SHEET HARBOUR – Physician shortages are a reality across rural Nova Scotia and have had a big impact at Eastern Shore Memorial Hospital in Sheet Harbour, in particular with frequent emergency department closures. Growing concerns and frustrations have sparked the formation of a community organization that hopes to help address the doctor shortage.
“Due to the ongoing emergency closures, people are upset and afraid that the hospital will close permanently,” Roberta Duchesne, Acting Director for Tri-Facilities, which includes Eastern Shore Memorial Hospital, tells The Journal. She noted that the community has mobilized to help address the problem and is “generating great ideas.”
Senator Tom McInnis led the effort in the spring of 2018 to establish the Sheet Harbour and Area Health Care Committee. “The first order of business was to familiarize ourselves with the health care system as it relates to our catchment area of Ecum Secum to East Ship Harbour,” says McInnis, chair of the organization. “We have reviewed the physical assets and held confidential meetings with many nurses, technicians and two of the doctors. We have met with the deputy minister of health, all of the senior members of the Nova Scotia Health Authority, especially the Central Zone which encompasses our area. We have held two town hall meetings. The one in June 2019 had seven senior members of the Authority to answer questions. They heard the concerns from the public firsthand.”
McInnis and members of the committee learned much about the challenge of doctor recruitment when they attended a physician job fair at Digby Pines in Sept. 2018, where it was mandatory for all Dalhousie medical students and their faculty to be in attendance.
“It was a real eye-opener as the conference room was jammed with representatives from across the province all trying to attract these soon-to-be doctors,” says McInnis. “We are not alone in the search for a doctor. It is a very competitive business. Most communities have professional promotional materials, aerial videos of their marinas, community centres, boating, hospitals and educational services.”
The NSHA promotes the Collaborative Practice approach to health care as a model, but that hasn’t taken hold yet in ESMH. In this model, the team is comprised of a doctor, nurse practitioner, social worker, dietician, pharmacist and other professionals. “(It’s) one solution for patient care,” explains Duchesne, “but we tried it here and it hasn’t as yet been successful.” A Collaborative Practice is something NSHA wants to continue to try to make work for ESMH.
“A Nurse Practitioner has been hired to be a part of the practice,” said Duchesne. “He is in school and expected to graduate from the program in May 2021. When he does, he has signed an agreement to come to practice in Sheet Harbour for five years.”
The recruitment effort is hurt by a lack of a hospital foundation and auxiliary in Sheet Harbour, says McInnis.
“Many hospitals in Nova Scotia have a foundation to help fund recruitment efforts,” he says. “Our area has no such effort and in fact we don’t even have an active auxiliary. This must change and we are completing the research to enable us to move forward with this effort. It was recently reported in the media that our Eastern Shore Memorial Hospital Emergency Department was closed 58 per cent of the time in 2019. In various discussions I have been told we do not require additional doctors. The question I have is, why then is our emergency department closed six days out of 10? Isn’t that predicated on the availability of doctors?”
Currently there are two physicians at ESMH who serve the on-call emergency schedule. Duchesne says, “In reality two doctors cannot maintain their office schedules and 24/7 on call. In the meantime, in the event of closures, residents with an emergency are asked to call 911.”
Duchesne says that regardless of individual hospitals’ emergency schedules, every Nova Scotian across the province has access to services. Regarding emergency care, she says, “It is important for patients to call 911 when they are sick and EHS will take them to the nearest site with an open Emergency (Dept.).”
Duchesne and Cathy Logan, clinical supervisor at the hospital, are the decision-makers, when the situation warrants, to close the emergency department. Decisions are based on the availability of physicians and less often, the experience of the nurses available.
In the event of a closed emergency department, the ESMH nursing staff will triage people that come to the ED and then will make suggestions based on their assessment. Duchesne explains, “Staff will do what they can within their level of experience and are covered by policy to do so based on the nursing assessment and the acuity of the patient. If the situation is not urgent, they will suggest options such as the patient can make a doctor’s appointment the next day for follow up or suggest the nearest open ED.” If it is an emergency, 911 will be called and the patient transported by EHS to the nearest hospital with an open ED.
Communicating the closure dates to the community has been an ongoing challenge. Duchesne says they attempt to give a minimum of two hours’ notice of impending closures. A variety of notifications occur which include the community board in front of the hospital.
“Obviously NSHA and EHS are notified first and it’s published on their community closures website. The RCMP are notified and we use Sheet Harbour Radio, their Facebook page and other social media. We are struggling to get the information out in a timely manner.”
“The closure of the Emergency Department has become all too easy or fashionable,” says McInnis. “As professional as our Emergency Health Services are, a stroke, heart attack or serious accident calls for immediate action as opposed to being transported for an hour and a half to the nearest ER. Residents of this region must always have a say in the future direction of our health care system. We must be proactive in our pursuit and be mindful that it is a competitive field out there.”