Frustration on the Frontlines

Workers' Stories in the COVID-19 Era: Installment #10

In the tenth installment of the Workers' Stories in the COVID-19 Era dialogue series, we interviewed a senior nurse who has worked at a GTA hospital since the 1980s. Below, Ahed shares their experiences as a worker on the frontlines of the COVID-19 pandemic. They talk about the mismanagement of pandemic protocol by the government and hospital administration as well as the need for nurses to have stronger labour rights. When comparing COVID-19 to SARS, Ahed is shocked that this pandemic response has been so horrible.

For privacy, all names have been changed to protect the identities of our interviewees.

Note: When Ahed references Bill 195, Reopening Ontario (A Flexible Response to COVID-19) Act, 2020 (passed into law July 24^th, 2020) they are specifically speaking to the impact that this has had on nurses. Namely, the fact that this Bill allows hospitals to deploy nurses to units they are unqualified to work in and, as per the Ontario Nurses’ Association, “it also grants enormous latitude to employers to override collective agreement provisions and the grievance arbitration procedure” across all unionized workers. The government will continue to possess these powers indefinitely.

As of August 24, 2021, 26, 835 Canadians have been killed by COVID-19.

Interview

Christina: Can you describe your job, typical duties, and how long you've worked there?

Ahed: I work in a short stay unit at my hospital. They do procedures, so people stay overnight and usually go home the next day. I've worked at this hospital since the early 80s and am senior staff. We don’t do chronic care in my area. Mostly, nurses prep charts, do paperwork, restock materials and medications, and we do patient care and discharge teaching. There are also some things that require more fine-tuned nursing skills.

Before the pandemic, we were only managing floor-type patients who were in for their procedures and then out. But with Bill 195, we started getting pulled to different units because they over hired on ours and were understaffed on others. This was also in conjunction with a sort of pandemic hysteria because the government was handling things terribly. Everybody was horribly scared, horribly afraid for their families, horribly afraid because there were no supplies. I worked as a nurse through SARS; I can't believe that the government didn't know to do more. A huge thing should have been some sort of disaster planning put in place to have the infrastructure ready to repurpose different Canadian industrial production plants in times of emergency. The hospital outsources a lot of our materials to places with lower production costs, but when these countries get impacted by disasters and supply lines are down, we have no backups ready. Most of us in healthcare could foresee this coming, unfortunately. Viruses mutate, viruses change, the flus get more virulent, and people get sicker.

I worked as a nurse through SARS; I can't believe that the government didn't know to do more.

Christina: What sort of response has the government had to COVID, and do you think that our governments have learned from past public health crises?

Ahed: To address the first part of the question, the pandemic response has been non-comprehensive, flip-floppy, and rather than listening to scientists and healthcare experts, regulations were implemented in a way to pander to partisan popularity among targeted demographics. The Conservative leadership is, and has always been, less focused on preserving and protecting human life so much as cutting corners for businesses. As a nurse, I am appalled.

[Governments] only think in four-year increments so they're not thinking about the long haul and the long term.

There were a lot of things we were unprepared for that we should have been. We’ve gone through SARS, we’ve gone through MERS, we've gone through HIV. All these things are precursors and really, a pandemic is something that was going to happen and will happen again. And they will happen over and over again due to the nature of viruses and how they mutate, particularly in a globalized context.

Christina: From a nurse’s standpoint, what do you think people need to understand about nursing during a pandemic?

Ahed: The thing with pandemics is that people don't get it. Hospitals have to be able to manage their occupancy. If hospital occupancy isn’t managed, all hell breaks loose and people are dying in the streets. They're dying in the hallways of hospitals if that’s not managed. People need to understand that it’s not just the pandemic virus that kills during pandemics; it’s also the fact that our healthcare system gets so bogged down that we’re at a lower capacity to treat other patients, too. We can't just create healthcare people to work in pop-up hospitals. It takes too long to train them and they’re superfluous once the pandemic is over. The healthcare system really needs to be able to figure out how to expand and contract to accommodate crap like this and the public needs to be pushing for this.

