Nunavut is enduring a shortage of nurses and the Government of Nunavut Department of Health has identified Rankin Inlet as one of the communities in greatest need of additional staff.
However, the impact at the community level is not readily apparent, according to Rankin Inlet's mayor.
"Nothing that I'm aware of. Nobody has brought it up at a council meeting," said Mayor Robert Janes. "We have a lot of nurses here, and doctors."
Cape Dorset and Iglulik are two of the other communities with acute medical staffing needs, states the Department of Health.
Nursing vacancies are causing a strain on existing staff and resulting in a lesser understanding of patient needs, says Madeleine Redfern, president of the Nunavut Association of Municipalities (NAM).
There are 119 nursing vacancies out of 295 nursing positions in Nunavut, according to the Department of Health. The Government of Nunavut uses casual staff and agency nurses to fill some of these positions.
The reliance on those temporary staff, who come and go from the south for stints of weeks or months, is far from ideal, said Redfern.
"The need to have stable health professionals," was a resounding refrain from several mayors at the NAM annual general meeting in Cambridge Bay in November, she said.
"There was a recognition that many of the health centres struggle with not having sufficient number of staff on hand," Redfern said. "(They're) often overworked – the high number that are coming and going; not necessarily consistent individuals and therefore not familiar with the community, not familiar with the residents."
The level of comfort and trust between patients and nurses can consequently be eroded, Redfern said.
The "burnout" caused by the shortage of nurses makes it less likely that long-term staff will remain in place, Redfern noted.
"It therefore perpetuates the challenging issue of bringing back the same individuals if they're not adequately staffed and supported," she said. "It's too much for the number of short staff to try and do the work of other people that simply are not in those position. Health service, as a result, is compromised."
There were an estimated 55 occasions when community health centres resorted to reduced services status in 2018 to this year due to either a lack of staff or because of medical emergencies that occupied most or all of the medical professionals, according to the Department of Health. That compares to 54 such instances in 2017-18 and 66 in 2016-17. Reduced services are not expected to last beyond 24 hours, stated a department spokesperson.
Neither the Registered Nurses Association of the NWT and Nunavut nor the Nunavut Employees Union was willing to comment on the issue of doctor and nurse staffing.
An existing job advertisement for a community health nurse in Cape Dorset reveals a salary range of $99,743 to $113,159 a year with a Northern allowance of up to $20,980.00 annually. Subsidized housing is also available.
For long-term nurses, various other allowances and bonuses are offered.
Subsidized housing, however, is not available in all communities at any given time. One of the NAM resolutions passed at the November AGM calls upon the GN to allocated more vacant houses to medical staff.
Another resolution calls for new health centres, as some of the existing facilities are aging and unappealing to workers and patients.
Redfern added that she and other mayors have also urged the GN to provide routine updates to municipal councils on the level of demand and the status of staffing at health centres.
"Right now, for the most part, there isn't that type of regular reporting that happens," she said.
The GN has increased the number of physicians in the territory to 24 at present from 18 in 2015. Although not every community has a doctor, those without are on four- to eight-week rotations for physician visits, based on population.
The GN's recruitment and retention strategies for doctors have changed to include "more flexible contract formats" and offer variable bonuses based on length of service, stated a department spokesperson.
There's also greater emphasis on recruiting medical residents – particularly through Memorial University of Newfoundland – who can learn under experienced Northern doctors, with a goal of having the residents return to start their careers in the North.