Hear Our Voice

Two years into the COVID-19 pandemic, and almost five years since the province's opioid crisis was declared a public health emergency, BC's nurses are feeling the strain, and struggling to keep their heads above water in a health-care system that was already in the midst of a nurse staffing shortage before the latest crises emerged. 

It's no wonder a growing number of working nurses are looking at the door – or counting the days until their retirement.   

According to the Canadian Institute for Health Information, over 3,500 BC nurses currently need to be replaced each year – just to maintain present staffing levels. Between 2011 and 2019, the province lost an average of 2,450 registered nurses, 181 registered psychiatric nurses and 946 licensed practical nurses per year due to various forms of attrition. 

Graduation rates, unfortunately, are not keeping up, which means the atrophy is unsustainable. In 2017, BC educated 1,466 RNs, 118 RPNs and 579 LPNs. Those 2,163 new grads represent a 3.7 percent decrease from 2016's numbers. 

Danette Thomsen is all too familiar with growing nurse attrition rates. Prior to stepping into the role of interim vice president, Thomsen served as council member for BCNU's North East region, one of the hardest hit by the nursing shortage and COVID-19 pandemic. 

"Nurses are exhausted. They're burnt out. I know a nurse in Fort St. John who worked 42 consecutive shifts!" Thomsen told radio station CKPG in September. "That's just unacceptable," she said, suggesting that demands like these are driving nurses away. 

Kelowna General Hospital (KGH) full-time steward Lorna Thomas tells a similar story. "Nurses in my site are exhausted, frustrated, scared and ready to leave their jobs at the earliest possible time," Thomas reports. "Some would stay longer if work environments and expectations appeared to be more reasonable, but some only continue to work because they can't afford to quit." 

Thomas says she doesn't feel nurses at KGH trust anything their employer has to say in response to concerns they have raised over practice conditions.  

"Our employer is good at talking the talk. But if they want to reduce moral distress and violence on the job, they need to prioritize our wellness, get serious about reducing short staffing, and they must start treating nurses like valued members of the team, not disposable cogs on a faulty production line." 

Ron Morley works as a full-time steward at Coquitlam's Forensic Psychiatric Hospital. He's also feeling frustrated by the staffing shortage, and the systemic problems associated with it, like forced overtime which, he argues, should only occur in exceptional circumstances. 

The practice has, unfortunately, become so common that it is part and parcel of the ongoing staffing crisis. But overtime work is risky, and the potential costs must be acknowledged. 

"Nurses need to be aware when they are being guilted into forced overtime, that they have responsibility over their licenses," he warns. "And they need to make their employer aware if they are too exhausted to work and state they are not fit to practise." 

Morley reminds members that the BC College of Nurses and Midwives puts a duty on nurses to ensure they are fit to practise, and if their fitness is compromised by fatigue or other factors then they have the right and duty to decline to work extra hours. 

"A fatigued nurse will make mistakes, Morley states. "It's not the nurse's fault that employers are unable to staff their worksite. 

"Forced overtime occurs frequently throughout the week at Forensics. Nurses are constantly worried they'll be pressured to stay when they are already exhausted from working with a challenging, complex, and often violent patient population," he reports. "Members reasonably fear for their licences and making a mistake when they're unfit to practise beyond their assigned shifts and against their will." 

The message from nurses at the point of care is clear: they feel sad, scared, unappreciated and burnt out. These were the findings of a BCNU survey conducted during the height of COVID-19's third wave. Some 3,500 nurses participated in the research, which reveals the full extent of the mental and physical toll the pandemic has taken on members. 

The staffing crisis was by far the most cited issue in the survey and had nurses considering leaving a profession they once loved. In addition to staffing woes, nurses surveyed described what they felt to be a lack of respect, and they highlighted the need for government and employers to be actively seeking their feedback and engagement to find solutions to staffing and occupational health and safety issues. 

Lions Gate Hospital full-time steward Alexandra Hansen shares her frustration with conditions at her worksite, and feels nurses are given no place at the table for discussion. 

"I talk to nurses daily who tell me through tears that they've failed their patients," Hansen reports. "And as a steward I feel so overwhelmed. I need to support my nurses and feel that I am failing them. 

"We can recruit all the nurses we want but unless we are able to retain them it's just going to be a revolving door," she argues. "Nurses need to feel valued by their employer and their communities and respected for the work they do." 

Nurses have been waiting long enough, she says. "The government needs a plan; they cannot continue to put a band aid on a nursing hemorrhage." 

Danna Cattermole views nurse staffing through a particular lens. She's the full-time steward covering Langley Memorial Hospital and community services in Langley, Surrey, White Rock and Delta 

"In the community services sector, the biggest problem with short staffing is that the employers are deferring patients and putting the onus on nurses to make the call to defer the patient," says Cattermole, who explains that the practice means a client who should be receiving three visits a week may only be seen by a nurse once or twice. 

"When you go on vacation, there's no one to backfill you," she adds. "This means that upon your return you not only have your existing clients, who've had no home health visit, but you also need to care for new clients who were onboarded in your absence." 

So, what's the solution? 

Cattermole says education and communication are important factors for retaining the nursing workforce. "If we can foster good relationships with our managers and feel valued and empowered by the work we do, more will stay," she argues. 

"The next big step is education, more seats for nurses in schools and making time for mentorship and preceptorship in the workplace," she adds. "There won't be new nurses coming in if we can't keep the ones that we have." 

Thomas wishes that employers would provide sufficient education and mentoring before expecting nurses to perform tasks that require specific skills, and provide sufficient orientation to each unit before expecting them to take a full workload. 

 

"What we really need for safe nursing practice is for our new grads and undergrads to get paid work experience and mentorship to get up to speed on the work they must do," she argues. "We need to place that onus directly on the employer."    

Hansen says nurses do have solutions to the unsafe situations, but they don't feel like they are being heard. 

"The pandemic led to the elimination of committees and working groups that fostered a collaborative working environment, and these aren't being reinitiated," she reports. "We've been trained to be leaders and healers, let us lead the way out of the disaster that is health care right now. Let us use our nursing skills to assess and create care plans to restore the wellness continuum of our workplace." 

There's is no quick fix solution to the many staffing issues nurses have faced, both pre- and post-COVID, but it's clear that more needs to be done.  And the bottom line is that BC needs nurses. 

"Government needs to listen to nurses, collaborate with us on creating a plan and be willing to be held accountable," says Thomsen. "As we head into the next round of provincial bargaining, the ongoing nursing shortage will top of mind, and negotiations will succeed or fail on this issue alone."•