Amie Archibald-Varley and Sara Fung are nurses in southern Ontario, and co-hosts of the podcast The Gritty Nurse.
Anxious. Depressed. Even suicidal. These are words now frequently associated with nursing in Canada. Almost a year into the pandemic, our mental health is not getting better. Throughout COVID-19, nurses have been there for Canadians’ best days, worst days and all the days in-between. And as always, we have been discounted and unrecognized, our skills and expertise repeatedly devalued.
We have each practiced this profession for over a decade. And throughout our careers, we’ve repeatedly heard the dismissing, devaluing phrase “just a nurse” spoken by doctors and hospital executives—once, when Sara was a novice nurse, she even said it herself. She was promptly interrupted and corrected by her manager at the time, who said “you’re not JUST a nurse, you’re much more than that.” But it was probably too late: Once you hear something enough times, you subconsciously internalize it.
Which is perhaps why it has taken almost a year of this for nurses to really start speaking out. Across the country, the long-awaited vaccine rollout has been bumpy, to say the least: Perhaps because government and medical policy makers have all but ignored nurses, who administer by far the majority of vaccines in this country. But before nurses are asked to help even more, Canada needs to address our record levels of burnout.
Nurses are the health-care workers that spend the most time with patients. We are 400,000 strong in Canada; in comparison, there are just 90,000 physicians in the country. Approximately 91 percent of Canadian nurses are female. While COVID-19 is a “novel” coronavirus, the principles surrounding appropriate infection practices are not new. Many nurses working today were also working during the 2003 SARS epidemic: We knew early on what the pandemic meant, but we never imagined that we would not be listened to, never asked for advice.
Amie remembers her first shift screening patients for COVID-19 last March, standing in an emergency department behind a hastily erected Plexiglas frame, not wearing any personal protective equipment (PPE). It was available, but no one else was wearing any—at the time, she was advised that the screen was sufficient protection. But Amie didn’t feel safe. She remembers getting home, taking her clothes off in her garage and yelling at her family to stay away from her until she washed off.
This was the moment she knew that if she didn’t protect herself, no one else would. As of mid-January, over 66,000 health care workers in Canada were infected with COVID-19, representing 10 percent of cases. Forty of those people have died. The toll that COVID-19 is taking on nurses is terrifying. We are constantly working in crisis mode, and many are making plans to leave the profession, right when we are needed the most: on Sunday, the Globe and Mail reported that job postings for nurses are up 50 percent over this time last year, and that many of those are specialized nursing position that can’t be filled by new grads without the right experience (though there has been a recent spike in applications to nursing school).
Yet to this day, nurses are largely underrepresented at most COVID-19 decision-making tables, in both healthcare and politics. Only one of the 31 members of the Covid-19 Immunity Task Force Leadership Group that the federal government put together last April is a nurse—Gail Tomblin Murphy, from Nova Scotia, who hasn’t worked at a bedside since 1986. That lack of representation hasn’t changed as the pandemic has unfolded.
In December 2020, Ontario’s solicitor general released a report naming the people on the province’s COVID-19 Vaccine Distribution Task Force. We read the list aloud: there was not one nurse on it, and it wasn’t because of a typo or other mistake. This was, and still is, a direct insult. Again, nurses were left feeling under protected, under resourced, and under appreciated. Since then, Ontario’s vaccine rollout has been slow at best, farcical at worst. Could we have helped? Absolutely. In our experience, nurses spearhead the majority of education, quality improvement and evidence-based practices in many hospital organizations.
Meanwhile, our conversations with colleagues are increasingly grim. Burnout, mental health stress, depression and anxiety are not new: In June 2020, the Canadian Federation of Nurses Unions released the results of a survey of 7,358 nurses across the country. Completed in September 2019, well before the pandemic, the survey found that one in three Canadian nurses has screened positive for Major Depressive Disorder. About 23 percent had screened positive for Post-Traumatic Stress Disorder, and one in three reported having suicidal thoughts.
To reiterate—these numbers are from before the pandemic. It is only getting worse. Statistics Canada just reported that 77 percent of health care workers who cared for known or suspected COVID-19 patients are experiencing worsening mental health issues. In late January, Stefanie Van Nguyen, an oncology nurse who worked at Humber River Hospital and Halton Healthcare on Ontario, died by suicide. Many of us have reached our breaking point. Many of us are beyond it.
How and why did it come to this? Is there a light at the end of the tunnel? There is, but first we need to honestly discuss the shitshow this last year has been. Nurses need accountability, recognition, and to have a voice. We need a seat at the table. Here’s how to start.
How many physicians can say they spend 12 hours a day with their patients? Doctors work hard and are experts in their fields, but nurses are also experts and can contribute a different perspective. Yet nurses have been all but excluded from mainstream media, political agendas and healthcare decision-making tables since COVID-19 began. If you or your organization has asked for a doctor’s input on a panel, news story or anything else, you might want to invite a nurse, too.
Paid sick days
Despite the fact that we look after the sick 24/7, not all nurses receive paid sick days. Many nurses who work casual or part-time hours do not have paid sick days, and right now, some nurses aren’t even being given sick leave when they have to take time off to isolate while waiting for their COVID-19 results.
Those that do have sick leave are sometimes paid a fraction of their regular salary while they are off. In many hospital organizations, the “Attendance Support Program” discourages nurses from calling in sick—those who are seen to do so too often can become ineligible for internal job transfers, and in extreme cases, terminated. Even if the program isn’t meant to be punitive in theory, in practice it often is.
No one should ever be forced to choose between putting food on the table and going in sick to work, potentially infecting patients and colleagues. Nurses in particular shouldn’t have to make that choice as increasingly contagious strains of COVID-19 start spreading in Canada.
Robust employee assistance, and a national strategy for mental health care
Employee assistance plans in most hospitals and other health care settings are limited in scope. Most are not diagnostic, nor are they helpful during a full mental health crisis. Some organizations offer as little as $200 annually, which is less than the cost of one session with a psychologist in Ontario. And that’s for staff who have any support—like sick days, extended health benefits often aren’t offered to casual and part-time staff. Mental health benefits need to be available to all, regardless of job or employment status.
Nurses take care of Canadians every day. Now it’s time for Canadians to take care of us. Although we enjoyed the banging of the pots and pans at the beginning of the pandemic, it’s time to talk about what nurses really need, and deserve.