Temporary ER closures worsening across rural Ontario

Nursing shortages are becoming more common, causing rural communities to shut down their ERs temporarily.

Emergency services, such as the Wingham and District Hospital Emergency Department, have had to close their doors overnight or on weekends for the last two years. This summer, however, closures are becoming more frequent: as of June 19, the Wingham hospital was closed for at least one day seven weekends in a row.

Karl Ellis, the president and CEO of the Wingham and Listowel hospitals, says most of their closures are due to nursing and lab technologist shortages. Urban hospitals have the resources to staff 20 registered nurses at once, but rural hospitals may only have two nurses at any time—if one goes on sick leave, there’s a high risk the hospital will close down.

“When you don’t have the bodies to fill in all the shifts, you have to make decisions about what you can cover,” Ellis says. “That’s what it’s come down to: looking at our schedules, shifts, and vacancies, looking at what we can staff, and trying to balance between two sites.”

He says many of their registered nurses are currently on maternity or paternity leave, which has made it harder to plan out shifts. In the meantime, Wingham and Listowel’s hospitals have been assigning more work to their registered practical nurses and lab tech assistants, who are both at an earlier stage in their medical studies, Ellis says.

“I would challenge anybody in any industry to try to continue to operate under normal workload and schedule when 23 per cent of your staff are off,” he says.

When the Listowel Wingham Hospital Alliance announces closures for the Listowel and Wingham hospitals, it lists other nearby hospitals with a disclaimer that residents should call ahead to make sure they’re open. Registered homecare nurse Ashley Fox says on one weekend, two of the Wingham hospital’s four recommended emergency centres were also closed.

“In an emergency, the last thing I’m going to be doing is calling a bunch of hospitals making sure that they’re open,” Fox says. “Anyone who’s called a hospital knows it’s not easy to do.”

Fox says the issue reaches beyond the Wingham area. Rural Ontario communities such as Seaforth, Clinton, Chesley, Mount Forest, and her hometown of Palmerston have faced similar closures over the last year.

A mid-2022 closure in Palmerston, for example, terrified Fox when she was due to deliver her daughter. The hospital’s maternal care wing was closed for the summer, so she says they referred her to the hospital in Fergus, which then shut down the week before she was due.

“The next hospital after that would have been Kitchener, Waterloo, or Orangeville, which is more than an hour away both ways,” she says. “And my pregnancy was considered a high bleed risk—right up until delivery they weren’t sure if I was going to have a C section.”

Though she doesn’t work at the Palmerston hospital, she’s concerned it will face severe enough staffing issues to start temporarily closing as well.

According to Kim English, a Trent University nursing faculty member with expertise in rural emergency care, one of the main causes of the provincial shortage is Bill 124. After placing a one per cent cap on nurses’ wage increases across Ontario in 2019, the bill was struck down as unconstitutional by Canadian courts. They awarded nurses a 2.5 per cent pay increase for this year, with a 3.75 per cent back pay increase for 2022.

English says this isn’t enough, given the recent increases in the price of living and inflation. She adds that higher wages are especially important for rural communities, where she estimates around 35 to 40 per cent of nurses have to pay more to travel since they live outside the communities they service.

Listowel and Wingham hospital president Karl Ellis says the Bill 124 cap was a province-wide demotivator, but he can’t say whether the increase will improve staffing issues. He says the province needs to instead work on an official long-term plan and set of policies that show a better understanding of Ontario’s “medical labour needs.”

“We need to make sure our education systems are set up to train adequate numbers of professionals,” he says. “Some of it is happening—there are some increases in medical residencies in Ontario, for example—but those announcements today aren’t going to create any new doctors for the next five to six years.”

English says the province needs to fund medical schools to develop nursing programs that train rural nurses and doctors to work in their own communities; only the Northern Ontario School of Medicine and Queen’s University currently run this kind of program, she adds.

“We don’t expect to have everything in rural communities, so it would make no sense whatsoever to have a neurological trauma unit,” English says. “What I do expect is that if I need those services, I have an emergency department nearby that can stabilize me and get me shipped out.”