Staff Shortages Impact Mothers’ Safety, Midwives Say

The vast majority of midwives in Iceland say mothers’ safety has been put at risk due to staff shortages. Almost one-third of midwives have considered leaving the profession altogether within the last two years. Too much strain, staff shortages, and dissatisfaction with how the shortening of the work week has impacted shift work are all named as key reasons.

The data is from a recent survey by BHM which was commissioned by Icelandic Association of Midwives last month. According to the survey, 85% of midwives say the safety of mothers has been put at risk at some point in the past six months due to staff shortages, and 48% of them say that such incidents happen more often than before.

More strain on shift workers

When asked to consider the last six months, 85% of midwives say they have encountered situations where staffing was not sufficient to ensure minimum safety requirements for patients. This percentage is lower among midwives who work daytime hours (72%) and higher among those who work shifts (93%). Notably, 39% of shift workers stated they have often encountered such situations within the past six months.

Dissatisfaction with impacts of “shortened” work week

Three-quarters of midwives stated that the level of strain they experience on the job is “high” or “very high,” and 70% say that strain has increased over time. These figures are higher among shift workers than daytime workers.

When asked how their working conditions had changed with the shortening of the working week, 54% of midwives working shifts in the public healthcare system believe that working conditions have worsened as a result, while only 30% believe that working conditions have improved. There is great satisfaction with the shortened work week among midwives in daytime work, while dissatisfaction among shift workers is mainly related to a system that financially incentivises them to take more evening and night shifts, as well as the negative effect on work flexibility.

Staff shortages and strain have been an issue across Iceland’s healthcare system for years, including among nurses and in emergency care.

COVID-19 in Iceland: Domestic Cases Drop as Hospitalisations Rise

Domestic COVID-19 case numbers appear to be dropping in Iceland, though strain on the healthcare system continues to increase, particularly in North Iceland. Those were the main messages from a pandemic briefing held by Icelandic authorities in Reykjavík this morning. Tighter restrictions took effect in Iceland on Saturday, halving the national assembly limit to 10 and instituting wider mandatory mask usage.

Iceland reported 26 new domestic cases of COVID-19 yesterday and 6 from border testing. Active case numbers are at 905 and have been dropping for several days. The number of people hospitalised due to COVID-19 is, however, at a record high of 72, with 3 of those in intensive care. Patients have also been hospitalised in Akureyri, North Iceland, though none of the cases there are currently serious.

Growth in Cases in North Iceland

Chief Epidemiologist Þórólfur Guðnason stated that while community-spread infections appear to be trending downwards there are fewer tests conducted during the weekend. Numbers over the next few days will show whether the trend will continue. There continue to be small group outbreaks, particularly in North Iceland. Of yesterday’s new domestic cases, 25% have a legal residence outside the capital area. No new strains of the virus have been detected and for now Iceland is not seeing exponential growth in case numbers, in contrast to many nearby countries.

Update to Border Regulations

Current border regulations, which allow travellers the option between double-testing and five day quarantine or 14-day quarantine without testing, are in effect until December 1. Þórólfur stated that he will be submitting his recommendations for continued border regulations to the Health Ministry soon. He noted that current regulations have prevented a large number of active cases from spreading into the community and expressed his support of implementing mandatory testing for all travellers entering the country.

Outbreak Response Team Established

According to National University Hospital Director Páll Matthíasson, the group outbreak that began at the hospital’s Landakot location nearly two weeks ago seems to have been contained. Director of Health Alma Möller announced that an outbreak response team had been put together over the weekend that can react quickly in the case of such outbreaks at healthcare institutions. The team is able to respond to such events across the country.

Stores and Schools

The tightened regulations that took effect on Saturday made mask use mandatory in stores across the country. Chief Superintendent Víðir Reynisson expressed bewilderment that there had been cases of customers refusing to wear masks in stores and even threatening employees who were often young people simply trying to direct customers. “It’s such a load of nonsense that I can’t believe we are dealing with it,” he stated.

Víðir said authorities had received hundreds of requests from businesses asking for exemptions from the tightened COVID-19 regulations. He urged the public and companies to stop requesting exemptions and follow the rules for the next two weeks.

