Nurses haunted by 'moral distress' as they scramble to treat kids at Alberta Children's Hospital

Nurses have come to call it "Black Sunday." It was a day in November when the Alberta Children's Hospital was so overwhelmed, staff worried a child could die in the waiting room.

Calgary nurse says children can be very sick after waiting hours to be triaged

A trio of viral illnesses — Influenza, RSV and COVID-19 — are putting pediatric hospitals around the country under intense strain. Front-line health workers spend their shifts scrambling to keep up with demand and are facing what experts call 'moral distress.' (Ben Nelms/CBC)

Nurses have come to call it "Black Sunday."

It was a day recently when the Alberta Children's Hospital was so overwhelmed, staff worried a child could die in the waiting room.

"It was very unsafe. It was the darkest day," said an emergency room nurse, whom CBC News has chosen to call Emily. 

We've agreed to use a different name because the registered nurse worries she'll be disciplined by Alberta Health Services for speaking out.

A sense of angst has become the new normal for front-line health-care providers as the pediatric hospital reels under an unprecedented wave of viral illnesses, including influenza, RSV and COVID-19. 

"Going into work you feel stressed. Leaving work you feel defeated," said Emily.

She's haunted by the same feeling every time she dons her scrubs and begins another shift.

"My biggest fear is missing something.… It would be hard to come back from that," said Emily, her voice quivering.

"I fear it might just be a matter of time before you have a waiting room full of people, it's the middle of the night — parents are sleeping, kids are sleeping — and we find a child who has decompensated [respiratory distress] and we haven't noticed and it's irreversible. That's my fear."

With extremely high patient volumes, families can wait hours just to be triaged. By the time triage nurses are able to lay eyes on them, some children are very sick.

A trailer was recently set up outside the ER at Alberta Children's Hospital to provide additional waiting space for famlies. (Nick Brizuela/Radio Canada)

It happened to Emily recently.

"As soon as they walked into the triage room, I knew," she recalled. The child was struggling to breathe and had a blood oxygen level of just 79 per cent.

"She needed immediate care. She went to trauma straight from triage as a few patients do."

According to Emily, despite their best efforts, nurses are not able to meet Canadian standards for how often patients should be reassessed based on their acuity.

"There's no way we can with the volume that we're seeing," she said.

Moral distress

"When nurses are not able to provide the standard of care they expect for themselves, or they feel that their work is unsafe, they can develop moral distress," said Jennifer Jackson, a registered nurse and assistant professor in the department of nursing at the University of Calgary.

Jennifer Jackson, an assistant professor of nursing at the University of Calgary, says her colleagues on the front lines are experiencing moral distress due to 'impossible' working conditions. (Supplied by Jennifer Jackson)

"[It occurs] when there is a gap between what you want to be able to do and what you actually can do. This is something that is created in the environment and can be prevented."

According to Jackson, moral distress can have serious mental and physical health impacts, including higher rates of anxiety and fatigue as well as an increased risk of errors.

"It's a normal response to bad working conditions. It's not that nurses lack resilience or nurses aren't up to the job. It's, they've been put in an impossible situation and it causes harm to them and risk of harm to their patients as a result."

With a shortage of nurses already plaguing hospitals, Jackson worries the crisis in pediatrics will drive even more nurses out of the profession.

"What worries me most is the fact that policy-makers aren't supporting nurses," she said.

The most efficient way to relieve pressure on the hospital and the staff working there, according to Jackson, is to rein in viral transmission.

"Right now, we should have mask mandates in all schools that have higher than a 10 per cent absenteeism rate. We should have masks among the general population. We should have hand santizer [widely] available," she said.

"That is the lowest hanging fruit, and I don't know why that hasn't been a policy priority already. Because to me, that is the easiest, most cost-effective, most straightforward thing we could do to support nurses and make sure children are getting the highest quality health care they can."


Jennifer Lee


Jennifer Lee is a CBC News reporter based in Calgary. She worked at CBC Toronto, Saskatoon and Regina, before landing in Calgary in 2002. If you have a health or human interest story to share, let her know.