By Sheri Monk

When Maureen George, a nurse with 35 years of experience, accepted the job as health services manager at Maple Creek hospital, the seasoned manager viewed the position as a way to come back home. Originally from Eastend, she wanted to retire with her husband in the region. Instead, she resigned her position in November of 2009. In an exclusive interview with The Badger, George describes what she perceived as a systematic and chronic failure by Cypress Health Region to provide the support, leadership and resources required to perform the duties she was ascribed.
When George was interviewed for the position early in 2009, she was warned of the “special” employees at the facility. By the time of her resignation, she says she was clearly considered one of them.
“When I went for my job interview, I was told that Maple Creek was a very special group of people. It certainly did not mean Maple Creek was special in a good way.”
But she accepted the position and started at the hospital in February of last year. George says at a manager’s meeting within two weeks of being hired, several comments were made insinuating working at the Maple Creek Hospital would be a negative experience. And the lack of support, she says, began almost immediately.
George says her general orientation to the position and Cypress Health Region overall was only three days and despite her extensive years as a nurse in management at other facilties in Alberta and the Yukon, the lack of introductory support made the job difficult.
“When I went in there, I didn’t even know what reports I would have to submit monthly. I didn’t even know if I had to submit any reports,” she said, adding she was not told how to access the hospital’s voicemail system.
But the real problems of confusion and lack of direction, according to George, began a couple of months later.
“Things went along, and then we had one diversion,” she said.
A diversion is when a hospital is closed or temporarily disrupted for a weekend – and sometimes longer – because of a physician shortage.
“I know the questions around diversions started at that particular time with the staff. What happens? I was given a sheet of paper which said in the event of a disruption, whether it’s during a weekday or a weekend, these are the sorts of processes that you go through. But it was really very simplistic, because what you did is you called whoever is on in management. You got the patients out and that was it,” George said, adding clear direction of what to do in specific situations was not provided.
“Are the doors closed? Are the doors open? Who comes in the hospital? What’s available? Who do you call? What do you do with people when they come in? As time rolled on and we were getting into a summer diversion and I think it basically started coming to a head in June, when they started the regular diversions up in Leader, well we still had no clear-cut guidelines as to what was happening during disruption,” George said.
She cited an example of the lack of specific guidance staff were asking for, but she was unable to obtain from the health region.
“If somebody comes in and they have a dressing change and we’re doing the dressing change and we look at the dressing and think, “Well, that thing is bloody infected.’ So now this person now has to go onto Swift Current or did we have a doctor on-call – we weren’t given any of that information. So this is the stuff we started to push for really hard when we knew these diversions were becoming more and more and more. What do we do in this particular case?” she asked.
George says in addition to specific patient care concerns, she was concerned that if the hospital doors were open to allow people access to lab services, what should happen in the event someone needing immediate intervention walked through the hospital doors when the hospital was closed. While direction from the health region was to call EMS, George says having qualified medical staff at the site and denying medical intervention is a legal issue.
“Once you let someone in that door, you have to do something. We needed direction.”
But what bothered her more were the ethics of refusing care in an emergency that she or her staff were qualified to provide. Rural nurses are often trained to a higher level of cardiac care, which meant there was an immediate question of where an on-duty nurse’s responsibilities were while working at a closed hospital. Compounding the question, one practise advisement applying to nurses in Saskatchewan is that in the absence of a doctor, they can only treat patients to a first aid level. But George says the higher level of rural nurse training changes that guideline.
“What was going to happen, you were going to end up with some sort of a lawsuit. If some lady from the U.S. comes roaring out of the Cypress Hills, if her husband has a heart attack she’s going to come roaring down Highway No. 21 and slide right into that Maple Creek Hospital and she’s going to expect some care there. And she’s going to have people that are ACLS (advanced cardiac life support) trained and they’re saying, no, EMS should be there first even though they don’t have that level of care. What we were trying to tell them is that we were trying to save them a lawsuit.”
George says her manager said EMS staff were to handle the care during closures.
“How can you let EMS take over when at that particular point, not everybody in the EMS that was there was as highly trained as the nurses who were there?” she asked.
George added sometimes there were a higher level of EMS staff stationed at Maple Creek during some disruptions, but that often, the nurses not allowed to offer any care were more qualified to help. She maintains she has a high level of respect and appreciation for all EMS staff, but that she felt strongly that all health professionals must work together to offer the highest level of care possible.
“They are a wonderful group, truly they are, just absolutely fantastic young guys. But it has to be teamwork and that’s not what was happening. It was basically the nurses can stay behind closed doors and the EMS can handle everything. EMS is in addition to, not instead of.”
