Canada was already desperately short of nurses before COVID-19. Now nurses say they're hanging on by a thread
Fix will take strategic planning, incentives for a more sustainable work life: experts
When the Clinton Public Hospital emergency department had to close its doors on the August long weekend because it didn't have enough nurses to operate, Holly Braecker was embarrassed.
"I mean, we work so hard, and it felt like we kind of let the community down that day," said Braecker, a registered nurse who, four years into her career, is one of the newer staff members in the small rural hospital about 80 kilometres north of London, Ont., near the shores of Lake Huron.
"You don't see emerg departments closing for a day. So for us to be kind of the first — well, that I've ever heard about — is embarrassing. That put us on the radar, and not in a good way."
With a small pool of six or seven registered nurses to pull from, the workload routinely spills over the four 12-hour shifts she and her colleagues are supposed to work each week. When White Coat, Black Art visited the hospital on Sept. 3, Braecker had worked every day that week.
The slim staff and unpredictability of the emergency department mean "some days are just honestly terrifying," she told host Dr. Brian Goldman, making it critical the team doesn't fall below two nurses per shift. "Like, they're scary. And so knowing that you have someone experienced working with you, I mean, I feel competent. I have all my courses that I need. But it's still terrifying. And it's emerg, so sometimes you see things you've never seen before."
And though these small communities have it the worst, the critical shortage of nurses is a problem across the country, including in major cities, said Linda Silas, president of the Canadian Federation of Nurses Unions (CFNU), which represents about 200,000 nurses.
"Our teams out there are trying their best to provide excellent care.... The issue is there's not enough personnel," Silas said.
A failure to plan
Nurses' unions, labour economists and others have been sounding the alarm for years that the number of qualified nurses was already falling short of demand in Canada, especially given an aging population. They say the COVID-19 pandemic has only served to highlight and exacerbate the nursing shortage and that it's going to take strategic planning, incentives and a whole lot of effort to make work life more sustainable for nurses in order to build a bigger workforce.
This is happening "because we don't know how to plan," Silas said. "In health care, what we've been doing for the last 20, 30 years is a lot of Band-Aid approaches."
In a crisis like the one created in long-term care homes during COVID outbreaks, governments will respond with announcements to create thousands more personal support worker positions, she said. But even the construction industry has a federally funded forecasting agency that's the envy of nurses, Silas said.
"You know how many electricians you will need in five years.... We are in a critical shortage of nurses working in intensive care. You think there's a program out there to help educate more to go work in that area? No."
In the first quarter of this year, nearly one out of five unfilled jobs in Canada was in the health-care and social assistance sector, which includes nurses, according to Statistics Canada's Labour Force Survey data. The biggest year-over-year increases in vacancies were among registered nurses and registered psychiatric nurses, which had 7,200 more open jobs than in early 2020. Total vacancies for the whole sector were 98,000, with nursing and residential care positions representing the two largest subgroups.
Silas said Canada needs one "centre of expertise" tasked with the modelling required to forecast health-care staffing needs for all of Canada so that small provinces, such as Prince Edward Island, for instance, don't need to hire and fund their own strategic planners.
CBC Radio asked Health Canada to comment on whether this kind of central planning is being considered. An emailed response said that while the federal government provides financial support to the provinces and territories for health-care services, "the responsibility for matters related to the administration and delivery of health services, including health workforce planning and management, falls within provincial and territorial jurisdiction."
Silas said the problem dates back to the 2008 recession, when "all governments put blinders on what was happening in health care, and didn't pay any attention."
"We weren't looking at who should be in home receiving home care, who should be in palliative care, who should receive their surgeries and the services they need. And we didn't plan the human resources."
That means many of Canada's 300,000-plus registered nurses work long hours and are at risk of burnout.
Registered nurse Mike Gaerlan says long hours and a shortage of staff are taking their toll in the intensive care unit where he works in an Edmonton hospital that's one of the busiest in Western Canada.
"We've always had some sort of nursing shortage.... Now we're stretched even more thin [than] before this pandemic happened," Gaerlan told Goldman. "And it's overwhelming, to say the least."
'We've had to double our workload'
While in most hospital wards a nurse may have four or five patients to look after in a shift, ICU patients need one-on-one nursing because their fragile conditions require so much work and vigilance, he said.
"In recent times, because of the COVID pandemic, we've had to double our workload. So now we have nurses looking after two patients requiring life-support sustaining measures, like the ventilator and blood support medications."
In order to deal with the influx of patients — many of them critically ill COVID patients who haven't been vaccinated — Gaerlan said his ICU, like many others across the country, has had to borrow nurses from other departments.
Gaerlan, who said he's worked "far too much" overtime during the pandemic because he doesn't want to leave his colleagues in the lurch, said the long hours and patient load have prompted many of his co-workers to leave in just the last few months.
"And some of them had 10, 20 years of nursing experience," he said. "They have left for other provinces, for a change of scenery, a different political atmosphere.... Some of them have gone to nursing jobs that are more consistent, like Monday through Friday, say 7 a.m. to 3 p.m. kind of job, instead of the whole 12 hours. So there's a lot of different reasons, and some of them include work-life improvement."
In normal times, Gaerlan said, he loves to meet up with friends and also go bouldering at his local rock-climbing gym on his days off. But these days, he doesn't have the energy.
"Sometimes I stay in bed until 6 p.m., even though I wake up at, say, 10 a.m. when I sleep in. And now that's becoming more of a norm — just biding my me-time to deal with my own physical burnout and mental exhaustion."
Better environment, better pay
It's not enough just to hire more nurses; you have to provide the working conditions where nurses will stay in the roles where they're needed the most, said Linda Aiken, a nursing professor at the University of Pennsylvania in Philadelphia who is regarded as one of the world's leading experts on how nurse-to-patient ratios affect patient outcomes, including mortality.
"The jobs that are being offered, despite what the hospital industry is saying, are not good jobs," Aiken said. "The salaries don't reflect the fact that people are risking their lives to take care of COVID patients. They have done nothing to improve work environments, and nurses still cannot take a break really even to go to the toilet in a 12-hour period. That's not a reasonable job for anybody to take."
She said some jurisdictions, including rural areas where hiring is really tough, have had success with offering $10,000 signing bonuses — something Linda Silas of the CFNU noted is also on offer to nurses who relocate to New Brunswick. Programs that offer student loan forgiveness are also good hiring incentives, Aiken said.
"So you're going to have to pay more for nurses to get them. And you're going to have to really invest in the work environments, so once the nurses get there, they can really take care of patients."
'Ripple effects' on patient care
Back in Clinton, Ont., Dr. Nadine Potvin, one of the site chiefs at the hospital that had to close its emergency department on the August long weekend, said the nursing shortage "absolutely" affects patient care.
"So wait times increase, because you just don't have enough staff to see the people ... there's fewer beds for people to be admitted into. It just has continual ripple effects," Potvin said.
"When people are overtaxed with extra burdens, extra hours, stuff like that, I don't think we can expect everybody to be in on their best game either."
Produced by Jeff Goodes, Amina Zafar and Colleen Ross.