Nurses pleaded with management to call a Code Orange when the Halifax Infirmary emergency room was understaffed and overcrowded on Wednesday night, but were denied, according to their union.

There were just three doctors on rotation and three fewer nurses than required with 99 patients waiting, the Nova Scotia Government and General Employees Union said in a release on Friday.

By 4 a.m., 42 patients left the ER without being seen by a doctor.

A Code Orange is a special alert usually reserved for incidents with mass casualties. The last Code Orange was called in June 2017 when five trauma patients arrived in a short period of time, while other critically ill patients were already in the ER.

In a Code Orange, surgeries are delayed, staff are put on standby to come in if necessary and the emergency operations centre is activated, said Nova Scotia Health Authority spokesperson John Gillis.

Unsafe conditions

Nurses reported unsafe conditions on Wednesday night with seven critically ill patients in trauma beds. The patients required one-on-one nursing and there were only four nurses on duty.

The nurses outlined the situation in a clinical capacity report.

Five other patients requiring a high degree of care, who would have normally remained in trauma beds, were moved to an area covered by new nurses who were not fully familiarized with the ER.

There were nine ambulances with patients over the age of 85 waiting with paramedics for more than 12 hours.

Meanwhile, four other hospitals in the region were trying to transfer patients to the Halifax Infirmary ER.

The Cobequid Community Health Centre stayed open overnight — marking the 12th time the centre had to stay open past midnight in recent weeks.

'Extremely busy night'

The Infirmary site, along with the ERs at Dartmouth General, Valley Regional, Cape Breton Regional, Colchester East Hants and other hospitals are operating at exceptionally high capacity, resulting in overcrowding, said Gillis.

"Wednesday was one such extremely busy night at the QEII emergency department and in addition to high patient volumes, some staff were off ill," he said.

Staff were called in to cover shifts as much as possible, Gillis said. Others stayed past the end of their shift.

Gillis said a Code Orange wasn't declared because there wasn't an external disaster that required that type of response.

No breaks, no food for nurses

Nurses on staff that night had no breaks and no food during their 12-hour shift, said NSGEU President Jason MacLean.

"This is simply unsafe for everyone: patients and workers," said MacLean. "It is unacceptable that our health care workers are being treated this way. They are the ones on the front lines, trying to keep the lid on a system that is about to boil over."

Health Minister Randy Delorey said he's gathering information from the health authority about what happened on Wednesday night.

But Delorey said the province does not have an issue with a lack of nurses.

"We have about 15,000 licensed nurses within the province," said Delorey on Friday. "I believe that's about 2,000 more nurses than we've had in the province over the last five or 10 years, which means we are growing the nurses and the availability of nurses to provide care to Nova Scotians throughout the province."

NDP Leader Gary Burrill disagreed.

"There is no need of our having a chronic shortage of nurses anywhere in any ER. We have the people, we simply have to have the government to hire them," Burrill said.

Burrill said the lack of long-term care beds are also causing overcrowding in ERs.

"As long as the government refuses to open new nursing home facilities we're going to continue to have this problem. We're going to have patient flow that is sometimes chaotic. We're going to have ERs that are overcrowded and that's where we are."

Tory Leader Tim Houston said he is seeing the health-care system deteriorate.

"I can feel it getting worse from the cries I hear from Nova Scotians. So it's the time for the government to acknowledge the seriousness of the issue and start to move forward," said Houston.

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