications dispensed to a patient do not conflict or react with other medications.

"Removing pharmacists from this process increases the potential risk for error," she says.

The Board has advised that nurses assigned to retrieve medications on the weekend shift are not responsible for checking for allergies, contraindications and compatibility with other medications that a patient may be prescribed, or for creating or reviewing medication profiles of patients.

That makes them wonder, who is responsible?

"Nurses are fearful it is going to lie with them," says Forward. "It will also lie somewhat with the physician but it will fall on the shoulders of the nurse who is going to administer that medication."



Options

Forward says adding nursing staff is not a solution to the pharmacist problem.

"The issue is we need pharmacists desperately," but she adds, "Nurses have put forward solutions to the employer."

One of those solutions is to have managers do medication retrieval.

"Have the responsibility fall on management, not on the front line nurses."

She points out, "If we were in . . . a job action and pharmacists weren’t working, the responsibility would fall back on management to make sure that role was being carried out."

Forward warns the impact on nurses in this situation could worsen if a solution is not found soon.

"A spin off issue, which is a real issue for nurses in the Clarenville area, which I don’t think even the employer can ignore, is that nurses have been working a lot of overtime in the last couple of months because of lack of relief.

"The employer is telling us there is no shortage of nurses, yet there were many times over the summer when nurses had been mandated to work overtime because there hasn’t been a replacement when a nurse is off."

Forward wonders if the hospital will be able to recruit nurses to go into that position, given the responsibility that is being placed on them.

She adds nurses are also fearful that, as result of the decision, their workload and their requirements to do overtime are going to be increased again which is going to increase their job related stress.

"I have said publicly that I think this is indicative of government and employers attitude of reacting to issues versus being proactive. This is a symptom of a bigger problem. I don’t think this is going to be an isolated to one site . . . or one group of professionals.

"There will be instances where we are going to have acute shortages of health professionals in this province and employers and government are going to be scrambling looking for solutions that are short-term."

Forward says short-term solutions only put stress and responsibility on those that are left which only exacerbates the problem.

"I place the blame squarely at government’s feet because they have ignored the problem for years but also at the employers feet because they have seen it coming as well.

"Now they are trying to put in short-term solutions to try to fix the gap. They are focusing on the pharmacists but the nurses now are saying you are putting unrealistic expectations on us and we are not willing to fill those gaps forever."

Forward was in Clarenville Friday to meet with officials at G.B. Cross.

"We look forward to having some productive discussion with them and looking for some solution here that is acceptable for nurses.

"We want to make sure nurses are protected in this situation and it doesn’t snowball so that the next thing they are going to be talking about in Clarenville is having enough nurses because of the responsibility being placed on them," says Forward.

As of press time on Friday there was no indication if the union and management had reached an alternative solution.

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