The Health Care Crisis Part I: Nurses

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Jordan Heath-Rawlings You have no doubt heard. Our healthcare system is in crisis. The average wait time in ERs was 20 hours before the patient got a bed. People across the country are dealing with record level wait times when trying to access healthcare services. New Brunswick’s Premier called the Province’s Healthcare System unacceptable after an elderly man died in the emergency department waiting. Staff at one of Toronto’s busiest hospitals are outlining just how dire the problem is describing an emergency department in chaos and on the brink of collapse. That’s true, but unless you’ve dealt with it directly, you might not understand how that takes shape. Crisis is a pretty nebulous word after all. For something as big as thousands of medical clinics, doctors offices, hospitals, and long term care facilities. For people, from nurses, to [00:01:00] doctors, to specialists and technicians. But once you end up needing them, any of them, you’ll get it. This week on the big story, we’re gonna try to give those of us who have been lucky enough not to need urgent care or elective surgery or tests or consultations or anything. An understanding of how our healthcare system is breaking down. Of where it’s broken, what’s missing from it, and what the solutions are. And here’s the other thing, Solving this crisis is not as simple as throwing money at it. We should do that. Of course, lots of money in every province, but money alone won’t create more nurses or doctors tomorrow. It won’t empty out our emergency rooms or clear a waiting list or a back. We are going to have to confront some basic facts about our system and how it works, why we’re losing good people, [00:02:00] and why we are falling behind our peer countries. So we will start this week where basically every encounter with our healthcare system begins with nurses, or rather the lack of them. I’m Jordan Heath Rawlings. This is The Big Story. Natalie Stake-Doucet is a spokesperson at the Quebec Nurses Association, a doctor of nursing science and faculty lecturer at the university, Universite de Montreal. And until recently she was a working nurse. Natalie, I feel like I could say that for a lot of people.

Natalie Stake Doucet Absolutely. There’s many of us leaving the the healthcare system right now.

Jordan Heath-Rawlings Maybe before we get to the healthcare system, which is why we’re speaking today, take me back to the beginning of the pandemic when you came back to work and we were banging pots and pans for you and things were horrible, but, but maybe you felt supported. What was that time like?

Natalie Stake Doucet Well, there were a few reasons. I actually left a few years ago, and then at the beginning of the pandemic, like many of my colleagues, I came back because I knew I could help and I felt a duty to respond because this was something new. Uh, nobody in my generation at least had been through. Several generations, I think nobody had been through a pandemic of the scale and scope that we saw. And so I worked, uh, throughout basically two years, just over two years on the front lines. I started out in long term care at the very beginning of the pandemic. Then I got very sick, so I had to stop for a few months. I went back, worked for public health for a little bit, and then the last year. I spent working in a testing clinic and a vaccination clinic, and the reason mainly that I left was really a sort of, how would I put it? Uh, a bit feeling abandoned by the healthcare system. We, I mean, we went from banging pots and pans every night to having protests in front of children’s hospitals.I mean, it’s, it’s kind of, it’s unbelievable. How quickly things changed. At the beginning of the pandemic, I was, in the early stages of writing my, my thesis for my PhD, so I figured I could put that on hold for a few months and join the effort to help because I knew a lot of my colleagues were sick, and couldn’t go to work because they had covid or were, you know, a lot of them were actually very, very sick and ended up in the hospital as well. We didn’t have vaccines back then. And at that point we thought it only would be a few months. Right.

Jordan Yeah. We thought it would be a few weeks.

