HALIFAX — Nurses who filed workload reports at Halifax-area hospitals last year complained of "unsafe" situations for patients caused by a shortage of nurses, including one case where an unattended patient yanked out his intravenous tubes.

The Workload Situation Reports -- also referred to as Quality Care Situation Reports -- describe staffing levels at half their normal level in 2008.

In 34 reports received through freedom of information laws by The Canadian Press, there were 17 instances when nurses with the Capital District Health Authority were assigned between 10 to 12 patients. Managers say the normal ratio is four or five patients per nurse on the units involved.

In one instance on an orthopedic unit at the Halifax Infirmary, two nurses called in sick for a night shift on Sept. 27, 2008, and no replacements were found, leaving nurses with 10 patients each to care for.

The situation report in that case refers to the care one patient received, saying "when the sitter went for their break, staff decided to make frequent checks on the patient as opposed to sitting with the patient during this time frame."

In between checks, "the patient climbed out of bed, pulled the IV and catheter out, and then sat on the next bed in her room." The patient was seen by a doctor and no injuries were reported.

The charge nurse wrote, "it is my conclusion that staffing was not adequate following two sick calls."

In most of the reports, problems began when staff called in sick and no replacement could be found. The nurses contend they were caring for too many patients, which meant they were often late giving patients their medication and the nurses questioned whether they had the time to do proper patient assessments.

Brian Butt, a director of health services for Capital Health, said the reports filed through the unions reflect worker dissatisfaction that they can't provide care at "the time it was expected, or when we would like it to happen."

However, he said "the safety of the patient wasn't compromised" in the cases he reviewed.

Janet Hazelton, president of the Nova Scotia Nurses Union, said nurses across the province are sending in similar reports.

"Halifax is better staffed than many facilities across the province," she said in an interview. "Many of the facilities which I represent simply don't have any casuals to work as replacements."

Hazelton said she recognizes the province, with a $12.3 billion debt, faces "fiscal realities," but she argues that without a higher nurse-to-patient ratio, and more funding for nurse training, patients will be increasingly at risk.

"If someone gets up and falls and breaks their hip ... what's the cost to the system for that patient to have surgery and rehabilitation?" she said.

The issue of nursing shortages in Nova Scotia was raised during the recent provincial election campaign, with nearly half of the registered nurses in the province eligible to retire within seven years. The NDP said during the campaign it supported a plan in the Conservative's proposed budget to increase registered nurse training seats by 71, and the party plans to reintroduce that measure this fall.

On one wing of the Dartmouth General Hospital, several nurses wrote reports saying they felt patient care was compromised as they focused attention on dying patients or patients who going through painful rejections of blood transfusions.

On March 1, 2008, Susan Bowers, a nurse on the general medicine unit, wrote that because of a shortage of nurses, "I gave meds and care to 12 patients that day (Saturday). I felt it was an unsafe situation, which happens frequently on weekends."

She said in a recent interview the situation has improved, with additional nurses hired and more duties assigned to licensed practical nurses. But she also said shortages of casual employees mean there are still occasions when nursing units are having to carry heavy caseloads.

"I think people should be concerned, because how safe are you in the hospital if your nurse has 12 patients? She doesn't have time to check your blood work. She doesn't have time to check your history, if there's something in there she needs to know," Bowers said.

On April 8, another nurse on the wing wrote: "I had 11 patients. ... I had a patient who needed one-on-one attention and ended up going to intensive care at 1:30 a.m. The rest of my patients did not get proper care or assessment."

On April 24, a nurse who was on the unit wrote that she was an hour behind on providing medications to patients, and summarized her situation as "insane!"

On Jan. 19, three nurses on the same unit wrote that there were 32 patients on the unit, some of them "unstable," creating a workload of 10 or 11 patients per nurse.

"Meds were late. Unable to give patients care required. NOT SAFE. Unable to truly assess patients," wrote the nurses.

The emergency room at the Queen Elizabeth II -- which closed its doors because of a backlog earlier this year -- showed signs in the spring of 2008 of an emerging problem.

On March 3, a nurse documented how the emergency room "refused to accept a dialysis patient with pneumonia," from the Queen Elizabeth II's dialysis unit because of a backlog of 12 ambulances waiting with patients outside the ER's front doors.

The dialysis unit sent the patient to emergency despite the request to keep him out, and the department eventually found him a bed.

Butt said in the situation where the patient pulled out his intravenous, the sitter should have stayed at the station and charged overtime, rather than going on break.

"When sitters are with patients, they don't leave patients unless there's another person who is able to be directly within eye sight and eye sight of that person," he said.

He also said staff could have asked assistance from other nearby units.

"There were some expectations of safety nets that could have been handled differently on that particular shift."

Butt said a recruitment drive has the units he oversees back up to a full staff complement this summer.

Karen Mumford, health services director at the Dartmouth General Hospital, also said the safety of patients wasn't affected, due largely to the "professionalism and compassion" of the nurses on duty.

"For me, unsafe becomes a point where the essential clinical care cannot be delivered. In these situations the essential clinical care was delivered," she said.

"Were they as nurses pushed and pressured, and did they find it difficult to deliver? Absolutely, without question."

Mumford said she has also been successful in recruiting nurses, and staffing levels have been restored to a full complement.

She added there are still occasions when nurses who call in sick can't be replaced, because it is difficult to find nurses willing to work on a casual basis.

Statistics for 2008-09 kept by the health authority indicate the unit that reported problems at Dartmouth General Hospital had staff off sick about 5.6 per cent of the year, or about 3,300 hours.

Butt said the reality of staff shortages is likely to continue as the population ages and the available pool of nursing graduates doesn't keep pace.

"We know we're going to be short of registered nurses, according to the number we are permitted to employ according to our funding," he said.