George says even the lab staff had unanswered questions about procedure during closures – and she – the hospital’s health services manager – couldn’t answer them.
“If you have somebody who has some sort of blood work that’s out of line and it’s a very critical value, well, what do you do?”
George says she asked her manager, who works of the health region’s Swift Current office, what to do.
“He said, ‘That’s not my issue.’,” George described, adding the manager said lab staff must find an answer within their own supervisory structure.
She says her manager very rarely visited the hospital and contact was infrequent.
“I would say if I had two or three visits from my boss, I would be very, very lucky. And really no contact, other than through email – maybe, sometimes. There was no support.”
She says after a heated July meeting her boss and her counterparts at other hospitals, her relationship with her superior further deteriorated and support from the region diminished.
George says she and another manager requested that their manager’s boss also attend the meeting, but her manager denied the request.
“We had a very difficult manager’s meeting when everything really came to a head. These were the types of questions we were trying to ask,” said George, who confirmed she was not alone with in her frustration with a lack of information.
George says they wanted one thing – simple direction on what to do with patients, care and treatment while the hospital was closed.
“We weren’t asking what to do if someone has a hang nail. We weren’t asking what to do if someone cuts a toe. The nurses know what they’re doing. We just wanted policy backing procedure from the region to say that when we’re in a disruption, this is what we do. We were having a very difficult time getting any of that written down.”
After failing to receive clear direction, George and another manager eventually met with the manager of their supervisor.
“We said we were having some difficulties with (the manager) and we needed help from the health region.”
George says they were given a complicated three-page document which failed to answer their questions.
“Nobody could really understand what it meant.”
George says hospital closures raise a unique set of questions for residents of long-term care homes.
“You’ve got very, very skilled people working in long-term care as nurses. But in Maple Creek, there’s no nurse on nights. So at 8 p.m., the registered nurse and her LPN go home. There is a registered nurse on call,” said George, adding that the decision to not have a nurse on-duty overnight was made a number of years ago. “Everyone I was asking the other night, they figure it’s been 11-12 years this has been going on.”
George says they wanted to know what to do with people in long-term care in the event of longer diversions, such as those lasting as long as five days. She says they were told that health issues needing attention should be handled before the nurse went home at night. George wrote to the health region’s director of long-term care.
“Who do you call? If you have somebody who is what they call a brittle diabetic, sometimes at 3 a.m. their blood sugar will just plummet. You have somebody who is palliative and their pain is out of control. If you’re looking at not having a doctor you can call or get a-hold of in four or five days, and you have somebody who has a urinary tract infection,” said George, describing the types of questions she asked. “What are you going to do? You are not going to transfer someone to Shaunavon at 3 a.m. when all you need is an insulin order.”
George expressed frustration at the idea of having to transfer an 86-year-old patient because of a bladder infection when there is no doctor available to order treatment.
She says she did receive an answer back from the long-term care director, but the reply served only to further frustrate George.
“She wrote back to me and said, ‘Maureen, I know this is relatively new for Maple Creek and that not having a nurse on nights is new to you.’ But we haven’t had a nurse on nights for 11 or 12 years,” exclaimed George. “I don’t consider that new. The frustration – why would somebody who is director of long-term care not know that this has been going on, that there is no nurse on nights and there hasn’t been one for years? Why would the person not know that?” she asked.
Eventually, George and another manager enlisted outside help to identify the role nurses should play while working at a hospital in the midst of a temporary closure.
“In September, we had a lot of contact with the SNRA (The Saskatchewan Registered Nurses’ Association) and the practise advisors and I called the Canadian Nurses Protective Society (and organization which offers legal advice) to find out exactly what we needed to do. And their recommendation was nurses have to be able to function to the level of their capabilities. So we got the SNRA and the Saskatchewan Union of Nurses. There was a meeting called in September,” she said.
But once the meeting was called, George’s manager and his manager both advised her and another health services manager from another hospital not to attend.
George says she couldn’t understand why they were asked not to come, when it was they who requested the meeting.
“We were fighting for this all along, why would we not attend the meeting? Then the SNRA said told us, ‘No, you must attend the meeting as managers.’,” explained George.
At the meeting, George says they were finally given some direction.
“We basically got the steps outlined that we wanted. At the meeting, this protocol, it was gone over and it was okayed by the SRNA at the meeting because they were of the understanding that you have to allow nurses to function within their capabilities and that was really all we were asking.”