Natalie Stake Doucet I remember hearing Quebec, the, the premier said we’re gonna, you know, press pause for about two, three weeks and then you’ll see everything’ll go back to normal. So, that was, yeah, that was then, this is now as they say. And, so, yeah, so I, I, I applied and applied, and applied. That was another thing, another issue that happened in the beginning of the pandemic. It was very hard actually for me to go back, you know, nobody would answer me. And, uh, it was finally through a friend who’s a nurse manager that I was able to get a job. And so I started working in, in long-term care, and actually in the. The long term car home. That was the worst hit with Covid at the time. Uh, it’s a place called Yvon Brunet and, we lost like 80 residents almost, I believe in, in less than two months. So that was probably the worst experience of my career, if not my life. And I remember the pots and pans. It wouldn’t make me cry every night. Cause, you know, the, the situation at times seemed so hopeless and desperate and, and just tragic and devastating every day at work. That it, it felt nice to neighbours and friends just come out and give a little shout out. So, yeah, So that, that was, that was quite an emotional intense period. And what probably what, you know, hurt the most, aside from the constant deaths, was the fact that we didn’t have PPE. We didn’t have enough or proper PPE. And it was very frustrating cause I had a lot of friends at the time who worked in the hospital and they, even if they had no cases of Covid on their units, they had N95s. They had, you know, the whole, everything that they needed. Whereas us in a long term care home, a publicly owned and run long term care. , we, you know, we had to fight for every single little surgical mask. Um, and most of the times we didn’t have enough, even though over half of the residents that we were taking care of were sick with covid. So that was, that was very frustrating. And it sort of compounded the tragedy of the pandemic because, you know, it wasn’t like everybody was throwing in and helping. It was like there was a few of us. Really fighting to help and we, there were, we were being imposed barriers every single step of the way.

Jordan Do you remember the time when it, it, it must have changed for you at some point from feeling like, you know, it was your duty to help and this was hard, but it was worth it and, you know, we must stick together and, and beat this virus to, when it started to feel like a grind to when? You know, you kind of began, I guess, the slow burnout process, for lack of a better term. Like what, when did it change?

Natalie Stake Doucet I mean, I’ll be honest, I’ve been a PhD, you know, I, I started my PhD in 2016, uh, 2017, something like that. And, um, so, you know, I’ve been doing research into the healthcare system for a long time now. I’ve always worked as a nurse as well. Uh, always a floor nurse. I’ve never been a manager. Um, but I have studied management quite extensively. And so I came back knowing the pitfalls and the, the main issues with the healthcare system. Uh, so I already had some knowledge of it. Mm-hmm. probably, it’s hard to pinpoint an exact moment of when things changed, but I think. It was probably, probably, actually it was, uh, one time, cause I remember I worked evenings, right? So I started around 3:30-4 PM and I finished around midnight, one o’clock in the morning, depending on the days, depending on what was going on. And so when we’d get to work, uh, sometimes we would see the press conferences that were happening on TV. And, um, so we, we would sort of have this double reality where we’d see the politicians talk. Covid and PPE and saying, don’t worry, we have enough, you know, personal protective equipment for everybody. Everything’s gonna be fine while you’re in a place that’s literally on fire. And I remember one time the health minister at the time, Danielle McCann in Quebec had said, you know, don’t worry about it. Everything is under control. Everybody has personal protective equipment. If there’s any issue, you know, you can even call my office if you want . And, uh, so I took her word for it, and I called her office because, uh, at the, at the very end of that press conference, our nurse manager came in to tell us that we wouldn’t get any, uh, protective blouses. And so we would just have to. And, uh, she even asked us to do laundry for, um, to wash a patient, gowns and to wear those instead. And so, obviously, you know, when you’re a nurse, you’re understaffed, you’ve got people dying left and right that need care, people having trouble breathing. The last thing on your mind is doing a load of laundry. And you know, for me that was sort of probably the tipping point that at this point we were asked to do laundry. It just, I think something snapped. Uh, and so I called the, the health minister’s office and you know, the poor receptionist that was there had no idea what to do with me . Cause I was pretty angry. Exactly that. That’s exactly what I said. I said, you know, she said to call. I want it to be known at the highest levels of government that we do not have proper PPE. I’m working right now in a public healthcare institution and I do not have access to protective equipment that I need to provide proper care. And she was like, Well, you have to. Talked that up with your employer, and I said, Can you tell me who in my healthcare institution is responsible for that? And she said, Well, look it up. And I said, I did. And there’s no email address, there’s no title. There’s nobody. There’s no way for me to reach at the highest levels of the healthcare system to explain what we need and how, and, and that really drove home. I knew the healthcare system in Canada and in Quebec was very top down, but to actually live through such a frustrating, and tragic situation and knowing what needs to be done, but not being able to reach the people who have the power to make it happen was absolutely devastating.And, uh, I, I was, I mean, to be honest, I was, I was a bit cynical for a while because I just felt that we were so abandoned, and that the residents were abandoned, the families were abandoned, and it’s like nobody cared. Nobody who had cared. And you know, they’d go on TV every day. You know, sometimes shed a little tear and say how bad it was. Montreal was kind of the epicenter at the, for the first wave, uh, we lost thousands and thousands of people in long-term care homes. And to actually be there and to listen to the politicians afterwards talk about it. You know, and shed a little tear. Was it, It just made everything so much worse because they did nothing to help us.

