Staff are raising alarms about an unsustainable situation in the medical-geriatric clinic in Skellefteå.
Norran spoke with several nurses at the medicine-geriatrics department in Skellefteå. They described an unsustainable situation marked by severe overcrowding, with significant consequences for both staff and patients.
The long-standing problem intensified during the Christmas and New Year holidays. The nurses requested anonymity to keep the focus on the systemic issues rather than themselves.
They emphasised their dedication to their work and colleagues but acknowledged they had reached their breaking point.
No matter how fast they run, they are too few, the nurses explain. They cry after work and warn that the work environment is dangerous for both patients and staff.
In the medicine-geriatrics department, there are recommendations that a care team – one nurse and two nursing assistants – should be responsible for a maximum of seven patients. In recent weeks, they have been responsible for nearly double that number.
The medicine-geriatrics department consists of four wards, each caring for patients with different medical conditions. When staff have to switch wards at short notice to cover for each other, there isn't always time for proper training.
The situation leads to long, stressful shifts. The nurses describe days working nine hours without a break for food, or twelve hours without time to use the restroom.
Oavsett hur fort de springer är de för få, berättar en av sjuksköterskorna. Bilden är en genrebild.
They also explain that they don't always have time to read patients' medical records and must rely on verbal reports and handovers. The healthiest patients are prioritised last, and their medication is often delayed.
The stress and the feeling of not being able to cope are affecting the employees' health, according to the nurses. Many are now experiencing symptoms of exhaustion and concentration difficulties, they continue. This can lead to mistakes.
Staff are sometimes forced to take double shifts when colleagues fall ill. And when they finally have time off, they worry about the phone ringing – with more work to do.
The medicine-geriatric clinic in Skellefteå has frequently experienced overcrowding.
In the autumn, they called for measures to be taken ahead of the Christmas and New Year holidays. Two meetings were held with department and operations managers, where the staff made suggestions. One of the suggestions was to temporarily bring in agency nurses. That did not happen.
The nurses like their workplace and say they understand that a solution is being worked on. But if the situation doesn't improve soon, they foresee resignations and sick leave.
Norran also meets Johanna Davidsson and Linnea Berglund, chief safety representatives for Vårdförbundet (the Swedish Association of Health Professionals) in Region Västerbotten. They take the situation seriously and express concern for the health of the staff.
– A 6:6 a request for action has been submitted. The response has been received from the employer, and the safety representatives will review the response on Monday, says Davidsson.
A 6:6 a request is made according to Arbetsmiljölag (Work Environment Act) to ensure a good working environment.
– If the employer doesn't come up with a good plan, we can take it further to Arbetsmiljöverket (the Swedish Work Environment Authority), says Johanna.
Johanna Davidsson and Linnea Berglund, chief safety representatives for Vårdförbundet in Region Västerbotten.
Operations manager Marie Jinder has been on-call herself recently. The clinic, which provides acute internal medicine and geriatric care, usually has 50 beds and operates around the clock, even during holidays.
– We always have to consider patient safety, medical quality, and the work environment in our planning, Jinder explained.
– That was true for this Christmas and New Year's as well.
Operations manager Marie Jinder has been on call herself.
Between December 13 and January 6, the clinic cared for between 58 and 60 patients, despite being staffed for only 44 open beds. As a result, additional staff were required.
– The plan was to give staff some relief, not to require overtime or force them to work extra shifts, says Jinder.
The high occupancy rate and unexpected sick leave created challenges, she explains.
She emphasises that the overcapacity is largely due to the municipal care system not accepting patients who are ready for discharge. These are people who have completed their treatment at the hospital but still need ongoing care.
This could involve needing a spot in a care facility or home care services. While waiting for these services, patients remain in the hospital. This issue has persisted throughout 2024. Over the course of the year, the clinic has cared for between 12 and 25 discharged patients per day.
Nurses describe days with nine hours of work without a break for food. Stock photo.
– These individuals are not part of our medical responsibility. We don’t have the budget or staffing to address their needs. If it were a third or half, we might have managed, but not to this extent. We understand that some planning time might be needed from the municipality, but this is beyond what’s reasonable, says Jinder.
She points out that the situation in Skellefteå is unique compared to other hospitals in the region.