Regarding criticism of tightened regulations that take effect in schools tomorrow, Þórólfur stated the regulations, which give more freedom to younger students, aimed to strike a compromise between infection prevention measures and keeping schools operating as normally as possible.

Iceland Review live-tweets authorities’ COVID-19 briefings on Mondays and Thursdays at 11.00am UTC.

COVID-19 in Iceland: Group Outbreak in National Hospital Strains Healthcare System

COVID-19 ward Iceland National University Hospital Tómas Guðbjartsson

A group outbreak of COVID-19 at the National University Hospital is straining the Icelandic healthcare system. In a briefing today, Director of Health Alma Möller recommended all optional surgeries be postponed to minimise the risk of further hospitalisation. Chief Epidemiologist Þórólfur Guðnason stated that authorities would be monitoring to see whether the hospital outbreak leads to community infections, and if so, whether COVID-19 restrictions need to be tightened further.

Iceland’s National University Hospital is currently treating 51 patients with COVID-related illnesses, the highest number of COVID patients it has ever had. There are 15 patients in the ICU, three of which have COVID-19. The hospital is currently operating according to a state of emergency, in part due to a group outbreak of COVID-19 among elderly patients at its Landakot location. The outbreak has infected 79 individuals: 27 (largely elderly) patients and 52 staff members. The outbreak heavily impacts operations at Landakot.

Landakot Outbreak Could Lead to Rise in Community Infection

Though previous COVID-19 outbreaks in hospital had not led to a rise in community infection, the Chief Epidemiologist stated that he would not be surprised in the Landakot outbreak spread to the community. Case numbers over the next few days would show whether this was the case, and whether he would recommend further restrictions would depend on those numbers.

Patients Spread COVID to Other Institutions

At the briefing, the hospital’s director Páll Matthíasson commended hospital staff, which he stated were shouldering an “inhuman” workload. He stated that the hospital currently had three priorities: ensuring it can treat COVID patients, making sure hospital services remain accessible to those who need them, and containing the Landakot outbreak.

Before the outbreak was discovered, some patients were moved to Reykjalundur and Eyrarbakki, resulting in infections in those institutions. Þórólfur stated that the patients were not tested before being moved as the outbreak had not been discovered at that point, but added that authorities would be more careful in the future when transporting patients between healthcare institutions. It was necessary to transport the patients to ease strain on the hospital.

Authorities Consider Mandatory Border Testing

The Chief Epidemiologist expressed his concern that individuals may not be following rules on quarantine upon arriving to the country. While travellers arriving from abroad can currently choose between 14-day quarantine or double testing with five-day quarantine, Þórolfur stated that authorities were considering making the latter option mandatory.

As usual, Þórólfur responded to news of an impending vaccine with cautious optimism, reminding the public that we still have a long way to go in this pandemic and personal preventative measures such as handwashing remain crucial in bringing down case numbers. Chief Superintendent Víðir Reynisson underlined the importance of staying home if you have symptoms and asked employers to make this policy clear to their staff.

COVID-19 in Iceland: National Hospital Capacity Key to Third Wave Response

National University Hospital Páll Matthíasson

The National University Hospital can handle the projected strain of the current wave of infections, though some reorganisation will be necessary, according to its Director Páll Matthíasson. Páll discussed the hospital’s strengths and weaknesses in tackling the current uptick in COVID-19 hospitalisations at a briefing in Reykjavík this afternoon. Iceland’s current wave of infection will rise slower, fall slower, and last longer than its first wave last spring, says Chief Epidemiologist Þórólfur Guðnason.

Spread of Infection Likely Slowing

Þórólfur stated that the number of daily infections in Iceland and the number of those diagnosed outside of quarantine both appear to be dropping, though slower than expected. Exponential growth of the local pandemic had been successfully avoided, and thus he believes it is unnecessary to impose harsher restrictions, though the situation is being re-evaluated on a regular basis. On the other hand, he stated it was likely that restrictions would be maintained over the coming months as “this virus is not going anywhere.”