Jordan Thank you for sharing your story. And I, I guess I wanna know from you, in your role at the Quebec Nurses Association, what kind of stories like yours did you hear? And maybe if you could even just quantify it a bit, like what kind of numbers are you hearing from, uh, nurses? What kind of numbers are you seeing in nurses just walking away as this pandemic has kind of dragged on and, and wound down? I mean, fingers crossing, you know?

Natalie Stake Doucet Well, we know, I mean, there are, we’re talking about thousands, if not, you know, 10,000 nurses leaving. Um, The healthcare system in Quebec, at least. I know at the beginning of the pandemic it wasn’t, It was less than a year, maybe 10, 11 months after the beginning of the pandemic, we finally were able to get some numbers, and at that point there was already 4,000 nurses that had quit just. Completely quit just in Quebec. So that is a huge number of, of nurses. Uh, and we’re talking registered nurses. So this is just nurses. We’re not talking about orderlies, licensed practical nurses, physicians. This is just for nurses. So you can imagine the, the impact that this has had on the healthcare system and. What, again, every week as a spokesperson for the Quebec Nurses Association, I’m, I’m tasked with talking to colleagues who are, are living, uh, situations like that, who are going through difficult situations where, you know, they’re telling me, Listen, Natalie, I, I need help because, either we fix this or I’m leaving. I want to, this job is not allowing me to live and I need to either fix it or get out and I don’t know how. And so a lot of them, they’ve tried every possible solution at work and they can’t. So a lot of them want to speak to journalists, for example, about some horrible things they’re seeing at work, the way they’re treated. And so, you know, we help sometimes do that, build that bridge between journalists and nurses. But it’s, I mean, it, for the past three years, it’s been every week, depending on the week, there’s worse weeks than others. But I’ve, there hasn’t been a week, uh, where I haven’t spoken to at least one colleague that’s thinking of leaving or that is leaving, or that’s literally emailing me her, her, letter resignation and saying, you know, is this okay? How do I make sure that I can leave, but I, I also leave a trace of why I’m leaving.

Jordan Can you explain to us maybe the economics of nursing a little bit? I know a lot of us have heard through the pandemic that we simply, and I know this is true in Ontario, where we are, I know it’s true in Quebec and some other provinces, that nurses simply don’t make enough money to deal with the stuff you’re describing. And I also keep seeing how much more lucrative it can be to like, just work as a temp nurse rather than have a full-time job in a hospital. Is that true? And like how does that work?

