This past week Canadians learned of our country's first registered nurse death due to COVID-19. It likely won’t be the last. Tragic loss aside, this death is a harbinger of what COVID-19 will do to worsen a looming crisis in our healthcare system: Canada does not have enough nurses.
The Canadian Nurses Association’s (CNA) latest report on nursing supply estimates that, without intervention, we will have a deficit of 60,000 registered nurses (not including practical or psychiatric nurses) by 2022. In response, they’ve issued policy recommendations for governments, educators, and employers to mitigate their estimated shortfall. Unfortunately, COVID-19 is a wrench in the works of these recommended policy changes. COVID-19 also presents novel challenges to Canada's recruitment and retention of nurses.
The CNA policy recommendations aim to increase nurse productivity, school enrollment, and retention, and to lessen absenteeism and attrition. Essentially, we need more nurses and we need them to work more often. The fix is complex and involves a healthcare system with adequate support staff, manageable workload, professional development opportunities, and a workplace culture that enables nurse leadership and participation. It's hardly surprising that the COVID-19 crisis —and the extraordinary steps we must take to avoid overwhelming our health care system—will make it difficult to achieve these changes.
Our leaders—in government, public health, and workplaces—are in crisis and have made top-down decisions, such as public health directives and resulting policy changes that alter day-to-day nursing practice, without the collaboration and consultation that nurses expect in order to feel valued and heard. While this is necessary during a pandemic, it unfortunately threatens to worsen a workplace morale problem that nursing unions and associations have rallied to address for years. It is likely that many nurses are afflicted by anxiety and feel a loss of control in their professional lives since the pandemic began. This could undo any progress health authorities have made in adopting cultures of collaborative leadership.
The pandemic has also exposed distress amongst support staff, such as care aides or house keepers, in our healthcare system. An emerging public narrative suggests that support staff have given their lives, sometimes literally, to a system that has underpaid them and treated them as expendable. Ultimately, if we lose support staff—whether from illness or attrition—we will lose nurses in turn. Nurses know that support staff are linchpins in our healthcare system; they keep nursing workloads manageable and burnout at bay. We rely on and need one another. If support workers' voices go unheard during this crisis, and if enough of them leave their respective fields, nurses will surely follow.
COVID-19 has changed the landscape of nursing in Canada for the foreseeable future. Prior to this pandemic, our nurses did not expect to put their own health – and lives—on the line when they went to work. They certainly never expected or agreed to risk the health and lives of their children and families. We are fooling ourselves if we insist that every nurse who enters the profession has answered a call to their life's passion, rather than made an economic decision, guided by a desire to help and care for others.
What it means to be a Canadian nurse is different today than it was in 2019. Current and future nurses have to decide whether or not to accept a novel risk in the line of duty. I believe many will choose not to; and that their choice will depend on how well nurses are protected by our leaders during the pandemic.
Our government must continue to do all that it can to secure personal protective equipment (PPE) for healthcare workers, both by importing supplies and creating domestic manufacturing capacity. If we find ourselves in the worst-case scenario— without the PPE required to work safely during the pandemic—I hope our leaders defend nurses and other staff who refuse to accept the increased risk. Anything less than this would signal that nurses are seen as disposable.
The public will see this, too. It's unusual for the public to be paying such close attention to the occupational safety of nurses; nursing unions usually expend money and effort on public education to raise awareness of our workplace issues. Now, the entire country is watching—and banging pots and pans for health care workers every night— and those watching include the future enrollees in our nursing schools.
In British Columbia, the provincial nurses’ union issued a May 4 statement alleging that they have gotten more than 1,700 complaints from nurses about inadequate PPE. A week later, provincial health officer Dr. Bonnie Henry publicly contradicted the same union, claiming there were no PPE shortages at a hospital where several nurses contracted COVID-19. A very public tension is growing.
In England, nurses and doctors are raising alarm over the National Healthcare Service (NHS) officials allegedly gagging staff from speaking publicly about PPE shortages, or other safety concerns, during this pandemic time. While it’s commonplace for large organizations to have media policies to prevent staff from maligning them, or sharing confidential information, perhaps now is an opportune time to demonstrate leniency in these policies.
The public is thirsty for stories from nurses and frontline workers to feed their "healthcare hero" narrative. I believe staff should be allowed to speak out, even negatively, about how the pandemic is affecting them. (As long as patient confidentiality is maintained.) It would be unfortunate if Canada’s healthcare officials adopted the same defensive stance of the NHS. The whole world is watching; let’s allow our health care workers to speak freely.
COVID-19 has left us all afraid of impending equipment and bed shortages. But we can have all the beds and equipment we need, and without nurses, there will be no care. Government, public health officials, and health employers should all be alive to the fact that their handling of the pandemic will affect Canada’s longstanding nurse shortage—and that even their best efforts may be insufficient to prevent a worsening of our nurse deficit in the wake of COVID-19.