The Cayman Islands Health Services Authority has nearly 60 vacant positions which are either being covered through overtime expenses or left vacant, according to the authority’s chief executive.
Most of those staff positions are for clinical healthcare staff, such as nurses and doctors, Health Services Authority Chief Executive Lizzette Yearwood told the Legislative Assembly’s Public Accounts Committee this week.
Ms. Yearwood said auditors noted last year that the authority had a budget for 890 total staff, but only had 833 employees.
“[There is] difficulty recruiting our professional staff,” Ms. Yearwood said. “There are some positions that have been on our books now for a couple of years; oncologist [cancer specialist] is one that we’re just not able to attract the individual that we desire with the remuneration packages that we have.”
In other areas of the hospital, staff members are experiencing a high turnover rate. Ms. Yearwood noted this is particularly true in the nursing profession.
At the moment, the health authority is covering vacant nursing positions through overtime payments to fill-in staff members. The Cayman Islands Auditor General’s Office noted in a 2016 financial evaluation of the Health Services Authority that hospital system overtime payments had increased 310 percent in one year between 2015 and 2016.
Ms. Yearwood said the public hospital faces a different kind of recruitment challenge with its nurses and front-line clinical staff.
“With nursing staff, there’s a high turnover … in some other jurisdictions, they’re actually giving citizenship papers to certain professionals,” she said. “We’ve been trying to compete in that sort of environment.”
Deaths or serious illnesses had occurred involving other health authority staff members, Ms. Yearwood said, leaving their positions unfilled.
In its 2016 evaluation of the authority’s financial statements, the Auditor General’s Office warned the hospital system about overreliance on overtime payments to cover vacant shifts.
“Reliance on overtime to such an extent could have a detrimental impact on staff well-being and the quality of care,” Auditor General Sue Winspear said.
Prospect MLA Austin Harris, a member of the Public Accounts Committee, noted that the auditor general’s statement is not the first time concerns have been raised about hospital staff overwork.
“There have been certain suggestions before this committee that … the hours worked by your staff are having a detrimental impact on the patients at the Health Services Authority,” Mr. Harris said.
“I disagree with that” Ms. Yearwood said. “It has not come to my attention. If the staff [members] are tired, we definitely ensure that they have time in order to have some downtime. Overtime is shared amongst the staff; it’s not one or two individuals that do the bulk of it.”
Nursing and other clinical staff work 12 hour shifts, four days on and four days off, Ms. Yearwood told the committee. She said hospital staff have been spoken to about the longer shifts, but they have indicated they prefer the longer time off.
“We haven’t seen any difference in the work,” she said.
West Bay MLA Bernie Bush said that is not the response he has received in discussions with hospital staff. “Out of the 14 nurses I spoke to, 10 did say [the longer shifts] were a problem,” he said. “Being tired, being stressed … leads to, especially in the medical field, big mistakes. We’ve had our share of mistakes, even as much as we try to cover [them] up, we’ve had our share of mistakes at [the] HSA.”