Jordan Heath-Rawlings: Try to remember how you felt over the past year and a half as COVID cases rose and fell. Stressed, anxious, overwhelmed, afraid, maybe just exhausted by everything. Of course, you felt that way. Now imagine if you were a nurse. Since the early days of the pandemic, experts have been sounding the alarm about the stress that constant waves of the virus place on medical professionals. And nurses are on the front lines of everything to do with COVID. So they’ve borne much of the caregiving burden, many of them holding up phones or iPads so that families can remotely say goodbye to their dying loved ones. That’s impossible work and a nurses job wasn’t easy before the pandemic struck. And right now we are finding out the hard way what happens when an overworked and often underpaid group of professionals carries an impossible added burden for more than a year.
As it turns out, a lot of them quit. On every list of vacancies created during the pandemic, nurses are at or right near the top. Despite some good will gesture early on in this fight, we simply haven’t done enough to convince them to stay in a job that’s been exhausting, scary, and dangerous. What happens when too many nurses walk away from a health care system that was already short on them? What happens if we can’t stop them from leaving, and there’s another wave of COVID in the fall? How can we convince nurses to stay in the game? What happens if we can’t?
I’m Jordan Heath-Rawlings. This is The Big Story. Tim Guest is the President of the Canadian Nurses Association, and he joins us today. Hey, Tim.
Tim Guest: Hi there!
Jordan Heath-Rawlings: Why don’t you start just by telling me if you’re worried about the current shortages on the current level of resignation that we’re seeing from nurses across Canada.
Tim Guest: I would say that I’m becoming more concerned about it as time goes on. It was an issue that we’ve been following for a considerable length of time. We’ve written reports on it over the last couple of decades. I would say that the pandemic has certainly raised a much bigger red flag on it, and I would say has made the situation considerably worse.
Jordan Heath-Rawlings: Take me back to before the pandemic, then, how well staffed were nursing positions in Canada at that time?
Tim Guest: So pre pandemic, we saw pockets of areas of the nursing profession where there were vacancies. And I can give you some examples.
Jordan Heath-Rawlings: please.
Tim Guest: Rural and remote locations like, for example, the far North, nursing kind of outposts in really isolated communities. There were challenges there. There were challenges in specialty areas like intensive care units. We saw pockets of challenges in mental health, certainly the long term care and home care sectors. And we were seeing those things start to worsen in areas that we didn’t see those issues prior.
I think, Jordan, the issue that is creating the most concern is that we did know pre pandemic that there were nurses that were verbalizing signs of burnout, particularly in areas where there was significant use of overtime as a staffing strategy. We saw it in areas where there were high numbers of vacancies and in areas with significant demand pressures. And during the pandemic, we surveyed nurses and what we have found was alarming. And that is, nurses verbalizing significant increases in symptoms of burnout. They’re verbalizing significant deterioration in their self reported and self assessed status of their mental health. And we’re hearing significant increases in nurses that are choosing to retire sooner than maybe they had planned because of the working conditions and experiences in the pandemic.
And even more troubling is we’re hearing stories from nurses at the beginning of their careers saying, this is enough. We’re done. When this pandemic is over, so are we. And it is all of that together, which is creating significant worry about what will be left and our ability to manage what the Canadian public needs us to provide for them in the future.
Jordan Heath-Rawlings: Can you tell me about what was done at the beginning of the pandemic, knowing that there were already these shortages, that we desperately needed nurses and we were going to need more of them. The stuff that comes to mind for the general public is probably those temporary pay rises and, of course, the banging of pots and pans. But what else was going on to prepare or to encourage nurses to stick around, if anything?
Tim Guest: I don’t think there is really anything in particular there was going on outside of those things that you verbalize and outside of things that were already happening. I think employers were actively recruiting, and in some ways, I think their need to downsize some activities to focus on the pandemic, really allowed them to move the workforce around in order to manage the demands of the pandemic that is just not realistic going forward as we need to ramp the system back up and as the system has been ramped back up to deal with the significant backlog of surgical procedures and diagnostic procedures and other things that the Canadians have had canceled and delayed during the pandemic.
Jordan Heath-Rawlings: What kinds of stories have you heard from nurses who are leaving the profession? What is the last year and a half been like for them?
