St. Joseph's Healthcare Hamilton announced Monday it will cut 136 positions and 30 to 40 of those will be layoffs as it grapples with a $26 million shortfall.

The hospital said 136 staff will be affected by the cuts, which it will make through offering early retirement, "managing vacant positions" and working with unions, according to a hospital statement.

But the hospital said even those measures may "regretfully" leave "up to 30 to 40" jobs cut. The hospital currently has more than 5,500 staff and physicians and runs on a $550 million annual budget.

It will be three to five months before exact cuts are known as the hospital negotiates with unions representing its front-line workers, said hospital president Dr. David Higgins.

"It's been a very tough day at St. Joe's," Higgins said.

If I don't make this decision ... this hospital will be in very, very serious trouble. - Dr. David Higgins, St. Joseph's Healthcare Hamilton president

Linda Haslam-Stroud is a nurse at St. Joe's and the president of the Ontario Nurses Association. She said the hospital signaled to nurses it would cut 61 RN positions.

"I think the hospital is actually putting our patients at risk," Haslam-Stroud said. "This is devastating for patient care."

Michael Hurley, president of the Ontario Council of Hospital Unions/CUPE, said the cuts come as a "direct result of Ontario government underfunding."

"In a facility that was already struggling to meet the needs of Hamiltonians —staff at St Joe's were already struggling with workloads — it's frankly staggering," Hurley said.

Higgins said it's been several years since the hospital has had to consider layoffs as part of its cost-cutting strategy, but this year the depth of the budget hole combined with inflation and the weakness of the Canadian dollar left administrators with little choice, he said.

The hospital will not reduce the number of nursing hours, he said. But some of those positions will be filled by RPNs instead of RNs.

Haslam-Stroud said the hospital will be cutting 61 RN positions as part of the restructuring, including RN positions in the recovery room and neonatal intensive care, "where our little babies are unpredictable and require the care of an RN," Haslam-Stroud said.

"They're gutting everywhere."

Haslam-Stroud said there's a place for both qualifications in the hospital, but RNs have more training and skill in dealing with unpredictable and complex patients.

"I'm not here to debate the benefits of either [RN or RPN qualification]," Higgins said.

'Try to find the minimal impact'

Higgins said the hospital's board accepted the administrators' plan. But they admonished the team to measure the impact on things like wait times and mortality rates to ensure that patients are receiving the "same quality of care and access" the administrators are promising.

"These are difficult decisions, to try to find the minimal impact on our staff and our programs," Higgins said.

What further efficiencies don't compromise the quality of care? - Michael Hurley , president, Ontario Council of Hospital Unions

Higgins is a physician – an internist and a respirologist. He said making the decisions on the administrative side of the table, knowing what it's like to provide patient care with limited resources, is difficult.

"I'm sure some of the people who will be affected I've worked with as colleagues," Higgins said. "But if I don't make this decision along with our executive team this hospital will be in very, very serious trouble.

"Believe me, it causes me significant distress but we have to make these decisions," he said.

'Do better and differently'

Higgins said he's been in touch with provincial leaders but said the province is facing its own budget shortfall and it's up to the hospital to find efficient ways forward within its funding.

"The challenge is out there to all of us to do better and differently," he said.

But Hurley, from the hospital union, remains skeptical.

"Efficient by what standards, though?" Hurley said. "What further efficiencies don't compromise the quality of care?"

And Haslam-Stroud said the hospitals across Ontario where similar cuts are happening should unite and stand up to the government.

"The last thing our patients should have to deal with is the cutting of the front-line care," Haslam-Stroud said. "They basically are rolling over and agreeing to these cuts because they're told that they have to balance their budgets."

"We're all taxpayers —we understand balancing our budget," Haslam-Stroud said. "But not at the stake of our patients' lives."

Other changes include:

using more registered practical nurses "where appropriate"

moving six respiratory rehab beds to an outpatient service

discontinuing community day therapy services

closing three beds for mothers who've given birth, getting them and their babies home earlier

"Our focus today is on supporting those who will be leaving or changing positions, and continuing to support our patients through this difficult time," Higgins said in a press release.

kelly.bennett@cbc.ca | @kellyrbennett