Natalie Stake Doucet Absolutely. So that’s, there’s twofold in that the, the main issue with nurses usually isn’t money. Although money is important in terms of the value we attribute to a job as a society. So, In terms of how we feel remunerated and how that is related to the value that we feel society attributes to us, that makes a big difference. And so, you know, when, for example, Doug Ford, passed Bill124 for the, the, the wage cap in the middle of pandemic. That was, that was an insult. It wasn’t just about the money, it was the text. What that meant of how he saw nurses and how he, uh, saw our role and our importance in the healthcare system. And that basically meant we don’t care about you. Do we even really need you? You’re gonna do, as we say, and that’s it, kind of thing. And we’ve had a lot of similar issues in Quebec. Here probably the, the main driver of nurses leaving the healthcare system is something we call forced over time. Here we call it TSO , but it’s, it’s been a plague on the healthcare system for over 20 years now, and there’s no process or mechanism surrounding it, and it is widely abused. So a lot of nurses. You know, they come into work, they don’t know when they’ll be allowed to leave, and that’s, you know, that sort of eats away at your soul because, you know, a manager can impose you forced over time every single day with complete impunity. There’s no accountability to whatsoever in terms of forced over time. So obviously it’s gonna be abuse and the only person that can get sanctions if they refuse are the nurses on the ground. And so, you know, when you work in that context, You know, in Canada, in the 21st century, it’s like you walk into the hospital and you feel like you’re going back in time, at an epoch, at an era where women didn’t have any rights, where we were not valued. And, where the role that we play is not taken into consideration. And, you know, I’m sorry, but without nurses, the healthcare system is crumbling. And that’s what we’re seeing right now. So, you know, Money is an issue, but one of the main reasons why nurses are going to temp agencies is also the. And the, the flexibility that comes with the schedule. You know, nurses are a big majority of women in most provinces. The average age is about 40 to 45. And so it’s often women with young children and you know, you can’t ask us to miss every single milestone of our children or our families because the healthcare system needs us there. There needs to be, give and take. It can’t just be us giving all the time because you know, at one point the, the lemon has been squeezed, there’s nothing else to give.

Jordan This is gonna sound like a really dumb question, but it only is to somebody who already knows how everything works. We’ve heard you just said it, and we’ve heard it many times over the past several months, that without nurses, the healthcare system just crumbles and falls apart. Where does that show up? Like what actually, happens and and where does that fall apart?

Natalie Stake Doucet Sure. So it’s not a stupid question at all. It’s a very important question actually. And you know, the healthcare system in Canada and Quebec as well is kind of a very nebulous thing that most people don’t know. It’s not very clear, it’s not, it’s often not super transparent in the way that it’s managed and organized and structured. So it can be very sort of nebulous and and mysterious as to how it actually works. So probably the main thing we’re seeing of, the main consequences of nurses fleeing the healthcare system, which is, which is really what it is we’re fleeing, the healthcare system right now is, is dangerous to us and our health, uh, as well as to the health of patients is closures of units. So closures of beds, closures of units. So for example, in Quebec, we’ve had a lot of emergency rooms that have had to close during the night. You know, surgeries that have been delayed, labor and delivery units that have had to close beds or sometimes close the entire unit because there’s no nurses, and that’s not because there’s no physicians or orderlies. That’s really because there are no nurses. And so I just find it again, devastating that, we’ve waited this long to have this discussion. And now it’s an election and we we’re having a provincial election right now in Quebec, so it kind of feels like a fake discussion, but we’ll see.

Jordan And in all this, you are lecturing at the university level. What do you tell young students entering the nursing profession right now?

Natalie Stake Doucet Also that’s, you know, talking to young nurses, future nurses, for me is probably one of the important things. It’s something I really love doing, and it’s something where I feel I can actually contribute and where my voice is valued because I, I, value tremendously the voice of my students as well. Nursing students have been through hell in this pandemic as well. And it’s important that we listen to them too. They’ve done a lot of work, but my main thing is I try to give my students the tools to protect themselves. And, you know, in nursing, A lot of times it, it, it, the sort of emotional tool that’s used against us is guilt. So we’re guilt tripped into doing more work than we should, or, or working a few, you know, an extra 15 minutes here now we’re there without getting paid over time or things like that. And so the healthcare system has come to rely on. Basically us doing a lot of volunteer work, doing a lot more than what we are supposed to do because we’re basically taking hostage and we’re told, Well, if you don’t do it, then who’s gonna do it? And is the patient’s gonna pay for you not doing that? And so I’m trying to tell my students that. That’s not the discourse that we should accept. And instead, we should flip it around and say, Well, how come you haven’t hired somebody to do that job? How come I’m not supported so that I’m able to do all the, all the work, all the nursing work that only I as a nurse can do. And so it’s important to look at nursing work and that’s probably my most important message, not as basically everything , uh, and anything. That needs to be done, but as a specific profession, as a job, and that as individuals, we don’t owe anything to the healthcare system, aside from our taxes, which I’m very happy to pay.

