Nurses face burn out during healthcare crisis

“Something has got to give. If you don’t have the same number of staff, the same amount of work cannot get completed in a day.” – © Unsplash (stock photo for editorial purposes only)

By Jaymie White

Local Journalism Initiative Reporter

– with files from René J. Roy

Editor’s Note: This is Part 1 of a series taking a closer look at the direct impact of the healthcare crisis and its affect on services and staff in our region. Part 2 will continue next week and include discussions with Western Health and the Department of Health and Community Services. Identities of some interview subjects have been redacted.

WEST COAST — Newfoundland and Labrador has been in the midst of a significant healthcare crisis for years, a situation the pandemic made even more dire for those awaiting medical treatment and those who are on the front lines.

For nurses, doctors, and other medical professionals, having to work under the added stress of a global pandemic was a struggle only exacerbated by the severe shortage of healthcare workers around the province. Now these same professionals, who have been heavily relied upon, who have sacrificed time at home with their families, days off, rest, even to the point of sacrificing their own health and wellbeing, are suffering job burnout while awaiting help that never seems to come. It seems that everyone in the medical field is feeling the strain of working under increased pressure, taking on roles and jobs meant for at least two people, all by themselves.

Nurse A has been working with Western Health less than five years, and in that time they have seen the situation get progressively worse.

“The consensus at the hospital is that things have been slowly getting worse for years, but now it has ‘hit the fan’ after the pandemic,” said Nurse A.

They added that nurses are being moved around from department to department, because there are many times when there just isn’t enough staff to cover.

“In nursing, the scope of the work is broad. When you go to work each day, you don’t always know what department you will be in and whether or not you have enough staff scheduled to cover the patients. There’s a lot of shifting bodies around to fill a need because we don’t have enough staff, but I think that is Canada-wide, not just in Newfoundland.”

Nurse A is adamant that nurses are struggling to cope.

“A few people have quit now and a lot of people have been looking for different jobs, but if they are in a full-time position and they apply for a job that isn’t another full-time position, Western Health has the ability to hold them back. So they aren’t allowed to leave this job until they find something equivalent.”

Nurse A said being mandated in to work is one of the most difficult aspects about dealing with the lack of staff.

“We get mandated after a night shift to come back to work after going home for a four-hour break and that’s insane to me. I don’t know how you are supposed to be safe and effective in a healthcare setting when you work 16 hours, all night, then you go home. I don’t know how you could even sleep for more than 30 minutes before you are back to work again,” they said. “It seems like, from what I understand, mandates have been relied on for the past few years as a way of getting through with less employees, but they don’t have enough staff to cover the hospital. So if somebody calls in sick, there’s usually no one to work. That was heightened with COVID and so many staff having to be off at the same time.”

On top of the mandates, Nurse A said there isn’t a lot of training offered to nurses who are coming in, whether they’re fresh out of school or from a completely different department, and that they are just expected to come into work and know what to do.

“There isn’t any training happening really. They do an annual training each year, and that was put off in March, and that really heightened the shortage after COVID, and it made everything worse. That was planned, management training, but other than that, as employees working in a field where you are required to be continuously learning, they don’t offer any extra training. When I went to my boss about extra support, they basically looked at me and shooed me away as quickly as they could.”

Nurse A said the lack of support isn’t just stemming from those who are managing the employees, but with the union as well.

“It’s almost like it’s being taken advantage of, like they all have a good understanding of how to use the agreement to their advantage, like any company, but it’s almost abused in some situations.”

Nurse A said they feel that with such a shortage, having customary responsibilities outside of work, like a family, appointments, or emergencies, isn’t an option.

“I do understand the importance of it, the responsibility of it, but when you don’t have the support you need, it’s like being told I don’t matter.”

Nurse A said they are getting at least 80 hours a week, though it’s usually more, and they are simply exhausted.

“It’s tiring. When you work three 12-hour shifts in a row and go from a day shift to a night shift, there’s no leeway in between. Trying to communicate any concerns you have to management regarding the difficulty of maintaining this type of lifestyle falls on deaf ears.”

Nurse A said the difficulties are increased for those employees who have children at home and must arrange more childcare on a day that was supposed to be their day off, but the guilt they would feel anytime they couldn’t go in isn’t worth it.

“I usually will take the shifts regardless, because I know what it’s like for the people who are stuck there working. You wouldn’t believe how bad the day becomes when you are short even one person. I don’t think it’s good for the health of the workers, long term or short term even. Everyone is feeling the pressure,” said Nurse A. “One of the solutions has been to have locum workers come in temporarily who are getting double-time wages to work the same floor as everybody who is working for straight time. A lot of people are getting really upset by that, as you would, instead of bringing in more permanent employees. Just bring them in on locum and pay them more than everyone else. That’s not fair to the workers that are there every day and are already burning out from working so hard.”

Nurse B, who has been employed by Western Health for the better part of 20 years, agrees with Nurse A that the state of the healthcare system has continuously gotten worse.

“In all categories, it’s worse coming from Western, it’s worse on the floors as requirements (go) and what is expected of you keeps getting added on. It’s worse with coworkers because, for the most part, all workers and employees are feeling the crunch. It’s definitely nowhere near the safe, happy place to work that it once was.”

