Our Safety is Non-negotiable

In the months before the COVID-19 outbreak was officially declared a pandemic by the World Health Organization (WHO) in March 2020, BCNU was already raising the alarm about the coronavirus's risk to members' health and safety

This advocacy began when the union was made aware of BC's first case of COVID-19 in January. In the absence of definitive science to confirm the transmission of COVID-19, the union called on health employers and governments to ensure point-of-care nurses had access to the highest level of personal protective equipment (PPE) as they worked to confront the global public health crisis.

In those early days, elected BCNU leaders met with health employers and government officials daily, and they insisted that the precautionary principle be applied to all of its occupational health and safety planning. This approach begins by recognizing that reasonable actions to reduce safety risks should not await scientific certainty, and that workers should be afforded the highest level of precaution in the face of uncertain hazards.

"The precautionary principle supports nurses' ability to conduct point-of-care risk assessments and use their clinical and professional judgment to determine their own risk and PPE requirements," explains BCNU President Aman Grewal.

The union also voiced concerns for pregnant, vulnerable, or immune-compromised members, and fought to ensure they were provided with medical accommodations during the pandemic. BCNU labour relations officers helped more than 550 nurses make duty-to-accommodate requests to their employers, upholding nurses' right to work free from discrimination based on their medical status.

"The first few months in 2020 were unprecedented for the union," recalls Grewal. "The information around the novel coronavirus seemed to be changing daily. And as the crisis in the province grew, so too did our response for our members."

Grewal says that even with its staff working remotely, the union was able to ramp up member services and provide support for a 24/7 phone line to respond to members' health and safety concerns.

ACCESS CHALLENGES

In March 2020, the province updated its PPE allocation framework to advise that, when at particular stages of supply, health-care workers would be required to wear the same surgical mask and eye protection for their entire shifts, despite having close contact with patients.

The scientific community remained divided on how the virus was spread, yet
the provincial framework stated that droplet-based precautions were sufficient to protect health-care workers.

Grewal says the allocation framework became a tool in the hands of employers who could use it to deny nurses access to higher levels of PPE, including N95 respirators – the standard when managing aerosol-based transmission.

Government officials came under greater media scrutiny as more nurses began reporting that their employers were locking up PPE at worksites to ration products. Nearly 25 percent of nurses surveyed by BCNU reported PPE being held under lock and key at their worksite, despite health ministry reports that tens of thousands of pieces of PPE had been purchased.

"The reports from our nurses on the ground differed greatly from the information provided in daily media briefings from health minister Dix and provincial health officer Dr. Bonnie Henry regarding the availability of PPE in this province," Grewal recalls, noting that one in four nurses polled in a BCNU telephone town hall in May 2020 indicated that they did not have sufficient access to PPE at their worksite.

"We knew the truth – and it was unacceptable."

The union continued its call for properly fit-tested N95 respirators and training and supports for health-care workers to effectively manage the challenges of working in an overloaded health-care system that was already critically understaffed.

Unfettered access to PPE was the union's line in the sand.

"Protecting those on the front lines who are risking their health, and those of their families, to provide care for sick British Columbians should be non-negotiable," states Grewal.

As the pandemic wore on, the scientific evidence for aerosolized transmission of the virus was growing. In October 2020 the WHO acknowledged that the COVID-19 virus could spread via short-range airborne transmission and inhalation of infectious particles. And the following November the Public Health Agency of Canada revised its guidelines on how COVID-19 spreads to include the risk of transmission from aerosols. The agency advised that aerosols could remain suspended in the air or travel farther than conversational distance, especially in poorly ventilated and/or crowded indoor settings.

In December 2021, as BC entered the fifth wave of the pandemic that was driven by the rapid spread of the new Omicron variant, the union reached out again to Minister Dix raising concerns about safety and risks to members.

"The international scientific community, including BC's Centre for Disease Control, have acknowledged aerosolized spread as a primary mode of transmission of the Omicron variant," Grewal told Dix. "Yet we continue to hear directly from members who are not able to consistently access appropriate PPE."

The union also called on Dix to update the province's outdated PPE allocation framework to include aerosolized spread in addition to droplet-based transmission and precautions. To support its position that the framework was not good enough to protect health-care workers, BCNU cited 2020 WorkSafeBC reports showing that workers in the nursing occupation registered the highest number of COVID-19 illness claims. Nurse aides, orderlies, and patient service associates account for the second highest number of registered claims.

SYSTEM-LEVEL CONSEQUENCES

BCNU conducted a member survey in the spring of 2021 during the height of the pandemic's third wave, and it found that nearly two-thirds of respondents felt like the government was not doing enough to ensure their safety. Thirty-six percent reported that their employers continued to restrict access to PPE in their worksite. Of those, a staggering 73 percent said that PPE was placed under lock and key.

"Our nurses are already working under increasingly difficult working conditions – and access to appropriate PPE should not have been another challenge," states Grewal.

Grewal notes the changes to the Point of Care Risk Assessment process announced in February that make it easier for nurses to access N95 respirators, but she says this may be too little too late, especially when coupled with crushing workloads and inadequate staffing levels that nurses are experiencing.

BCNU's November 2021 report, The Future of Nursing: Impacts of the COVID-19 Pandemic and the Nursing Shortage in British Columbia, found that 82 percent of members reported that their mental health had worsened during the pandemic and 65 percent said their physical health had worsened.

Just as worrying, 35 percent of respondents indicated the pandemic experience has made them more likely to leave nursing in the next two years. The figure rises to 51 percent of nurses working in ICU and ER care settings.

"These numbers are heartbreaking," says Grewal. "The government needs to act now to mitigate the devastating impact these conditions are having on our health-care system. Without immediate investments and swift action, we fear that patients and nurses will continue to suffer." •

UPDATE (Spring 2022)