`I'm stressed out. I can't sleep'

Front-line workers detail feelings of betrayal and anxiety in study

Behind the masks, front-line health-care workers in Ontario are burned out, stressed and angry, new research suggests.

“When COVID-19 is over, the employer won't have enough counsellors on hand to handle what I think is going to hit,” predicted one nurse who was interviewed for the study on health-care workers' experiences during the pandemic. The peer-reviewed qualitative study, released Tuesday, was sponsored by CUPE.

During the first half of the pandemic, nearly one in five Canadian health-care workers became infected with COVID-19, according to the Canadian Institute of Health Information. That is significantly higher than global rates.

That fear of becoming infected and bringing it home to family, or of infecting vulnerable residents, played a significant role in the anger and sense of betrayal expressed by some of those interviewed last spring for the research.

Most said they didn't feel properly protected to do their jobs safely and are exhausted because of chronic and growing staff shortages.

Tellingly, researchers had difficulty convincing many workers to participate in the study, even with the promise of anonymity. In the end, 10 people agreed to undergo lengthy interviews, but another five workers dropped out, saying they feared for their jobs if they participated.

“There is so much fear of reprisal,” said Margaret Keith, who co-authored the study with James Brophy.

“They are being silenced. The public has a right to know what is going on in our health-care system. They should have the same rights as other citizens to talk about their concerns.”

A top concern was a lack of protective equipment to prevent workers from infection.

Not only was all personal protective equipment in short supply during the early months of the pandemic in Ontario, but many workers are still unable to get access to more protective N95 masks, despite widespread acceptance that COVID-19 can be aerosolized indoors and provincial directives that workers have access to N95s, rather than surgical masks. Some workers told interviewers they were warned they would be disciplined for using the supply of N95 masks, except if it was for a highrisk procedure.

Many workers said they believe equipment failings are responsible for the high rates of infection among workers in the province. More than 3,000 health workers in long-term care homes alone have been infected with COVID-19 since the beginning of the pandemic in Ontario. That number increases daily.

A poll of 3,000 workers by the Ontario Council of Hospital Unions and CUPE found similar concerns about inadequate personal protective equipment.

The authors noted that statistics show health-care workers are much more vulnerable to infection than the general public but they do not tell the whole story. “The numbers do not reveal the emotional toll or personal hardships that result from working in a highrisk setting.”

One interviewer talked about a co-worker, a nurse, who became infected after being sent, without proper equipment, to care for a patient suspected of being COVID-19 positive. She was told she had not been sufficiently exposed to isolate, so she had to remain at work. Within a few days, she tested positive and was eventually hospitalized.

The experience has affected her emotional well-being.

“She's physically OK now, said the nurse, but mentally I don't think she'll ever be the same.”

Another nurse talked about the emotional toll of working during the pandemic.

“I've come home and cried many times. I'm stressed out. I can't sleep at night.”

A personal support worker in a long-term care home said about 10 of her colleagues had tested positive for COVID-19, some with lingering medical conditions.

Others talked about the exhaustion of working amid constant staff shortages.

“Our workload is crazy and the girls are just running on the floor to keep up. A lot of the staff are working double shifts just to try to get through because you have to look after the residents.”

A long-term care nurse told interviewers that she was about to head to work for “44 out of the next 60 hours. I've prepared enough food for six meals and they're in two shopping bags right now, ready to take to work. So that's what it's doing to me.”

The nurse said the long-term care home had lost about 100 staff because of fear or work at other jobs.

Workers said their complaints about unsafe working conditions went largely unheeded and they were offended at being called heroes when they felt their safety wasn't a priority.

The authors said the provincial government failed to follow recommendations made after the first SARS outbreak in Ontario, especially when it came to following a precautionary principle for worker health and safety to prevent a threat even before all the evidence is clear.

Keith said the research was an attempt to get behind the statistics showing the thousands of healthcare workers who have been infected.

“We wanted to know what it was really like to be a health-care worker during the pandemic.”

Michael Hurley, who is president of the Ontario Council of Hospital Unions, said despite the recommendations made after SARS, the COVID-19 pandemic has followed “an eerily similar pattern” when it comes to the safety of healthcare workers, “but this one is far deadlier.”