It just becomes overwhelming when people are dying like this. People made this big outpouring for the healthcare workers initially that, “Oh yeah, you're doing great” and “We stand by our nurses and frontline staff” and all that which fizzled out really quickly. We were basically improvising left, right, and center. We didn't have stuff and my unit was pulled into critical care. We were told that's where we were going because we had added nursing skills. I have numerous health comorbidities and I was scared of taking care of COVID patients because I have no immunity, no protection. We didn't have equipment and resources; we were counting masks like we counted narcotics. And we still do; we're careful with the N95s. Everybody should be outfitted with N95s, but we’re not.

Christina: What were some of the changes to your experience of nursing, either organically or institutionally, during the pandemic?

Ahed: A lot of people left critical care nursing and a lot of people retired because of Bill 195 and the dangers of being a nurse. A lot of people couldn’t cope with it anymore. Just the misinformation, the lack of consistency… I know during SARS, one day we were told to fully suit up, next day we were told, “Don't worry, you're scaring the patients.” We got no consistency there. We had a little bit more consistency with COVID, but it was still really sucky and it became very confusing. You had to look at your hospital email every two seconds because they were notifying you of this that and the other thing because that's how they communicate with people, which makes it difficult when you can't access the website when you're at home due to security protocol.

A lot of people left critical care nursing and a lot of people retired because of Bill 195 and the dangers of being a nurse.

We even put ourselves in a WhatsApp group to try to communicate with each other about what the heck was going on in the unit because we were getting different stories from different people. It was a shit show. For the first four to six months, it was just a mess. We got pulled into the coronary care unit, we were told to do what we could. They also tried to give us assignments, and there was no way I was going to take an assignment because I am not a critical care nurse. I will help, I will do what I can with the skills that I have, but I am not going to take full responsibility over a critical care patient. They were so short staffed; they're still short staffed because they're doubling up on intubated patients on my unit, and really, it's a one-to-one job. People don't want to go to our coronary care unit anymore because of that, but they're also doubling up in critical care. We don't have enough chronic-care places that accommodate people that are intubated and who don't need acute care; there are just no places to put them.

It was a shit show. For the first four to six months, it was just a mess.

I was virtually untrained in critical care nursing, and I was expected to do what I could, which was… I felt just totally useless. I mean, here I am, a senior nurse, and they’d be saying, “Do this drip, do that drip.” I was really out of my depth and it's like, “Well, they showed us these new IV pumps, but we don't really use them in our unit.” So, I really haven't had a heck of a lot of practice and yet I'm supposed to be running this critical care medication drip and calibrating everything. You look like you're stupid, which is not the case; it's that you're untrained and you haven't practiced at it. You do tell that to people, but in a pinch, it frustrates your coworkers and you feel bad. And then you have a bad relationship with them because you can't do stuff that they want done, and they're short staffed so they need it done. All you can do is turn people, help them lift, maybe draw some blood, start an IV, and all those kinds of things, but it's just not enough to properly support a critical care unit, it's just not.

There should have been something special if somebody ended up dying because of this job. I mean, nobody goes into health care to die. Nobody. Nobody goes into the job for that, and you don't get danger pay. So, to go into work and think, “I could catch something and die” is too much. It’s just too much to deal with.

The basic healthcare worker is super empathetic and gives and gives and gives of themselves to their job and their patients. And then their life is going to be sacrificed because of this? That is ridiculous. We should be protected, and there was very little notification of what was being done to protect us, to help us. To give our hospital administration credit, they tried to give us information, but there wasn't much information to give us because the government was twiddling their thumbs. Doug Ford is all for business; he's not for healthcare. He is about business and money, and that's where his focus is, not healthcare.

Christina: What supports were available to you through your hospital, through your union, and through the government as a nurse and frontline healthcare worker during the pandemic?