Tim Guest: It’s been tragic. I’ve had calls with nurses that have worked in long term care early on in the first wave where there was just significant suffering and death that they experienced and how traumatized they were from it. And I’ve heard from critical care nurses in ICUs about the devastating experiences that they’ve had in these extremely busy intensive care units with these very, very sick people and them needing to provide care for these individuals, them being fearful for their own safety and that of their families and also needing to support these individuals and their families, often using technology and being the virtual connection between families and their loved ones because they weren’t there. And nurses really expressed how stressful and how much more that added to the difficulties of their jobs and them needing to be so much more for these patients and their families than what would be normal.
Jordan Heath-Rawlings: I’m glad that you mentioned the technology that nurses have been using to help people say goodbye to their loved ones, because I also wanted to ask just how different the pandemic has been from a nurse’s typical job description. I imagine there’s nothing they could have done to prepare.
Tim Guest: No, some of what they’ve done in the pandemic was completely foreign. Nursing is very much a profession that’s direct, where you have direct connection with those that you support and provide care for, and that includes a patient and their families. We care for them as an entirety. And when the family is separated from the patient, in an event that is so significant in a person’s life, that creates a huge challenge for care of that family entity and needing to deal with it at the end of a cell phone or an iPad, when individuals said goodbye and sometimes they said goodbye to loved ones very quickly and in a very shocking way that they just could not wrap their heads around that it was happening.
Jordan Heath-Rawlings: So given how difficult the last 18 months of being and, you know, I don’t think a lot of people would blame some of these burnt out, exhausted nurses for leaving, how bad is the shortage as it stands now? Do we have any numbers in terms of how many nurses are walking away or anything that can kind of contextualize it?
Tim Guest: There have been some numbers, like Statistics Canada did a survey of 18,000 health care workers, and they found that 70% of health care workers reported worsening mental health and CIHI, as an example, The Canadian Institute for Health Information released a report, and they do release a report in Canada each spring. And last spring in 2019, it showed a growth rate of 1.9% prior to the pandemic. However, the number of nurses working in nursing, however, decreased. So what we saw was we may have had an increase in nurses registered with one of the regulatory colleges in the country, but 40,000 of them weren’t working.
Jordan Heath-Rawlings: How do we change that?
Tim Guest: Well, I think there’s a few things. One we need to deal with some of the outstanding issues that are impacting them wanting to leave the profession in the first place. And some of that is related to workplace environments. It’s related to workload and demand on them. It’s related to them working short. It’s related to significant pressures on nurses needing to work a massive amount of overtime because overtime is often used as a strategy for staffing rather than creating regular positions. We see pay related issues between sectors. Historically, nurses that worked in long term care made less than nurses that worked in hospitals which creates a challenge in being able to entice and have nurses be interested in working in an environment event like that. And one of the others is nursing has become very specialized across practice settings, and nurses need access to education to develop the specialized skills required for them to work in some of these environments. And it’s very hard for them to be able to access it because there isn’t a lot of access to educational supports. Nursing, being predominantly a female dominated profession, come also with the realities in our country where there isn’t pay equity between men and women. And often that also creates an issue.
Jordan Heath-Rawlings: Where are new nurses coming from these days? Are they being trained in Canada? Are they coming from overseas? And where do we need to look to find more people who want to get into that profession?
Tim Guest: So we do train a lot of nurses. Nurses are educated very successfully in Canada. We’ve got among the highest trained nurses in the world, very sought after. We’ve got one of the most educated nursing workforces in our history, with a very high percentage of nurses with undergraduate degrees now. One of the other things we saw early on in the pandemic was increases in individuals applying to nursing programs, which is really a nice surprise. But part of our challenges were limited in nursing seats in order to be able to accept all of those individuals that are interested. And we also have challenges with nurses that predominantly work as faculty in these universities, where they’re also in limited supply. And so you can’t just snap your fingers and have enough faculty to grow additional seats. So it’s a bit of a vicious circle where we need to do a better job federally of planning ahead. And at CNA, we believe that we need to have a federal approach to having more successful and appropriate health human resource strategies for the Canadian health system and not do it 13 different ways.
