White Coat, Black Art

'The stress, the anxiety, the nightmares': What it's like to work in the country's strained ICUs

Acute care nurses and doctors say the influx of third-wave patients is taking a huge toll on them and other health-care professionals who care for the sickest patients in hospitals across the country.

Influx of third-wave patients taking huge toll on health-care workers who care for the sickest patients

Nikki Skillen is a 24-year veteran ICU nurse in the GTA. She said hospitals are now bringing nurses in from other departments to keep up with demand created by critically ill COVID patients. (Submitted by Nikki Skillen)

Intensive care nurse Nikki Skillen says she's losing sleep over what could happen if the number of COVID patients in her unit gets much higher.

"The amount of deaths that we could possibly see, the amount of sickness, that I can't physically give my all to my one patient — everything I have to keep them alive — if we have hundreds of patients? I don't know, honestly, it keeps me awake at night. This is scary," said Skillen, who works at a Greater Toronto Area hospital that she has asked CBC Radio not to name because she is not authorized to speak on its behalf.

The third wave of the pandemic, spurred on by coronavirus variants of concern like P1 in B.C. and B117 in Ontario, has ICUs approaching capacity. Acute care nurses and doctors say that's taking a huge toll on them and other health-care professionals who care for the sickest patients in hospitals across the country.  

"Nurses are resilient as a whole. ICU nurses are a very unique bunch, and they will rise to the occasion, guaranteed," said Skillen, who also runs a Facebook group for nurses with around 27,000 members. "It's just, you know, if there's going to be a breaking point, you can only stretch the system so far."

Skillen told Dr. Brian Goldman, host of White Coat, Black Art, the third wave "is a whole new beast." 

"These patients are younger, they're sicker, and they are coming to the hospital … needing acute care."

Adalsteinn Brown, co-chair of Ontario's COVID-19 science advisory table, said Friday that many intensive care units in particularly hard-hit areas of the province were never able to fully recover from the second wave and are now approaching that breaking point.

Skillen said the nurses in her Facebook community are worried about how the coming weeks will unfold, especially those who face being redeployed to ICUs or COVID wards, leaving behind patients they care about in other parts of the hospitals or communities where they normally work.

A nurse tends to a patient suspected of having COVID-19 in the intensive care unit at North York General Hospital, in Toronto, on May 26, 2020. (Evan Mitsui/CBC)

"Nurses are being put in places they maybe don't have those necessary skills," she said. Some are receiving more training, while others will work under the supervision of ICU nurses, because they can't be expected to take on duties "they don't have the knowledge, skill and judgment to do." 

The situation is especially complicated given that Canada already had a shortage of nurses before the pandemic. While it's challenging to measure labour shortages precisely, said Brittany Fer, an economist with the Labour Market Information Council in Ottawa, we can look at Statistics Canada's Job Vacancy and Wages Survey (JVWS) to get a pretty good idea.

"Since 2018 and leading into the pandemic, the share of job vacancies among nurses that go unfilled for 90 days or more has been trending up and has been typically twice as high when compared to all job vacancies," she said in an email to CBC Radio. "In the last quarter of 2020, more than one in every two job vacancies for nurses went unfilled for 90 days or more, compared to one in four for all other occupations"

Dr. Susan Shaw, the chief medical officer for the Saskatchewan Health Authority, works in intensive care wards. (CBC News)

'Next-level intense'

Dr. Susan Shaw, a critical care physician and chief medical officer for the Saskatchewan Health Authority, said she too is concerned about the impact of the pandemic on nurses and other ICU staff.

She told Dr. Goldman there's a lot of talk about whether hospitals have enough beds, ventilators and other equipment, but "that's the easy part."

"It's 'Do you have enough people? Do you have the right skilled, supported staff that are not exhausted?' And that's something that really worries me because we need to have a healthy team to be able to create health for our patients."

WATCH | Hospitals struggle with staffing during third wave:

Hospitals struggle with staffing during 3rd wave of COVID-19

The National

23 days ago
2:05
As the third wave of COVID-19 puts more Canadians into hospital and ICU wards, Ontario hospitals are struggling to find staff and resources, while non-COVID-19 patients are faced with longer waits for surgeries. 2:05

She said she's proud of how her colleagues have coped, but especially bedside nurses and the respiratory therapists, given COVID positive ICU patients are "next-level intense" in terms of the kind of care they require. 

"I've talked quite openly [with them] about what the stress, the anxiety, the nightmares, the fatigue have done to them. Most of them have actually, I think, figured out a way through. Some have not and some have left."

Shaw said she's worried there could be "a mass exodus of all health-care workers" after the pandemic.

Dr. Delbert Dorscheid, a critical care specialist at St. Paul's Hospital and associate professor of critical care medicine at the University of British Columbia, echoes that concern. He told Dr. Goldman St. Paul's is running at about 150-160 per cent capacity right now.

Dr. Delbert Dorscheid is a critical care doctor at St. Paul's Hospital in Vancouver, where on any given shift about a third of staff are on overtime. Many colleagues have burned out during the crisis, he says. (Brian Goldman )

"Already about one-third of our staff on any shift are on overtime because in the past 14 months, there's already been so many staff burned out: respiratory therapists, occupational therapists, nurses. It's the whole gamut. It isn't just doctors; it isn't just nurses. There's a whole lot of people involved in caring for these patients."

Dorscheid said he's watching how Ontario hospitals cope with its surge of patients — 4,447 new cases as of Monday, with ICU admissions topping 750 — and bracing for Vancouver hospitals to be in similar trouble in a couple of weeks.

In the thick of the Toronto-area crisis, ICU nurse Nikki Skillen said she worries about the long-term impact on her colleagues. 

"I think when this pandemic's over, and this is my opinion, I believe that you're going to see a lot of post-traumatic stress amongst all the professions." 


Written by Brandie Weikle with files from CBC News. Produced by Rachel Sanders and Jeff Goodes.

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