Ahed: Well, we got less than the teachers on our contract dispute. Nurses are nurses, they’re charitable people. They didn't fight last year in 2020 when our union contract came up for negotiation. A lot of nurses felt that we at least had jobs during a wave of mass unemployment, and it would not look good to ask for more money. And that's what I was told by one of the union reps when I specifically told them, “This is the time we have leverage, let's use it.” The response from their end was, “Oh, we can't use it because it would look bad, because then we're money hungry.”

I think we got something like a 0.5% increase, which isn’t even the rate of inflation. Every year we lose money. I think that annual cost-of-living wage increases should be mandatory and built into our contract negotiations; that should be a baseline.

Every year we lose money.

We got two payouts of ‘pandemic pay’ from the government, and it wasn't very much money. The first time it was like 500 bucks and the second time was like 200. It was kind of a joke between the nurses because the amount was so small and we only got it twice. The level of stress on critical care departments is horrible, horrible. People are having to make difficult life-altering decisions about who lives and dies, who stays on a respirator and who doesn't. For hospital staff to have to make those types of decisions is heartbreaking and it rips you apart.

Eventually, after a couple of months they had a number to call for stress and a number to call for assistance. You could also call your EAP, which “in four sessions or less, your problem can go away,” which is a fucking joke when it comes to mental health. It has to be ongoing; you can't just do it in four sessions. I mean, that's nuts, that's emergency band aid, that's ridiculous.

Christina: Have your interactions with other people outside of your nuclear family changed as a result of your being a nurse during the pandemic?

Ahed: The people on my street know I'm a nurse and initially they didn't want to come near me, they didn't want me to touch their cats. Of course, I understood, but it's very isolating.

At the beginning of the pandemic, my hospital offered those hotel rooms to stay to protect our families and they were offering this laundry service for clothing, which you were never guaranteed that you’d get your clothes back. I think that, in general, hospitals should be supplying uniforms nowadays. They do it for the operating rooms and stuff but when it comes to pandemics, they should be supplying everybody uniforms in a closed system and there should be on-site places to stay.

There needs to be some give and take, and some back storage of emergency equipment to be able to function during something like this. Scrambling around trying to secure intubation and ventilators for people should be something that should be relatively easy to increase supply of.  Whole companies that are creating things like video games should be able to retool their computer components to something else that is beneficial to healthcare for when there’s a pandemic.

Christina: How do you think the country should move forward?

Ahed: I think Canada needs to be working towards more self sufficiency for everything. Because if this happens again, and especially China being our primary source for a lot of medical supplies, it’s a risk because you're going to lose your supply.

Pandemics are going to be the norm. This is going to happen again and again, maybe not on such a big scale, but they will, and eventually we will hit another bigger scale one. We've got to be prepared for this. Healthcare being on high-tension, high-alert over a year and a half now is ridiculous, and training more people is problematic because it takes four years to produce a nurse and many more years to produce a doctor. So, you can't just expand and contract your staffing easily because there would always be an over or underabundance.

Everything’s got to be looked at with a pandemic in mind. There needs to be some flexibility and ability to accommodate when something like this happens, better than we have with COVID. Even if it's not perfect, it needs to at least be better than what's happened. That's a huge deal, and that is a general systems thing because everybody's got to do it and it can't just be one country; it's got to be everybody because it impacts everybody.

Christina: What has the role of ONA (Ontario Nurses’ Association) been during the pandemic, and have they been effective?

Ahed: *Laughs.* First of all, nurses are giving personalities. Nurses go into nursing because they're empathetic and they want to care for people. You're constantly told to work through everything and anything. My oldest daughter said that it is a toxic work environment. There are no rewards for excellence except little nameless things like the Nightingale Award where you get a little bit of money, but it’s not a lot and not many people can get selected for it. You don't get any pay increase beyond what your union can negotiate after 12 years, there’s no bonuses, and no raises for higher qualifications.

Inside the hospital, the regular nurses weren’t getting more during COVID, but they were offering more money to casual nurses from agencies and stuff, from what I heard. I don't know exactly what was offered in specific, but I heard that they were bribes.