Jordan Well, let’s talk about how to improve the lives and work environments of nurses. As you mentioned, Quebec is in the middle of a provincial election right now. Is anybody promising to tackle this, and if so, what are they saying about it as pretty usual?

Natalie Stake Doucet There’s a lot. Things that are said, but that address the problem, not in the way. It’s gonna be resolved. So, you know, for example, the, the, the reigning party right now, the, the cat, the Quebec is, is promising a family physician for everyone. And this is the same campaign promise that they had four years ago. And, you know, it’s, that’s not what’s gonna heal our healthcare system at all. And it’s kind of absurd cuz not everybody needs a health, uh uh, not everybody needs a family physician. Uh, we all need care at some point, but it doesn’t have to be given by a family physician. And so the question really is, is access to the proper care. In a timely way. Uh, and that’s how we should look at the issue and we should put everybody, uh, look at every healthcare worker’s contribution to that accessibility to care.

Jordan The last thing I want to ask you about is we’ve recently spoken to an epidemiologist, just, you know, asking about. Covid this fall, What does it look like? And I think the consensus is that while the fatalities may not be as bad as the seasons change, we’re still going to see an uptick. What are you hearing about the fall in hospitals in Quebec in particular, given the recent exodus? What’s it looking like?

Natalie Stake Doucet Pandemic is not over as much as politicians would like it to be. So they can win their elections. It’s not over , pandemics and, and issues like that don’t get resolved just because, you know, elections are coming and, you know, still very few measures have actually been taken to retain nurses.And so there’s, there’s a lot of places, in this province and from what I’ve heard in Ontario as well, where, you know, we’re really looking at probably. Hospital and bed closures in the fall. We, we, we’ve had some a lot here in during the summer. But again, you know, this is all predictable stuff. Right. And, you know, as we’re having the discussion now, uh, epidemiologists public health, um, you know, experts from across the board have been saying, We are gonna see an uptick. You know, schools coming back in and we’re not, we don’t have mask mandates anymore. So there, there are gonna be outbreaks and so what are we gonna do about it? And you know, some of the outbreaks include hospitals. So, you know, what are we, what measures are we taking to protect. The most vulnerable patients to protect healthcare workers who work day in, day out in the hospital and long-term care homes and clinics. There’s not much of an answer to that right now. So, you know, it, it reminds me of the, this discussion I have every year with, you know, media and sometimes politicians like, Oh, summertime is coming, or Flu season is coming. What are we gonna do? And. You know, summertime comes every year. Flu season comes every year. There’s, there’s so many issues like the one we’re talking about right now that would, that are predictable, that we could have planned for, that we could have put measures in months ago, before the summer in the spring to ensure that. You know, if the uptick that so many people were predicting was gonna happen, that we’d have measures in place to sort of, give us a, a little bit of a buffer in terms of the, the consequences of that uptick.

Jordan Natalie, thank you so much for this.

Natalie Stake Doucet Thank you for having me.

Jordant Natalie Stake Doucet of the University Montreal.That was The Big Story, episode one on the Crisis and our healthcare. A big thank you to all the listeners who wrote in and suggested we do more focused weeks to go in depth on a topic. This is the first of these. We will have another one for you in November. No, I won’t spoil what it is. You can find the big story at the big story podcast.ca. Naturally. You can talk to us on Twitter at the big story, fpm or via. Hello, at the Big story podcast.ca. You can find this podcast wherever you get ’em. If you like these kind of special themed weeks, please leave us a rating and a review and tell us so and always suggest something that we should cover.Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.