You are Deirdre Kavanagh, Director of Medicine and Acute Care at Lakeshore Regional Health, a teaching hospital in Ontario. In a single week nine experienced nurses have gone. The network's chief executive wants your stabilisation plan on Tuesday, and its first page has to say what kind of problem you are solving.
The situation
Your division runs six inpatient units and 210 beds, with 620 full-time clinical staff on a publicly funded budget of C$118 million a year. In the week to 11 June, seven registered nurses resigned and two went on stress leave: 8% of the medicine nursing workforce, and seven of the nine came from just two units. Two units have breached the safe ratio of one nurse to four patients at peak, and overtime on the affected units is up 38%.
They were not an average nine. Between them they ran night shifts as charge nurses, led codes, handled complex wound care and taught the new graduates. On the worst unit, the share of the required competencies actually on the roster has fallen to 62%. Four more senior nurses are known to be job-searching. Replacing an experienced nurse costs about C$65,000 and four to six months before the newcomer reaches full competence.
Your usual instruments are closed. The network has capped agency staffing at no net new posts, and C$1.4 million is all the flexibility you have this year, for incentives, redesign and technology together. The network also wants a go or no-go on an artificial-intelligence scheduling pilot on your units, and the bargaining-unit president has already told you her members read it as a headcount plan with a software budget. Around you, the same week is being told in different ways: nine posts to refill, a ratio to restore, an exhausted team that needs support, skills that have gone from where they were needed.