Patients concerned over after-hours medical changes

When you dial 911, it’s usually a bad emergency.

Valemount residents are used to having a second option after-hours if they aren’t sure how serious it is – phoning a local nurse directly.

But after changes came into effect Jan. 2nd, a local after-hours nurse will no longer be. During evenings or early mornings, Valemount residents can still call 911 for an ambulance or phone a nurse through a provincial 24-hour hotline (8-1-1) for general health information.

Northern Health administrator Debbie Strang says the change was made because burn-out among nursing staff at the Valemount Community Health Centre was a real problem.

“While that was a good service, it was quite a burden on the nursing staff because they weren’t getting sleep, they weren’t getting time off.”

She says many of the calls did not require the nurse to return to the clinic – most of the patients could wait until regular operating hours to see a doctor.

The Valemount Community Health Centre provides emergency services Monday through Friday from 8:40 a.m. to 4:30 p.m., and on a walk-in basis for emergencies only from 10:30 a.m. to 6 p.m. on Saturday and Sunday. Outside those hours, the clinic received 642 after-hours calls in the past 32 months. Strang says while some days they may not receive any calls, other days the nurse might receive 4-5 calls a night. They lost two nurses in the past year who cited after-hours duties as one of the reasons for their leaving.

In addition to being disruptive to sleep, Strang says it is also problematic if the nurse is scheduled to work in the clinic the next morning, which is sometimes the case if they have to cover night duties for another nurse. There are only four nurses who work at the clinic.

“We need to make sure we’re protecting our staff and keeping them well and healthy so that they’ll continue to stay in Valemount,” she says. “People aren’t aware that you’re not phoning a nurse that’s awake – these nurses are at home in bed, trying to sleep for their next shift.”

Patients who phone 811 will still speak to a nurse, but the nurse does not have access to their medical files or know their history – the nurse can dispense general information only.

Valemount resident Wayne Brown says, “A whole lot of links are missing now.”

His wife Annette sometimes needs medical assistance after regular business hours. Because of the complexity of her health issues, he worries that even simple questions could have big consequences – he doesn’t think the general information hotline will be of use.

“I could relax if one of the nurses in town could have looked up the history on the computer and said ‘Yes that looks like the right thing to do,’ or ‘No, we want you to come in.'”

On Saturday they had a question about new medications. Brown says phoning 811 would have been a waste of time since the nurse doesn’t know the history and what the specialists are trying to achieve.

“I would have preferred to have someone to chat with. I’m making a judgment call that I’m not qualified to make. That makes me feel uncomfortable as well.”

He says calling an ambulance to inquire about medications seems like overkill.

“We’re tying up resources that might save someone’s life.”

Valemount resident Edna MacLean says she is concerned for her daughter who has a serious heart condition. She sometimes has attacks after-hours twice a week, where her heart beats very fast.

Ordinarily they would take her to the clinic and phone a nurse who would be there extremely fast – a lot faster than an ambulance. The nurse would then phone a doctor, bypassing the need for an ambulance.

“They’re used to her coming so they know what to do.”

Now they will have to pay $80 for the ambulance each time she requires assistance.

Strang says some patients may be eligible to have the ambulance fee waived, but it depends on individual circumstances.

She adds patients can also phone the McBride Hospital 24 hours a day – though they also don’t have access to Valemount-based medical files.

Strang says they have moved the evening nurse to day shift, so people should be able to see a nurse or doctor faster when the clinic is open during regular hours.

“Mornings are very busy – people wait a long time – now with two nurses, we’re going to be seeing people faster.”

The clinic will also be adding an evening clinic once a week for people who work and can’t make the daytime appointments.

She adds the new system is a work in progress and there’s a feedback book at the clinic for people to write their comments about the new system.