Hospital Needs to Free Up Resources

The Chief Epidemiologist’s Office and the National University Hospital have been in communication regarding the challenges the hospital faces in tackling the current wave of COVID-19 infection. Páll stated that while the hospital has many strengths, including well-trained staff and new knowledge and experience in treating COVID patients, it needs to decrease pressure in other wards of the hospital in order to free up resources to deal with the pandemic. The hospital also needs to ensure it is flexible in its organisation and its reserve force of healthcare staff are ready to respond to emergencies. Space and staffing are the biggest challenges currently facing the institution.

Nursing Homes in Good Shape

Most nursing homes and disabled care homes in Iceland are in good shape, according to Þórólfur, and measures implemented to prevent the spread of SARS-CoV-2 have been largely successful. He added that there have been few severe COVID-19 cases among the elderly and at-risk in this wave of infection.

Chief Superintendent Víðir Reynisson ended the briefing by reminding the public of their personal responsibility in tackling the pandemic. “It is normal to be tired and bored of COVID and want our normal lives back. But we need to stick together to protect those most vulnerable.”

Iceland Review live-tweets Icelandic authorities’ COVID-19 briefings.

Palliative Care Services to be Expanded in South Iceland

The Minister for Health Svandís Svavarsdóttir has decided to grant funding to establish four rooms dedicated to palliative and end-of-life care to be managed by the Health Care Institution of South Iceland, RÚV reports. The new facilities and services are expected to cost ISK 43 million a year [$313,411; €263,007].

The Health Care Institution of South Iceland (HSU) serves roughly 20,000 people in the region and operates eight health care clinics, a hospital with 62 sickbeds in Selfoss, and health care service for the prison Litla Hraun. The institution’s new palliative care team will oversee treatment for patients nearing the end of their lives and will also support nurses and doctors working at the local health clinic and nursing homes.

The establishment of palliative care facilities outside of the capital area and around the country is in accordance with the government’s 2018 – 2030 healthcare policy, which aims to provide ‘the right care in the right place.’ The idea is that rural residents should not have to travel to the capital for vital health care services, not least palliative and end-of-life care. According to a working group focused on the future of palliative care in Iceland, this will not only better serve rural patients at the end of their lives and their families, but will also ease some of the pressure currently put on the National University Hospital’s ER.

WOW Flight Attendants Turn Back to Nursing

Flight attendants WOW air Icelandair

Vísir reports that many trained nurses who were laid off this week by WOW air have already inquired about work at hospitals. Anna Sigrún Baldursdóttir, assistant to the National University Hospital’s director, confirmed the fact with Vísir reporters. She says the hospital would be overjoyed to welcome back any nurses who are looking for a job. “There is no need for any nurse to be unemployed,” Anna Sigrún asserted.

Iceland Review magazine reported last fall on nurses taking off from hospitals in search of greener pastures with airline companies WOW and Icelandair. The bankruptcy of WOW has caused some of them to turn back to the profession they trained for – and hospital administrators couldn’t be happier.

Iceland Review Magazine: The Flight of the Nurses

Iceland has a shortage of about 570 nurses, according to a 2017 report by the Icelandic National Audit Office. In 2016, 9% of registered nurses were living abroad and 10% were believed to be working outside the field. As far back as 2014, up to a fifth of nursing students planned on becoming flight attendants after graduation. The profession has long reported high burnout rates and dissatisfaction with working conditions and wages.

Anna Sigrún says the National University Hospital has gotten in touch with WOW’s human resources team as well as the Directorate of Labour to remind them any trained nurses laid off by WOW can make a soft landing in healthcare.

Long Waiting List for Emergency Care

Emergency room

The National Hospital’s emergency ward operated at level three alert this weekend due to lack of space, RÚV reports. The waiting list for admission was 30 patients long, in part due to an influenza outbreak in the hospital. Twenty-seven patients at the hospital have come down with the flu, 14 of them just last week.

Chief Physician Jón Magnús Kristjánsson says the waiting list for emergency care was unusually long this weekend. “There was no single thing that explained the situation over the weekend, but the flu is in full swing which was a part of the situation,” he stated. Patients with influenza in some cases require hospitalisation for weeks.

Jón Magnús pointed out that such conditions could easily create a dangerous environment. “It’s always more difficult to fully ensure good service and safety for patients under these conditions,” he stated, adding that extra staff had been called out in response to the situation.