ONA has been there to sort of emotionally support nurses a little, but generally, because we cannot strike and even information pickets are very limited, nurses have little power in the workplace. It’s not democratic and we cannot leverage a strike, or threat of a strike, to get the things we need, the pay we need, the equipment we need, the treatment we deserve.

Most nurses are giving personalities, so they don't want to complain or cause problems, because then you're seen as a troublemaker. Nurses are nonconfrontational about everything but their patients. For themselves, they will take a lot of crap before their fuse blows. I think that's going to change the more guys that get into the job. But at this point, it's predominantly women, and they’ve been socialized largely to operate in a misogynistic world where it’s safer to stay silent.

On day shift, you're lucky if you get a coffee break, let alone going to the bathroom. Numerous times I had lunch when I worked days at four or five o'clock in the afternoon. I didn't eat all day because I was running like an idiot. If you’re doing the job properly, you don't have time to have breaks or to take a breather. The way they teach you to do the job and what actually happens are two totally different things. You put your patients first and everything else is second.

If you’re doing the job properly, you don't have time to have breaks or to take a breather.

So, you're running around like an idiot all the time and trying to cope. Nobody's got time to complain properly, nobody has time to follow through, and anytime you do you’re looked down on, as opposed to being an innovator trying to fix something.

Christina: If you could change anything about the pandemic response and how it relates to your working experience, what would you change?

Ahed: Unlimited funding would be great. That's unrealistic, but a huge increase in funding would have nonetheless solved a lot of problems. From worker benefits and hazard pay to an increase in productive capacity, more funding would have significantly aided our pandemic response as healthcare workers.

I think communication between the scientific community and the general public is also crucial. We need to have a good advertising plan, a good plan to accommodate different things like how to tell things to science-deniers. How can you present to them in an effective, knowledgeable, and relatable way? How can you reach people out in the boonies?

Christina: So, there's been a lot of symbolic support for nurses and healthcare staff during the pandemic with those yard signs and the announcements in stores, etc. Do you think that people now treat you with more, less, or the same amount of respect and consideration as before the pandemic?

Ahed: Some people do treat you with a little bit more respect. But generally, people take you for granted. It's just like being a mom, you get taken for granted. You bend over backwards, you do what you need to do, you do extra, and it gets taken for granted because that’s what the standard is. A big example of this would be Nurses’ Week. Normally, we get a lot of different giveaways, and we have a huge party, and so on. In 2020, the union took a poll about what we should do for Nurses’ Week. The response was to save the money for next year, for when we could do something, which we never did this year. So, we’re not getting it for 2 years in a row. We got one or two little handout things like a pen or whatever, which is kind of a joke since we have to supply our own pens at work anyway because the hospital doesn’t.

I told the union that we should just be given a $10 gift card for coffee or something. In some ways, lip service is done, but that's about it. You don't get the bonuses you're supposed to, they expect you to get the ‘bonus’ though the work that you do. You're supposed to get job satisfaction because you're doing a job well done. That’s very little. They make a show of thanking us periodically in emails, but not much else.

Everything's going up in price and we're making less and less money each year, so that should change. We should at least get a minimum of cost-of-living wage increases, and we should get full benefits. Oh my god. Don't even get me started on benefits. I don’t know of any nurse over the age of 40 who doesn’t have a back issue, but our chiropractic coverage is only for $400 a year. For glasses, you only get $500 every two years. Isn’t that nice if a nurse’s vision goes off after a year, you can't see for a year before you get covered. It's nuts. We need better medical coverage and that needed to have been one of our bargaining demands, especially during a global health crisis. It just floors me that nurses are not being taken care of by healthcare.

We should at least get a minimum of cost-of-living wage increases, and we should get full benefits.

Christina: Is there anything else you want to discuss or anything that you want the public to know about nursing in Ontario and during the pandemic?

Ahed: If you love your kids don't encourage them to go into nursing. None of mine are.

During COVID, people keep demanding more from us while they themselves do less. I know of a few patients that refused to get out of the critical care unit when they were able to and when medical advice supported it. They were threatening staff with reporting them to the College of Physicians and Surgeons and to the College of Nurses because their every whim wasn’t catered to.