Some of the most frail and vulnerable patients in Winnipeg on a chronic care ward at Riverview Health Centre had to fight to stay in their homes. Now, they are losing many of the nurses who know them best.

The complex continuing care ward at Riverview Health Centre has close to 20 patients who have specialized medical needs and aren't expected to ever leave a hospital setting.

Many are paralyzed by conditions like multiple sclerosis, acute lateral sclerosis, or have suffered severe trauma; most are elderly.

"This is our home. On our unit it's like we're one big family. Like the staff treat us like us we're a family member who is sick," said Shawna Forester Smith, 34, who has spent the past eight years of her life in and out of hospitals in Winnipeg.

Roughly 20 patients of the 29 on the unit have been there long-term — some for up to 20 years, she said. Many of the nurses have been there long-term too.

"There's something special about the people who work on the unit. They're very, very dedicated to the patients."

She was admitted to Riverview in February with gastroparesis and other medical conditions. She can't absorb food, suffers from chronic pain and osteoporosis and isn't expected to recover, but she's in better condition than many of the others.

"There's a lot of patients on this unit who end up spending a lot of time in bed, or have issues with communication either from an accident or a degenerative disease, so some of them are non-verbal so they've found other ways to communicate what their needs are to the staff," she said.

Patient had 'tears streaming down her face'

In the spring, she said the WRHA informed them of a big change.

In a meeting with the patients and their families, officials announced that the patients would all need to move to the Deer Lodge Centre, to clear the way for respiratory patients moving into Riverview, as part of the provincial direction to cut costs and consolidate care.

"There was one lady, and she can't speak, and she's in a wheelchair, and she just sat there with tears streaming down her face," said Forester Smith.

"Watching this woman who can't communicate about being upset about these changes just sitting there and the only thing she can do is cry and she can't even wipe her own tears. It was really sad."

She said there was such an uproar, everyone in the meeting were talking about picketing in front of the Centre to be able to stay. She and family members wrote frantic emails to the WRHA.

'I thought we were all safe'

A few days later, a memo from the WRHA went out to staff saying if the patients chose to stay, they could, she said.

"After that I thought what else could happen? If we dodged the bullet of moving, then we must be OK for further changes from the health authority … I thought we were all safe."

But on Monday, she learned that all 17 registered nurses on the unit received notices that their jobs were deleted. There would be new spots for only eight of them, come Dec. 1.

"Some of the nurses were crying," she said.

Shawna Forester Smith loves her nurses on the chronic care unit at Riverview Health Centre, and doesn't want to see them go. "I felt like I was getting the rug pulled out from under me. And I was really angry at the level of secrecy around what was being done. Like nobody actually came out and told the patients what was happening," she said.

The changes are part of the WRHA clinical consolidation plan to put geriatric rehabilitation at Deer Lodge Centre and Chronic Respiratory Program at Riverview, according to Gina Trinidad, the WRHA's chief operating officer for long-term care.

"This will be to better align speciality resources to provide more focused patients and resident care," she added.

'Level of care will not change': WRHA

Trinidad said it will mean Riverview will add additional personal care home beds to replace the geriatric rehabilitation unit at the site, which begins Dec. 1.

All nurses on the chronic care unit and the geriatric rehabilitation unit received deletion notices this week, she said, and will follow the channels based on seniority of applying for more.

"While there will be less registered nurse, there will be licensed practical nurses providing that nursing care. So the level of care will not change for those patients on the chronic care unit currently."

Trinidad said while LPNs will replace many of the RNs on the unit, the day shift is the only shift in which the staffing ratio will change; rather than four registered nurses on per shift, there will be a blend of three registered nurses and LPNs.

However, the charge nurse will be expected to pick up a patient assignment of up to six patients, with the remaining 23 patients split between two other nurses with support from a health care aide.

'It's unfair': Forester Smith

"For some of them it might lack the continuity of care but the goal is ultimately to provide the same level of nursing care for these residents as they had previously," Trinidad said.

But Forester Smith says care won't be the same, because the new staff don't know the patients, and the patient loads for nurses will be higher than they were before. Already, she said, they pull staff from other units on the night shifts.

"Over time, they'll get used to the new nurses, but it seems silly to replace all the staff that have been here for so long and know all the patients with newer nurses so they can lower [nurse numbers] and change the staffing rotation. It's unfair," she said.

"I love each and every one of the nurses here."

Earlier this year, Forester Smith said she was considering switching her care plan to possibly end her life, but when she got to Riverview, the care she received changed that.

"I still feel like fighting and I feel like there's hope … whereas in the hospital it just seemed so hopeless a situation because it was just like the revolving door\," Forester Smith said.

"But being here every day and having the same people looking after you all the time, it makes a big difference. I feel safe now," she said, through tears.

About five respiratory patients from the Deer Lodge Centre have arrived on the unit, said Forester Smith.

They'll continue to move in as chronic care patients pass away.