More than a quarter of nursing positions in St. Boniface Hospital's emergency department are currently unfilled, prompting staff to publicly demand help for what they call a crisis.

"The current state of the emergency department at St. Boniface Hospital is in crisis and unsustainable," nurses working at the facility wrote in an open letter to Manitobans.

The public plea details how nurses in the unit feel "extremely frustrated and burnt out," fearful to show up for shifts and worried about the potential that errors could be made, putting patients at risk.

"We are seeing patient numbers we have NEVER seen in the past," the letter said.

The letter was written by three St. Boniface emergency department nurses on behalf of the majority of nurses in the department.

Consolidation, which closed three emergency rooms in the city and resulted in staffing changes, has led to staffing and resource shortages, inefficient patient flow and poor morale, the nurses said.

"We want, as nurses, to provide the best care that we can, but we haven't been able to do that. We used to be able to do that until the changes," said an ER nurse at St. Boniface Hospital who spoke to the CBC on the condition of anonymity. "It's just not a safe environment for nurses or patients right now."

In a statement, Manitoba's Health Minister Cameron Friesen said health-care changes were long overdue and the province continues to try to improve patient care, even during a very significant influenza surge.

Normal nurse vacancy rate: 8%

Health Minister Cameron Friesen has previously stated that eight per cent is considered a "normal" nurse vacancy rate. The current rate for nurses at St. Boniface Hospital's emergency department is 28 per cent.

The nurse vacancy rate between Winnipeg's five other major hospitals ranged between eight per cent at Concordia and 15 per cent at HSC at the end of December. At the end of November, emergency and urgent care departments averaged 17 per cent.

Several problems are detailed in the letter, including patients waiting days in the emergency department to be admitted to rooms, nurses being forced to look after patients requiring intensive care due to lack of beds in the ICU and some patients getting "inadequate care" because of a surge of high-needs patients such as those on meth.

More than 1,000 nursing positions were deleted at St. Boniface Hospital in a scheduled overhaul in January 2018. The positions were reposted with different hours, but several tenured nurses opted instead to go elsewhere, said the nurse.

The nurse said changes were made without staff input and they "suffered for it."

"Since the changes two years ago, we have been physically and mentally exhausted as a result of the prolonged stress and frustration."

Meanwhile, the closure of the emergency departments at Seven Oaks, Victoria and Concordia hospitals and closure of the Misericordia's urgent care has caused an influx of patients to the Health Sciences Centre, Grace and St. Boniface Hospitals.

Visits to the St. Boniface emergency department have increased by more than 15 per cent between 2016 and 2018 and continues to climb, according to data obtained by the Manitoba Nurses' Union via freedom of information requests and shared with CBC News.

The nurse said it's common to see patients waiting six to nine hours in the waiting room and sometimes even 10 or 11 hours to see a physician.

At times, the 40-seat waiting room becomes "standing room" only.

Watch Darlene Jackson talk about Manitoba's nursing shortage:

Darlene Jackson, president of the Manitoba Nurses Union, says Manitoba needs aggressive recruitment to get more nurses working in the system. 0:27

In a statement, Health Minister Cameron Friesen said he has confidence in the leadership of the Winnipeg Regional Health Authority (WRHA) and St. Boniface Hospital to engage with the nurses and staff to address their concerns.

Change was long overdue and recommended by experts, said Friesen, adding that the government continues to stabilize and strengthen patient care, even during a very significant influenza surge.

"These efforts are designed to provide Manitobans what they have long deserved, better health care sooner," he wrote.

'Train more nurses, hire more nurses, treat them in a better way'

Flu season exacerbated an already existing problem, said emergency physician Paul Doucet, who has worked at St. Boniface Hospital's emergency department for 33 years.

"The biggest thing is a lack of capacity in the system and that backs up in the emergency department," said Doucet. "The waiting room keeps on building up and you can't get people in because you can't get people out."

Since consolidation, the problem has become worse, he said.

Patients still get good care, he said, but pressures are mounting and morale is plummeting without bed and nurse capacity.

The WRHA boosted nursing positions at St. Boniface Hospital from 88 to 111 this past summer, but can't fill them.

As a result, the unit relies on mandatory overtime, operating beneath the target number of nurses per shift and closing areas, such as the new cardiac monitoring room and rapid assessment zone. That further contributes to the backlog of patients, according to the nurse.

The nurses are quick to point out that their crisis is not due to flu season.

"Protocols are becoming more difficult to adhere to due to patient volumes, higher acuity and insufficient staff, which require us to care for patients in an improvised fashion," they wrote.

Dr. Doucet said the heavy-handed approach from the government and employers led to the current shortage.

"Nurses are alienated and have a feeling of despair when you read that letter," he said.

"Train more nurses, hire more nurses, treat them in a better way."

Emergency room doctor Paul Doucet says pressures are mounting and morale is plummeting with a shortage of beds and nurses. (Walther Bernal/CBC)

The Manitoba Nurses' Union, which has heard the St. Boniface Emergency nurses' concerns, is urging employers and the province to come together to aggressively recruit nurses and do everything in their power to keep the ones they still have.

"We are now reaching a point where we have to find capacity in the system. We have to find bed capacity, we have to ensure that we have enough nurses working in the system," said MNU President Darlene Jackson.

She said it's also imperative that there be enough experienced nurses to mentor and support the newer nurses, but first, the health-care system must stabilize.

A spokesperson for the WRHA said the nurses' concerns are being taken seriously and they're working with them to try to find solutions.

"We appreciate the frustration many of our nurses, physicians and staff are experiencing as we continue to manage high patient volumes and a sustained increase in demand for services," said a spokesperson for the WRHA in a statement.

The health authority would not share data requested by the CBC on patient visits over the past 6 years during flu season.

Employers recently met with the nurses to hear their concerns and create a plan, which will bring in medical and surgical nurses to staff the unit's 12-bed observation area to free up emergency unit nurses.

The St. Boniface nurse who spoke anonymously said more can be done, and demanded that the government and employers become accountable and transparent to Manitobans about what's going on inside their hospitals.

"The government is lying by omission to the public about the state of our health-care system," she said. "While this letter only shows a glimpse into the struggles facing St. Boniface Hospital [emergency department], it is a reflection of the entire health-care system across Manitoba."