The hospital usually operates at level two alert. At level three, all the hospital’s departments are activated and admit more patients than otherwise. “What needs to be done to prevent such a state of affairs is to provide adequate resources for elderly people who have completed their hospital treatment and to ensure adequate staffing of nurses and medical staff at the hospital’s inpatient ward,” Jón Magnús explained. While there is a plan to increase the number of hospital beds in the Reykjavík capital area over the next few years, he said, “there is nothing that will solve this in the short term.”

State of Emergency in National Hospital

Emergency room

Neither the lodging conditions nor the staffing at the National University Hospital of Iceland’s emergency room meet regulations on minimum professional standards, according to an assessment carried out last month. RÚV reports that current conditions are such that the ER cannot ensure patients’ rights regarding care. The assessment, carried out by the Directorate of Health, says understaffing and lack of space are the main issues.

Ignored alarm bells

The report states that although staff and management have been attempting to raise the alarm on the situation their efforts have received insufficient attention. “Now it has come to pass that the problem is of such magnitude that we cannot let these conditions go on. It can create grounds for unexpected incidents and the risk of additional staff dropout.” The problem is now of such magnitude that it requires immediate action – and is beyond the power of the National University Hospital to solve on its own, the Directorate asserts.

Longer stays in ER

The assessment found that the ER handled patients with acute problems efficiently, who are usually released in 4 to 5 hours. This average has not increased despite an increase of cases in recent years. Such is not the case, however, for patients waiting to be admitted to other wards. Their average length of stay in the ER has increased to 23.3 hours this year, from 16.6 hours at the same time last year. The longest wait for admission when the assessment was carried out was 66 hours, but there have been cases of patients waiting more than 100 hours in ER after they have been admitted. Those who wait longest are usually elderly people, patients with multiple issues, and patients in isolation. Wait times could become even longer as flu season hits.

Lack of space has led to cases of patients being treated in hallways and patients with conditions requiring isolation to be housed with others. Patients are also often placed in wards which lack the specialists needed to address their health issues simply due to a lack of space. The pulmonary ward in particular houses many long-term patients that could be at home, if not for a shortage of specialised home-care services.

Stressed staff

The audit cites stress on staff as a particular concern, with a shortage of nurses said to increase the risk of errors. It is reported common among hospital staff to miss meals or even stay overtime as their departure is considered dangerous for patients in their care. Many staff report feeling guilty both toward their families and their workplace due to the pressure.

Suggestions for improvement

As a result of the assessment’s conclusions, the Director of Health has suggested to the Ministry of Health to increase staff, particularly nurses, in the short and long term. It is clear that the wages and working conditions of nurses need to be reconsidered.

A nursing home in Seltjarnarnes scheduled to open in February should also be opened sooner if possible, as well as a nursing hotel scheduled to open on April 1. The assessment report suggests considering whether to outsource the operation of temporary care facilities to competent bodies. Other suggestions include reinforcing home care and in-home healthcare services, as well as elderly care.

Patients’ safety threatened

The evaluation was carried out after a specialist in emergency treatment notified the Directorate of Health that conditions at the National University Hospital of Iceland’s ER were threatening patients’ safety. The hospital’s CEO and Chief Medical Officer seconded the specialist’s concerns. The evaluation was a partial audit, examining factors considered crucial, rather than a comprehensive assessment.

Midwives Approve New Contract

The Icelandic Association of Midwives has voted to approve a new employment contract with a 95% majority. RÚV reported first. An overwhelming 91% of members voted on the deal.

When national broadcaster RÚV contacted chairperson of the Association of Midwives Katrín Sif Sigurgeirsdóttir for comment, she had not yet been informed of the outcome of the vote. Katrín expressed dissatisfaction that the government’s negotiation committee would publish the results online without informing the midwives’ negotiation committee first.

“We thought the results would be presented to us at two o’clock,” Katrín stated. “This really is the cherry on top of our relations with the government.”

The contract approval brings to a close a 10-month-long wage dispute between the association and the government. Midwives asserted their salaries did not reflect their level of education or the responsibilities inherent to their profession. Over 20 midwives resigned from their positions, most at the National University Hospital, as a result of the dispute. It remains to be seen whether they will return to their jobs.