Nurse B said the staff they work with are managing with how much is on their plates, but it isn’t easy on any of them.

“It’s a lot of extra stuff and, especially with COVID, that didn’t help. Management was able to bring in something called the ‘Good Neighbour Agreement’, which gave managers and management a way out to do whatever they felt they needed to do without abiding by union contracts,” said Nurse B. “This has been a thorn in peoples’ sides since it started because there were positions made on the greeting desk where they were screening people. It didn’t go by seniority. It didn’t get posted that there were positions. It was as if people were handpicked and put in these positions, which created a lot of animosity between staff because staff that were not full-time permanent, who were higher on the seniority list, were getting less hours than people lower on the seniority list.”

Nurse B said this descent into lower quality of service was on a downward spiral even before the pandemic hit, citing that one of the major issues was scheduling being moved to a different hospital.

“Our scheduling used to be done on site, but in Jan. 2020 our scheduling was moved to Stephenville. So Stephenville does the scheduling for the nursing staff and as of 5-6 months ago, now they also do scheduling for housekeeping, dietary, that kind of thing, and according to (them), Stephenville’s scheduling is done in Corner Brook,” said Nurse B. “The reason I was given is because they don’t want the scheduler to be in the next office so you can go in and bang on the door and have it out with the scheduler. Now they are a phone call away or an email away and it has created more issues. We have staff making their own schedules, calling up scheduling and saying they aren’t available at certain times when, under contract, we can’t. We have to be available for work.”

The fact that there aren’t enough employees affect scheduling and the amount someone has to come in, but Nurse B said the staff is suffering when they are left short, something that happens an average of three to four times a week.

The staffing shortage is compounded even more on the weekend simply due to the fact that less staff are already scheduled than on weekdays, but the same amount of work still needs to be done.

“A lot of times what has been going on as of late, if we get a sick call on Saturday or Sunday, they try their best to replace it, but there are a lot of times where there is nobody to call. Nobody is willing to come in for overtime,” said Nurse B. “I have not seen, since the scheduling moving to Stephenville, I have not seen overtime in that hospital like I see now. It’s amazing. It’s gone up. Overtime before was pretty much unheard of. You might get a scattered two or three shifts a year. Now you can pretty much book your overtime if you want to. It’s just ridiculous. I don’t know what the sole cause of it is, but it is since the scheduling moved to Stephenville.”

Nurse B also said the support they need is almost nonexistent.

“What service and support we do get seems to be lip service. They want to tell you the answers that you want to hear, but very little is followed through on. Even the union is not what the union used to be, not even close. It seems like we don’t have a right anymore. We’ve got a contract and a union book, but it seems like, whatever we go to the union for and the higher ups, what we have questions on, they’ll tell us to our face that it’s not right, that we can’t be doing that, but we can’t get nobody to fight for us beyond that.”

Nurse B said that working for them isn’t necessarily more stressful now than it was when they first started, but the stress is different.

“Back then it was stressful with the learning curve. Coming there with a lot of senior staff and not a lot of junior staff, trying to learn the ways and the personalities of all the staff, and nowadays it’s stressful too, because there’s more time where we are short staffed.”

Nurse B said burnout is a real concern for them.

“I, along with a lot of other coworkers, have injuries such as bad shoulders, necks, backs. That’s the business we are in, and I will say, for me and for my coworkers, we don’t get enough time off because on your first day off you’re still not feeling the best. Your body is still not there. Your second day off you’re starting to feel a bit better, and the third day you are back to work again, so you’re not recharged.”

Nurse B said the most unfortunate result is that patient care is unavoidably compromised.

“Something has got to give. If you don’t have the same number of staff, the same amount of work cannot get completed in a day. We try to bear it and work together as a group, work together as a team and do what needs to be done, but it is starting to come at our expense, the staffs’ expense, where they are getting burnt out, worn out, faster,” explained Nurse B. “So staff are no longer willing to take on the extra tasks. Whether it’s our right or not I can’t speak on that.”

Nurse B worries about healthcare workers reaching the inevitable breaking point.

“Everything has got to give. Anytime that we are shorthanded, something is being left out, and then it’s creating more animosity amongst staff and amongst different departments.”

Nurse B said healthcare is collapsing, but that throwing a little bit of money at the problem is not going to solve the root of the issue.

“The root of the issue is, if they are short staffed, that they need an extra full-time permanent put there. Instead of putting five, have it at six, and don’t have it temporary,” said Nurse B. “In the region, and I would say province-wide as well, a lot of the positions are open because the government don’t want to hire permanent anymore. It seems a lot of the positions that are posted are temporary full-time instead of permanent full-time, and it makes it hard for anybody to get in and get settled that way.”

Nurse B said respect and acknowledgment would be a nice way to show the employees that the fact that they are working so hard really does matter.

“A thank you goes a long way too sometimes, but that seems to be something in the past,” said Nurse B. “Instead of appreciation it seems that everything is a blame game now. ‘Who can I cast this on? Who is going to be at fault’, instead of really trying to help, and get to the root of stuff.”

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