Jordan Heath-Rawlings: That’s fascinating that there’s been an uptick and people wanting to become nurses, which really kind of speaks to the good nature of people who want to get into the profession. But even if we changed it now, even if we were going to take a federal approach and mandate pay equity and all the things that would help, how far behind are we, like you can’t just instantly take those people applying to nursing school and get their butts in the seats and put them in scrubs and get them working, right? And people are leaving right now. So how far is the gap lagging?
Tim Guest: We believe that total vacancies in health and social assistance sector, which grow significantly during the pandemic are about 98,700.
Jordan Heath-Rawlings: Wow.
Tim Guest: And we believe that a very high percentage of that is nursing. And so this is not a quick fix. And the other thing I would say is that we do recruit nurses from outside the country. We also need to do that ethically because we’re not the only country in the world that has challenges with respect to their nursing workforce. And it’s often countries who can’t afford to lose their nurses are where nurses want to relocate to places that potentially provide a better life for them and their families. And so that’s not the best strategy in itself.
Jordan Heath-Rawlings: That is a huge number you just gave me in terms of how far behind we are. And you also mentioned earlier that you’ve spoken to some nurses who were kind of waiting for the pandemic to be over, and then they were getting out. And I think there’s a consensus now whether or not it’s true that we’re approaching the end of this pandemic and this summer is kind of the end of it. But if cases tick back up in the fall and we end up in another wave, what’s that going to look like with our current shortages?
Tim Guest: Well, it’s certainly looking challenging. Quebec as an example had a significant exodus during the pandemic thus far, and they’ve had significant challenges being able to manage it. The military needed to be called in to support both Ontario and Quebec during the pandemic because they didn’t have the resources that they could pull to deal with the urgent staffing crisis that they found themselves in. It has the potential of being much worse. I do believe that nurses have always been committed to their profession and committed to the Canadian public in providing the nursing service that the Canadian public needs. And I believe that nurses will hang on as long as they can, but some of them are just hanging on by a shoe string. We’ve seen a massive resurgence in the United States in States that have low vaccination rates, and we’re starting to also hear rumblings of increases in case numbers in Alberta again because they dropped all of their public health guidelines in the 1st of July. We need to be very cautious when we make some of those decisions because we don’t have a glut of resources to deal with the after effects of those decisions.
Jordan Heath-Rawlings: Speaking practically, what does a hospital or a care scenario without enough nurses look like? Like what falls off?
Tim Guest: Well, what happens is the clinicians that are left are forced to have to rationalize the service that can be provided because there’s only so much that you can do with the people and the resources you have. And it might mean some people don’t get the care and service that they need.
Jordan Heath-Rawlings: Are you hopeful for the future of the profession? I know it’s an odd thing to ask, given we’re so short staffed right now, but you mentioned lots of people want to go into nursing. And do you think we are coming around to a more modern understanding of nursing, if that makes sense? Like I think there’s an antiquated notion of what nurses do, that this pandemic has kind of blown away.
Tim Guest: You know, I’m glad that you asked that question because nursing has been in the spotlight, and it has had media attention and more public awareness than I think ever in my career. And I think that it has done that. I think that it has demonstrated the breadth and value that nursing provides in the Canadian health system. And I think it has created more awareness of what nursing really is and the types of roles and the types of participation and the way that nursing gets to influence. And I think that’s why more people are interested, because they see it as a really good career choice.
Jordan Heath-Rawlings: I hope we can get those people into scrubs sooner rather than later. Tim, thank you so much for your insight today.
Tim Guest: My pleasure. Thank you so much for the opportunity to speak with you.
Jordan Heath-Rawlings: Tim Guest, President of the Canadian Nurses Association. That was The Big Story. For more from us, head to thebigstorypodcast.ca. Talk to us on Twitter at @TheBigStoryFPN and email us at thebigstorypodcast, all one word, @rci.rogers.com [click here!]. You can find our podcast as well as all the other Frequency Podcasts, including a new show that we just launched yesterday, it’s called The Reheat, at frequencypodcastnetwork.com. Of course, we’re wherever you get your podcasts, please check out The Reheat, but also do not forget to rate and review and like and follow and subscribe and all of that stuff for us.
Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.
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