Pandemic response ‘too little too late’
THE WORK OF NURSES HAS BEEN PARTICULARLY HARD-HIT BY PROVINCIAL MISSTEPS, SAYS RNAO
As the pandemic’s variant-fuelled third wave fills intensive care units and pushes many to the breaking point, the neighbourhood pot-banging that once showed support for health-care workers has fallen conspicuously silent. It’s not that the cause is falling out of favour, says Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario (RNAO). Rather, it is because “no one can put their heart into cheering when everyone knows our elected government should be doing so much more to prevent deaths and suffering caused by COVID-19.”
The work of nurses has been particularly hard-hit by provincial missteps, Grinspun says. Long before the pandemic struck, the RNAO repeatedly pressed the Ontario government to make good on its 2017 commitment to provide four hours of direct nursing and personal care to long-term care (LTC) residents. (Even today, only 2.71 hours are delivered on a daily basis, the RNAO reports.)
When COVID-19 began ravaging Italian LTC homes in February of 2020, the RNAO advised Premier Doug Ford to adopt the “precautionary principle” — the idea of erring on the side of caution to protect public health — to safeguard vulnerable LTC residents.
This guidance appears to have fallen on deaf ears. According to a new report from the LTC COVID-19 Commission, a combination of chronic underfunding, severe staffing shortfalls and infection control deficiencies exacerbated the loss of life in Ontario LTC homes, where 3,758 residents died from COVID-19 during its first and second waves.
The commission’s report mirrors RNAO recommendations in calling for a staffing formula of no less than 0.8 hours of daily care provided by registered nurses (RNs), one hour by registered practical nurses (RPNs) and 2.2 hours by personal support workers (PSWs).
While the Ontario government has pledged to introduce the recommended four hours of care, Grinspun scorns the lack of meaningful action. “It has all been too little too late in Ontario, with ageism fuelling the first and second waves, and racism taking a heavy toll in the third.”
Another RNAO recommendation echoed by the commission’s report — the need for paid sick days for LTC staff — has taken on wider significance as the pandemic has unfolded. As Grinspon points out, many of the people who are now becoming ill are essential workers who live in underprivileged communities and lack access to paid sick days.
“People don’t live in crowded apartments because they choose to live there,” Grinspon says. “They simply can’t afford anything else, and they certainly can’t afford to miss a paycheck because they are sick or caring for someone who is. We need to ensure that people aren’t forced to choose between their livelihoods and following public health directives.”
Brigit Umaigba, a critical care nurse at Credit Valley Hospital in Mississauga, has seen the fallout of this impossible choice first hand. “The number of young patients we see coming into our ICU because they were exposed to COVID at work is ridiculous. These are cases where people went to work sick and spread the virus there. Having paid sick days would have prevented a lot of deaths.”
While the Ford government recently started reimbursing employers for up to three paid leave days related to COVID-19 for every employee, the RNAO is joining Ontario’s opposition parties and other organizations such as Ontario Federation of Labour in calling for at least triple that amount.
The RNAO has also led the way in calling for a lockdown of all non-essential services, prioritizing vaccinations for all essential service workers, re-instituting a moratorium on all residential and encampment evictions, restricting non-essential travel within Ontario and between Ontario and other provinces and countries, and fully vaccinating nurses against COVID-19 to mitigate the risks posed to them in medical settings and thereby sustain the health system. At the same time, it has repeatedly urged the government to draw on the 20,000-plus home care and primary care nurses to help speed up the vaccine rollout.
Based on what has transpired thus far, Grinspon isn’t expecting much of an aboutface on these points. “We are very discouraged that the government is not listening to the voices of experts, and we are warning that the pandemic could get much worse without stricter measures to control the spread of the virus.”
However, yet another misstep can be averted by prioritizing the health, welfare and morale of those who have been caring for patients non-stop since the pandemic began, Grinspon says.
Indeed, a recent RNAO survey of more than 2,100 RNs, RPNs and nursing students found that 95.7 per cent said the pandemic affected their work, with a majority of nurses reporting high or very high stress levels. This led at least 13 per cent of RNs aged 26 to 35 to say they are very likely to leave the profession after the pandemic. Overall, the association anticipates 15.6 per cent of nurses to leave the profession within a year, including those who are retiring and those who are choosing to depart early. Ontario’s usual nurse loss rate is 4.8 per cent per year.
With Ontario already having the lowest nurse-to-population ratio of any province or territory, “the kind of exodus that our survey suggests threatens people’s health and our health system,” Grinspun says, pointing to RNAO recommendations for reversing this trend that include more support for early- and mid-career level nurses, and hiring more nursing staff to alleviate rising levels of stress and burn out.
Peel-based ICU nurse Naila Shaikh says she can relate to those nurses who have had enough. “As soon as you come in you have to be on the ball, and it doesn’t stop,” she says. “I don’t have time to think about all the pain and trauma around me, but I know I’ll have to deal with it later on. I’m withdrawn and exhausted on my days off, and a lot of the nurses I work with feel the same way. We’re in survival mode.”
Shaikh’s stress caught up with her in 2020, when she was hospitalized and off work for two months with shingles and meningitis. “Everybody compensates with this pandemic in different ways,” she says. “For some nurses, it’s just too much.”
For others, the pandemic has been a call to action. More than 400 who were not employed or were employed part-time volunteered to work in the Ontario nursing homes that were hardest hit by the first wave. When the RNAO put out a call for help during the third wave, it was answered by another 400-plus nurses, many of whom are now stationed in Ontario hospitals.
Grinspun offers two alternatives to banging pots and pans in support of these and other health-care workers. One is to observe Nursing Week by using the RNAO’s email-based “Action Alerts” to demand urgent and immediate action from the Ontario government. “There is no time left for logistical logjams and delays,” she says. “The response to this tidal wave needs to be simple and done with speed.”
The other: On or before June 2, 2022, vote for the party that will take action. “I’m not saying who to vote for,” Grinspun says, “but let’s see which party steps up to the plate to do what must be done.”
We need to ensure that people aren’t forced to choose between their livelihoods and following public health directives.
– Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario