Where have all the nurses gone? One irrefutable fact COVID-19 taught us: there are simply not enough of them. Nurses are a respected asset that we cannot ignore.
Prior to the 1990s, the health-care field was a rapidly expanding universe that saw huge investment in organized health care, such as hospitals, as well as health-care provider training.
Then in the 1990s, a dramatic shift occurred. Inpatient care got transformed to same-day surgery and discharge. Hospitals became burdened with older patients they couldn’t discharge due to a lack of nursing home beds and home care. The so-called ‘alternate level of care’ (a.k.a. ALC) patient occupied hospital beds. These ALC patients didn’t need the same level of care as the usual sick patient.
And so the registered practical nurse and the personal support worker were inserted into what used to be nursing positions. After all, they were cheaper to hire. Further to this, politicians made the huge mistake of downsizing Canadian hospitals as the old age cohort of the population exploded.
A number of organizations including the OMA warned of the disastrous results.
The absolute number of nursing layoffs continued through the 1990s up until about 2002, according to Pat Carr at the Ontario Nurses Association.
At present, the ONA reports that of hospitals surveyed, about 11 per cent of hospital nursing positions are unfilled in Ontario.
Further to this, ONA estimates that a large group of nurses will leave the profession after the pandemic. They cite poor working conditions, dangerous working conditions (for nurses and patients) as well as the bodily toll of personal protective equipment. Plus, they finally have a workable retirement policy.
Hard to argue with that.
While a global revolution was happening in health care, nobody anticipated the needs of an aging population. Indeed, we now know that Canadian hospitals are largely undersized and understaffed to do what needs to be done.
But wait. The year 2020 brought a pandemic not seen in 100 years and hospitals brimming with sick patients. The main problem – too few nurses.
So what happens. More and more is asked of a small cohort of nurses. They work double shifts. They work under-staffed, to the point that they admit their care is inadequate. Vacation and leaves are cancelled. They are gagged by contractual agreement and fear of losing their jobs if they speak out. But mainly, they fear for their patients.
And so they feel they have no recourse other than leaving, making the nursing shortage worse.
At present, StatsCan estimates that seven per cent of our entire health care cohort is due to retire. If you add that seven per cent to the 11 per cent of existing vacancies, plus the nurses that have vowed to leave due to poor working conditions as soon as the pandemic is over, we could have a real problem.
But wait, the province has just announced a retention initiative for working nurses. A $5,000 bonus if they don’t leave their jobs.
Wow.
I’ve spoken to a number of working nurses in hospitals and long-term care settings. Their stories are very similar.
That $5,000 spread over the year works out to about $300 per month, or less after taxes.
What do they say?
Hardly worth it for the overwork they’ve had to endure. Hardly worth it for the poor leadership they endure from non-nurse administrators. Hardly worth it for no backup when they can’t go home. Hardly worth it for the verbal and physical abuse they get from patients.
Yes abuse. I’ve spoken to and know nurses who have endured repeated verbal abuse. I know nurses who have been beat up by patients to the point of being off work with compensable injuries for months. When it happens, they are not supported. Rather, they are told something like, “You should know better,” or, “You need to learn to duck.” And their stories don’t see the public light of day due to confidentiality agreements.
Really? Where is their comeuppance? Are they expected to know what to do when they are physically assaulted? And it’s not uncommon.
Self-defence training was never a part of nursing education, which by the way, has expanded from two to four years.
One nurse told me, “Why would anybody invest four years of education in a career that is totally uncertain?”
Health care in this country has been totally unpredictable because of the whims of our politicians.
Health care providers were the political villains of the 1990s and early 2000s. Now they are heroes because of COVID-19. But how long will that last? Heath care will continue to be a political football, as it always has in this country.
But the bottomline worry, for everybody in the health care system who deals with “sick” patients, is violence against the health care provider. This has grown by leaps and bounds in my short four decades in the profession.
Are health care workers that taken for granted?
Indeed, the federal government passed legislation last week enhancing the punishment for people who attack health care workers physically, or who block health care workers access to facilities. Is this another political kneejerk?
The core problem remains engrained in health care culture. Health care workers are expected to duck and take it.
Canadians have constitutional rights. Patients have a bill of rights. Nursing home residents have a bill of rights.
Is it time for a health care worker’s bill of rights?
Dr. Klaus Jakelski is a retired family physician and author, who remains active in long-term care. He resides in Greater Sudbury. You can learn more about him by visiting his website, Jakelski.com.