While George was pleased with the outcome of the meeting and newly equipped with the direction she has been seeking for months, her relationship with her manager deteriorated.
“My boss never, ever talked to me again. I would get an email that this or that needs to be done,” she said, adding she was totally ignored at a meeting about the pandemic flu a couple of weeks later. “This sounds petty, but there was no acknowledgement whatsoever that I was there.”
By that point, George had already written a letter of resignation and had kept it with her for months.
“I had been carrying around my resignation to every meeting that I went to since July. You know how people who have anxiety attacks carry their little brown paper bag? Well, I had my little brown paper envelope. It was not pleasant.”
When it was time for her probation and performance review, George was shocked to learn her manager wanted to include the health region’s director of human resources in the review. She was informed of the meeting by email.
George asked her manager why the additional person was required, but he neglected to give her an answer.
“He said, ‘Because I’m your boss and that’s the way it’s going to be.’,” said George.
Because of the strained relationship with her manager, George insisted on finding out more before agreeing to the meeting.
“I said, ‘If this is disciplinary, I want to have someone else there.’,” said George, adding that she exchanged many emails trying to get a handle on what was happening. She says the health region’s policy on reviews is clear that they are between the employee and the employee’s manager.
Finally, George emailed her manager’s boss, Cypress Health Region CEO Jim Hornell and she also contacted a health board member.
George says the Cypress Health Region board member she approached was instructed not to talk to her again.
“He wasn’t supposed to concern himself with the day-today operations and he wasn’t supposed to talk to me,” George said. “How can they say that? If you’re having problems with your boss, you should be able to hop around your boss and go to your boss’ boss. But if you can’t do that or go to the next step up, what do you do? There is something wrong. If there’s nothing to hide, you’ll talk to people.”
George did eventually attend the meeting after it was confirmed the meeting was not disciplinary in nature. She went alone, and believed that had she insisted on bringing someone with her, she would have been fired.
Her review wasn’t positive. George says she was told of many small things she had unknowingly neglected to do, such as attend meetings her manager had told her she was not required to be at. She says she asked her manager why, if she wasn’t performing her job to his expectations, had he not come to see her at Maple Creek and tell her.
“He said he didn’t feel welcome in Maple Creek,” George said, adding that at the meeting, he was still perturbed by her decision to have the September joint meeting with the health region and the union.
“I had to keep getting him away from that, we’ve already dealt with that, we’re talking about now,” George described. “Why if I were doing such a poor job, why wasn’t I ever told?”
After hauling it with her for months, she finally handed over her letter of resignation at the end of her 90-minute review.
She used some of the time at this last meeting with her manager to bring up some fundamental issues of healthcare delivery.
George says the health region is administering regionalized healthcare to rural residents.
“I said, ‘You guys talk about regionalization. But you are practising centralization. If you were practising true regionalization, you would have a member of senior management living in each community. You just want everything in Swift Current.’,” said George.
George says there were countless examples of disconnected Swift Current management.
“They would say to us, ‘Well, you’re just going to have to pull staff from a different floor.’ I don’t know about anybody else, but I never found another floor in that hospital. That’s the not understanding of what’s happening in the community. What works in a bigger centre does not work in rural.”
George says she feels the health region wants daytime medical centres, not hospitals in the rural areas.
“I really and truly think that what the bottom line they’re wanting is for all these places to be health centres. For all their trying to get this new facility, they really want it down to a five or six bed facility,” she said. “I’ve been to those meetings (about a new hospital) and I’m looking and I’m thinking, ‘Aww, man, do you really think you’re snowing these guys, because you’re really not.’ You’re going to take this out and you’re going to take that out, but you’ll still have the number of beds. Well, no you won’t.”
While she doesn’t think the health region misses her, George says she loved serving beside the staff at Maple Creek and she believes she was also mutually respected at the facility.
“I don’t think they were unhappy that I resigned because I think I was causing way too many issues by challenging them. The number one important thing for me out there is my staff and patient care. You can’t separate those two things. But the only way that you get wonderful patient care is if you have wonderful staff and the only way you have wonderful staff is if you represent and stand up for those staff.”
George says at one point in her employment, she was admonished by her manager for sharing too much information with hospital staff.
“The only common information that the staff that work for me shouldn’t have is anything to do with patient confidentiality. These people that work in this facility, they are what’s making this facility run. They have a right to know. When you give people knowledge, you empower them. When you empower people, you lose some control and that is what this whole region is about – control.”
The health region was contacted for comment and declined the opportunity, but may comment in the near future. The identities of George’s managers have been withheld, pending comment from Cypress Health Region.