– Having so many patients ready for discharge in an emergency department is a problem. We can’t refuse our duty to care for patients who need treatment for conditions like stroke or pneumonia. We can manage up to ten discharged patients a day, but not 30 – that’s unsustainable.
She adds that the issue has been raised with both municipal and regional politicians.
– This is happening at the expense of our staff. We’ve worked hard on improving the work environment and continue to do so. But it’s difficult when there are factors beyond our control, she continues.
Nurses report that staff are sometimes forced to work double shifts when colleagues fall ill. Stock photo.
Jinder describes the situation in recent weeks as "unique," particularly due to the exceptionally high number of patients ready for discharge, a figure that peaked during the holiday season. She believes that, given their staffing levels, there was no alternative way to plan for avoiding this scenario.
– This level of pressure has never been seen before. The planning is based on past years’ occupancy rates and emergency admissions, but even the week before Christmas, we saw an overwhelming influx of patients with infections. Combined with so many patients ready for discharge, it placed an enormous strain on our staff.
Nurses describe a situation so intense that they were concerned about patient safety. They were so fatigued that they feared making mistakes. They simply didn’t have enough time to administer medications on time because of the overwhelming workload.
Between December 13 and January 6, between 58 and 60 patients were cared for at the clinic – which was only staffed for 44 open care beds. Stock photo.
How do you view this situation?
– We have a system for reporting deviations and system errors. We are quite quick to address these issues when they are brought to our attention. We place a strong focus on both patient safety and the work environment.
But the nurses are raising concerns that the situation is not safe for patients?
– I can't say that the situation poses a direct patient risk in that way. However, it is not a sustainable situation to care for 15 to 29 patients who are ready for discharge and actually require care from the municipality, while also fulfilling our role in providing emergency medical care. I want to find solutions moving forward, but it's difficult when we don't have control over the solution, says Jinder.
She adds that there are also risks for patients who are ready for discharge if they can't leave the hospital.
– Staying in the hospital, for example, increases the risk of infection, as well as the risk of falls, and consequently fractures.
Many nurses have said they are looking for other jobs. What do you think about that?
– It's very concerning. We're doing everything we can to ensure that our employees are happy and healthy, says Jinder.
Iosif Karambotis (S), chair of the social welfare committee, shares the view that patients who are ready for discharge are a challenge for the municipality.
However, he maintains that in "most cases," they manage to get them home within the agreed time frame (three days). He prefers not to engage in this conversation in the media, responding in an email.
The staff are exhausted. Do you understand why they are seeking answers?
– I understand that they are in a tough situation, and so is the municipality's staff, who are working hard every day to get individuals home as quickly as possible. In parallel, we’ve made several political decisions aimed at speeding up the process.
He adds:
– We and Region Västerbotten face several challenging issues, including the shortage of trained staff. To address this, we need to have a constructive dialogue together.
The problems mainly affect very frail patients, who have developed new ailments, he explains. In those cases, it takes more time to ensure the discharge process is handled correctly.
According to Karambotis, part of the explanation for the issue lies in the demographics of northern Sweden, with a growing elderly population. It also stems from the lack of staff in the care and nursing sector, which has forced the municipality to close care home placements.
He also mentions that Region Västerbotten's own cutbacks have had an impact, in addition to the shortage of doctors in primary care.
The head of the medicine and geriatrics department says they can certainly care for patients ready for discharge. However, the most they can handle at any one time is ten – not thirty. Isn't it your responsibility to care for those who no longer need hospital care?
– We have an agreement with Region Västerbotten that the average time for a patient to be discharged should be under three days. We can manage this in most cases. However, there are times when we experience unsustainable peaks, and we absolutely need to address this better.
What steps are you taking now to improve the situation?
– Through daily planning and the reopening of care home placements that were previously paused. We have also tasked the department with investigating whether we can increase the number of short-term care places. We are trying to work preventively, so we can deploy the right resources early and, to some extent, prevent hospital admissions. We aim to develop this approach together with primary care.
In the autumn of 2024, the social welfare committee decided to change guidelines for assistance assessments to enable faster implementation of decisions regarding care and nursing homes.
– This year, we are allocating six million kronor to our own Learning Center to address the skills shortage.