'What we want are safe staffing levels, safe work environments, so that we can safely care for our patients'
It’s no secret that front-line workers in Canada’s hospitals and health-care facilities have suffered greatly during the COVID pandemic.
But a new report from the Canadian Institute for Health Information (CIHI) shows just how dire this misery has been.
When it came to working extra, 236,000 or 21 per cent of the overall health-care workforce has put it in extra work regularly — but not all of it is being compensated: they averaged 8.2 hours per week of paid overtime and 5.8 hours per week of unpaid overtime.
For those who did the overtime, paramedics (45 per cent), general practitioners or family physicians (34 per cent) and respiratory therapists (31 per cent) reported they put in the most extra work, according to the CIHI study.
“It’s just not sustainable,” says Alexandra Heber, executive director of the Canadian Institute for Pandemic Health Education and Response (CIPHER), a knowledge hub being developed to provide resources for frontline workers most affected by COVID, in Regina.
“We’re finding that one-in-four health-care workers who responded to [our] survey have significant symptoms of post-traumatic stress disorder (PTSD); six in 10 have reported clinically significant levels of depression and anxiety and stress, and… over one in four [are] considering leaving their profession due to workplace conditions during the last few years.”
The CIHI research also showed that the number of new doctors entering the system is dropping: from 3.4 per cent between 2012 and 2014 to 1.3 per cent between 2019 and 2021.
This is contrasted with a rise in the number of nurse practitioners from 9.8 per cent in the earlier period, to 9.9 per cent in the last couple of years.
Poor wages are one of the biggest reasons some health-care workers are leaving the profession, according to a 2021 survey.
Opportunity for change
While some of the numbers are bleak, they represent a potential turning point for the long-term health of the system, says Heber, who is also an associate professor at McMaster University and has worked in a trauma and recovery unit.
“We have the opportunity here — because of this crisis that we’re having in healthcare — to look at ‘What do we need to do?’ and to really take a step back and look at our health-care system and say, going forward, ‘Do we want a public health-care system that can meet everyone’s needs?’ Because my concern is federal government, and provincial governments and territories, they are looking for patches to put on the current system, and unfortunately, I don’t think those are always the best solutions, especially not for the long-term.”
The CIHI report called for an increase in recruitment of health-care workers from other provinces and internationally — but this might be counter-productive, according to Heber.
“We recruit people from other countries, and then those countries are left without those staff; inter-jurisdictional, we recruit from one province to another, and then we have that same problem in the other province,” she says.
Ottawa recently loosened rules around permanent residence to address doctor shortages.
Instead, it might be wise to look to what other countries — particularly in Europe — have done in successful measures, says Heber, by providing robust health-care teams instead of single-family physicians for patients.
“In other words, they have teams that include nurse practitioners, physician’s assistants, social workers, regular nurses, pharmacists, because then that team can meet the needs of a much larger population of patients.”
By implementing these types of care regimes, primary doctors do not have to see each patient every time and other members of the team are able to step in to provide services, she says.
“I really think those are the kinds of discussions we need to be having.”
In early 2022, two groups called for better protection for healthcare workers and journalists against the anti-vaccination convoys in Ottawa and similar demonstrations.
Leaders have role to play
In the meantime, there are tangible steps that can be taken help to alleviate the problems, according to Heber.
“[For] health-care workers — especially when we are expecting them for a period of time to go above and beyond, as what’s happened during COVID… it’s critical for [employees] to be able to turn to their leaders, and that their leaders are aware of what’s going on in the front lines, and their leaders are providing both morale support and also helping when there are issues that need to be dealt with.”
Health-care organizations should work to support those leaders, says Heber so they can then support the health-care professionals.
“Helping those frontline workers to maintain that team cohesion because that’s another very important part is for people to feel that: ‘I have my team around me; it’s a tough job, we’re working very hard but we’re all here together, and we’re supporting each other,’” she says.
In early 2021, some restaurants in Canada said thanks to frontline health workers by offering them free hot beverages.
Those employees should also be supported when it comes to staffing, and not applauded for their efforts in overly stressful situations, says Heber who cited a quote from an ER nurse in Vancouver in the report.
“She said calling nurses ‘resilient’ is putting a patch on the problem. Calling nurses resilient means we can return to work after traumatic events, such as a patient dying; we can stay past our 12-hour shift when there is no replacement coming… rather than being resilient, what we want are safe staffing levels, safe work environments, so that we can safely care for our patients.”